How Come a Face Lift is Muscle Repositioning Oposed to Just Pulling the Skin Back?

When you hear about a face lift you hear the doctors say they have to re position the muscles in the face opposed to what seems to be the obvious thing to do and that is to just pull the skin back and sow???

Doctor Answers 25

How a Facelift is performed

It is not actually the facial muscles that are repositioned in a facelift, but the investing layer of fascia, called SMAS for short. By tightening the SMAS, overlying fat and skin are also tightened, but without direct tension on the skin, so the skin will not look stretched.

San Diego Facial Plastic Surgeon
4.5 out of 5 stars 23 reviews

Facelift - How Come a Face Lift is Muscle Repositioning Opposed to Just Pulling the Skin Back?

Actually, it's both.  The oldest approach is called "Skin-only."  It was the only thing done for many years and, in truth, it may be adequate for many situations.  More recently though (ie, the past 25 years or so) and ADDITIONAL layer of tissue has been addressed.  Called the muscles, or the SMAS (an acronym that refers to the tissues that partially invest the muscles), adding tension at this layer prolongs the effect of a facelift and, arguably, improves the overall result.  A lot depends on the specific anatomy in question but, in general, most surgeons do some sort of a combination procedure - they tighten the skin and, where applicable, the deeper tissues, include the muscles (both directly and via their extensions).

I hope that this helps, and good luck,

Dr. E

Face Lift - Muscle Repositioning VS Just Pulling the Skin Back?

Good question. After all,"skin only"  facelifts have been performed since the early 1900's. With a century of experience in facelifts why should there be so many ways to perform a facelift.

Let's take a step back.

CHANGE IS HARD AND SLOW. Doctors and Medicine observe Newton's First Law of Motion (Inertia): "An object at rest will remain at rest unless acted on by an unbalanced force... " Or, stated another way, they are creatures of habit and changes are hard and come about slowly. There is a natural tendency for people (including surgeons) and objects to keep on doing what they're doing. All objects resist changes in their state of motion. In the absence of an unbalanced force, an object in motion (including zero motion, or rest) will maintain this state of motion (or rest). Since pulling skin is so much easier, it MUST have taken a great force of convincing results and data to get surgeons to swtich to performing deeper, more complicated facelifts.

A long experience with "skin only" facelifts has repeatedly demonstrated (to anyone who examines these facelifts) that aging does not only result in only axcess sagging skin. It also is associated with loss of facial volume and sagging of several facial structures. Unless the volume is replenished and those saging structures are elevated and repositioned in their youthful positions the "skin only" facelift result produced a pulled, unnatural NON-youthful look in all people with more than just minimal aging / sagging.

From the moment Plastic surgeons realized that repositioning the deeper structures created more attractive rersults (Skoog, Mitz, Hamra etc) the results wewre vastly better than "skin only" facelifts.

SO - WHY DO PEOPLE STILL BOTHER DOING SKIN ONLY FACELIFTS? Such surgery is relatively easy and can be done quickly under local anesthesia. Many facelifts in the US and I suspect abroad are performed by non-Plastic surgeons; by doctors who trained in Dermatology, Family Practice, General Surgery etc.  Undermining skin, pulling it, cutting the excess and stitching the incision is much easier than performing a real facelift where knowledge of facial anatomy is important.  (By the way, most of the brand name "facelifts" advertised on TV are slight modifications of skin only facelifts. They are franchises intended to create volume not quality).

While a "skin only" facelift may be done in a small group of people with early aging, the same people may be better treated with laser skin resurfacing as with the Joule laser and profractional resurfacing.

For the rest, a deeper facelift technique is often the answer for morte attractive long-lasting results.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 101 reviews

Facelifting is a 3-dimensional procedure

Aging occurs at several levels, including loss of facial fat, sagging of the connective tissue layer that encloses the muscles of expression (called the SMAS), and also skin laxity. Puliing on skln without addressing the other issues can produce the flat, pulled, unnatural look that no one wants. Think of it as a 3-dimensional procedure rather than skin tightening alone. That is why all of the procedures called "nonsurgical facelifts" are not a facelift at all.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews

Facelift and How It Should Be Done

To borrow a quote from Dr. Bruce Connell, "If skin were a tension bearing structure, pregnancy wouldn't be possible."  The amount of tension that can be safely and aesthetically placed on the skin is limited.  Therefore, in the 1970's emphasis was placed on elevation of the deeper structure, or "SMAS" which is an acronym for the fibro-fatty covering of the facial musculature.  Therefore, most Facelift surgeons in this day and age rely on some form of SMAS based procedure to elevate soft tissues, allowing an appropriate amount of skin removal.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 81 reviews

Skin vs SMAS facelifts

   Several studies have shown longevity with either type of facelift.  However, the SMAS repositioning probably prevents some rather unnatural results.  Kenneth Hughes, MD Los Angeles, CA

Skin only facelift

The skin only face lift has been attempted centuries ago with minimal improvement and minimal duration.  Facial aging is much more complicated than just removing skin and the best and most natural results are obtained when all tissue layers are addressed together and when the lost facial volume is restored such as in the link below

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 209 reviews

Facelift Procedure

A facelift is essentially a reversing of the aging process.  What happens with aging is that not only the skin but also the muscles begin the drop-  thus, these are all areas addressed with the facelift, including the elevation of the SMAS, that deeper level which is attached to most of the facial muscles that need to be redraped.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 113 reviews

You will get a longer lasting result with nicer scars

The first time a muscle based facelift was done in 1978 it was met with skepticism by plastic surgeons.  But within a few years it became widely embraced since it gives longer lasting results, requires less dissection of the skin itself and when the sowing is done on the muscles the skin can be tacked down, not pulled.  The facelifts where all the tension is in the skin and not the muscles in general have much less fine lined scars.  I don't do any facial work without doing something to the muscle layer too whether it is a mini lift a full facelift or a neck lift.  if you find a surgeon who only tightens the skin I would keep looking.

Why the new facelift techniques reposition the muscle...

Thank you for the very good question. The old facelift was pulling the skin back which left patients with the "facelift look." The jowls and cheeks were not repositioned. You've seen these people and I'm sure you thought to yourself, "that woman definitely had a facelift."

Plastic surgeons strive to make people appear more attractive and the best compliment would be that someone looks more attractive without looking like they had surgery.  It is also important to understand aging in which gravity and genetics play roles in the stretching of the ligaments that hold up the skin of the face. To improve the appearance, manipulation of the underlying muscles and ligaments of the face is necessary.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.