Does Facelift Involve Literally Pulling the Skin to Tighten?

I have scars under my eyes. If I have a facelift, would it mean that the scars could be removed as excess skin as the face is pulled up tighter?

Doctor Answers 25

Face lift pulls tissue to tighten

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Yes, to a degree skin is pulled, but more importantly the tissue and muscle beneath the skin is tightened. This deeper layer is the secret to face lift surgery. The covering skin displays what is happening underneath the face. The majority of the pull should never be on the skin layer itself.

Face lift surgery has evolved over the years, but still involves tissue repositioning and tightening. Face lift surgery does not specifically involve surgery around the eyes. Eyelid surgery may be performed at the same time as the face lift, but it's normally a separate procedure.

Speak to a plastic surgeon who performs face lift, to determine which possible surgery would be most appropriate for you. Best of luck.

Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Scars and facelifts

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It depends on the nature of the scars under your eyes. They may be better dealt with using eyelid lift techniques.  Photos would really help to determine the nature of the scars you mention.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Basis of a good facelift

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The basis of a facelift is not pulling the skin rather it is repositioning of tissues under the skin and then re-draping the skin over the more youthful understructure. In some patients fat grafting and other procedures to the eyes or forehead are done concurrently.

Most modern face lift procedures involve tissue deeper than skin

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Thank you for the question.  A skin only face lift can be performed and for some select patients may be a good option.  Most facial rejuvenation procedures, however, involve tightening and repositioning of the deeper tissues.  Even with this, however, some extra skin is recruited and therefore some skin removal is often needed.  This extra skin may be able to impact the lower eyelid scars that you have mentioned.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Skin Tightening in Facelifts

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Modern facial rejuvenation is much, much more than just skin tightening. One can see this in the current franchise and heavily marketed “facelift type” procedures. These procedures are done under local anesthesia and the scar is in front of the ear and the skin is only pulled tightly. This does not last long nor does it look good. True facial rejuvenation is a deep layer manipulation using a “Lift & Fill” technique as aging is both facial skin laxity with facial fat atrophy (fat loss). Therefore, to perform modern facial rejuvenation one must restore a normal and youthful face without distortion.  You need to restore facial fat through the fat compartments, re-augmentation and deep layer facelift manipulation of the SMAS.


Rod J. Rohrich, MD
Dallas Plastic Surgeon

Eye scars being removed during a facelift

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The skin that is removed during a face-lift is mostly the skin in front of the ear. I cannot imagine that you have enough loose skin that a scar on or around the lower lid would be remove during a face-lift. If the scar is close to the lash line and you have loose skin of the eyelid, it might be able to be removed using an eyelid incision though. 

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Facelift and Skin Tightening

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An anatomically correct facelift is actually designed to lift up the deeper tissues of the face.  When the deeper tissues of the face are suspended, the excess skin is removed without tension.  

While it seems intuitive to just cut and remove skin, the skin only lift will place excess tension on the skin and relies on delicate skin to lift up heavier face tissues.  The reason this technique does not work is that ultimately the skin stretches back, leaving the patient with the exact same result as before, but now with obvious scars.  Skin only lifts were popular many years ago but have fallen out of favor out of most surgeons who perform facelifts.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

Facelift tightens the fascia and structures underneath the skin

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A comprehensive face/neck lift involves tightening the fascia and structures underneath the skin in the face, the tightening of the muscles in the neck, removal of fat deposits both above and below the muscle in the neck, and then gently removing any excess skin that is present after the muscle and fascial layer has been tightened. It will not affect any scars on the eyelids.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

A midface lift could recruit more skin and perhaps allow scar improvement

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The typical facelift done to improve the neck, jowls, and cheeks would do little for the eyelid scars. A midface lift, however, done at a deeper level elevates the cheek almost directly upwards and can recruit tissue into the lower lids. This has been well shown by a number of studies including one by Quatela in the Archives of Facial Plastic Surgery. Depending on the situation the scar could then be improved. Various peels and laser treatments could be added depending on the situation.

Wayne F. Larrabee, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Facelift versus lower eyelid scar revision

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It depends on how bad the scars appear and other factors such as lid tone, skin excess and the type of facelift you are going to have performed. If, for example the surgeon performs midface/ cheek lift with the facelift a fineline scar revision is certainly possible, but conservative laser resurfacing or chemical peel may do more to correct lower lid wrinkles or loose skin than another skin removing procedure. If there are other eyelid deformities (pseudoherniation, tear trough, hollowing, etc) the surgeon may advise transconjunctival blepharoplasty, fat transfer or other alternatives to improve the lower eyelid appearance.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 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.