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

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

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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

Memphis Plastic Surgeon

You will get a longer lasting result with nicer scars

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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...

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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.

How a Facelift is performed

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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.

Roy A. David, MD
San Diego Facial Plastic Surgeon

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

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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


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When we age, our faces go through a digression of bone, muscle and soft tissue (fat) loss creating the appearance of hallows in the cheeks and under the eyes. Think of the process a grape goes through to become a raison. The face sags down and inward. The best way to restore the youthful appearances is to reverse the aging process bringing the skin upward and out. Just pulling the skin will not accomplish this. Pulling on the plains of the muscles and adding volume and restoring the fat with soft tissue transferring is the best way to reverse the aging process.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Tightening of muscle layer with a facelift

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The earliest facelifts performed at the beginning of the 20th century were non-aggressive skin tightening procedures, and they did not last very long.  More aggressive dissection to tighten more skin produced only slightly better results.  Eventually it was discovered that tightening of the deeper muscle layer would help restore aging  structures to more youthful positions in the face.  A facelift should not be limited to thightening.  It should also be approached as a restoration of loose facial features to their natural, younger positions. 

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 17 reviews

Simple facelifts vs. muscular support facelifts

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Years ago a facelift only involved pulling the skin and creating a firm appearing lift that would look pretty good for several years.  The problem with this idea was that the hope of the patient was that a lift could persist for a longer period of time,  The concept today is to  strengthen the support for the lift by supporting the muscular  structures with internal suturing.  This will add many years to the longevity and strength of the lift.  The  current , modern facelift should always offer internal strengthening and support with one of several suture techniques availlable.  Better results and longer lasting  improvements  will be the results of this action.

Facelift with muscle repositioning

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In the past, a facelift involved lifting the skin, excising the excess and closing the wound.  this often resulted in a facelift that looked "overly pulled".  Also, this type of skin-only facelift often did not last very long, before renewed skin laxity was again noted.  In modern day facelifts the structures underlying the skin are also tightened and/or repositioned.  These structures often include the platysma muscle in the neck along with the superficial muscular aponeurotic system (SMAS) of the mid-face.  This type of facelift will, not only, result in a more natural appearance, but also, will last significantly longer than a facelift which places all of the tension on the skin instead of the deeper tissues of the face and neck.  

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.7 out of 5 stars 63 reviews

Facelift structure or muscle repositioning versus skin pulling. Help!

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Facelift surgery has been performed now for more than a century. what was initially a small undermining and skin pulling has been transformed into a procedure that can deliver a much more natural and long-lasting effect by including the underlying structure or muscles of the face as well. By contouring, tightening, and lifting of the underlying structure of the face, the procedure develops a more natural and long-lasting outcome. The skin is then redraped over the new lifted tightened and re-shaped structure. A more pleasing natural less operated look is achieved versus pulling on the facial skin.

Joseph Hunstad, MD
Charlotte Plastic Surgeon
4.7 out of 5 stars 56 reviews

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.