Facelift technique: Skin only pull vs Muscle pull

Do ALL Doctors use the SMAS technique (SKIN and MUSCLE) to perform a full facelift? If not, why?.... I read using the "skin" only pull is useless. Why would a doctor choose to use the skin pull and not the muscle pull?

Doctor Answers 14

Is a skin lift useful?

The only time that I do a "skin only" pull is when I am revising scars or pixie ear deformities on patient's who have had a facelift by another surgeon. If any lifting of tissue is desired by the patient, it is essential to address the SMAS. Lifting the SMAS and anchoring it in its more natural position is the most reliable method of providing a lasting result. A skin only lift would likely not last more than several months and there is a significant risk that unwanted scarring could result from putting too much tension on the skin.

Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Tightening the smas

Tightening the SMAS is beneficial in the vast majority of cases, and probably in all primary cases (patients who are having their first facelift). You should ask the surgeon why he is doing a skin only facelift as only he would know. Perhaps he is not comfortable doing a SMAS facelift.

Paul Wigoda, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Skin lift

Facelift technique that relies on skin pulling rather than tightening underlying SMAS had been commonly used a few decades ago, but now is practically abandoned.  You would be hard pressed to find a surgeon who still uses this method of facial rejuvenation.  However, there might be a situation when skin repositioning rather than tightening is indicated.  Skin only lift would be appropriate in this case.

Best wishes!
Dr. Konstantin

Konstantin Vasyukevich, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

SMAS vs. Skin Only Facelift

View are correct most plastic surgeons today use some variety of the SMAS facelift technique.  Perhaps your doctor feels that you only have a small amount of skin laxity and that is all that is necessary.  However you should specifically ask your plastic surgeon Y he or she is not using the SMAS facelift technique.

Facelift techniques

There are all sorts of facelift techniques that are used and every surgeon  is a bit different in his preferred technique.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews


For a good facelift the SMAS facelift remain the gold standard, and will last longer. why others do skin only facelift, maybe they do not know how.
Samir Shureih MD.FACS

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

There are many different ways to get great results in a facelift procedure

There are many different ways to get great results in a facelift procedure.  Depending on your examination, a skin only technique may be sufficient, or perhaps you would benefit from a more extensive procedure.  If you are unsure, you can always seek out a second opinion (a real second opinion = in person assessment.)

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

SMAS Lift is the better Option

The SMAS facelift is a general term for the lifting of the face with two separate planes of lift. The first plane is the deep tissues of the face which includes fat, muscle and fascia. The second plane is the superficial fat and overlying skin. This is the basic description for the best of all facelift techniques.

The first techniques attempted utilized pulling of only the skin. Early on it became apparent that pulling of the skin alone led to early recurrence and excess scarring - not an ideal outcome. Other techniques have been attempted with a modicum of success. The most prominent of these other procedures is the deep plane technique whereby the entire sandwich of tissue (Skin, fat, muscle and fascia) is lifted together. This technique leads to a large amount of swelling but an early recurrence of the signs of aging. But most importantly, this technique does not allow us to lift the tissues vertically.

The process of aging is caused by gravity, facial animation, stresses on the skin (weight gain, smoking, drinking, sun damage and age). The combination of gravity and facial animation pulls the tissues of the face in a downward and inward direction. Smiling reverses the sag - so look in the mirror and smile to see where your facial tissues use to be and where you hope that surgery would replace them. It is for this reason that the SMAS lift should move all tissues in a vertical direction - put the tissues back to where they once were.

So with that said, what are the risks and benefits of the Vertical SMAS Facelift.
  1. More natural lifting of the fascial tissue avoids the windblown or pulled look of many other techniques.
  2. Vertical lift adds to the volume of the cheek, removes the jowl and marionette lines to yield a more oval face.
  3. Vertical lift often eliminates the malar depression or tear trough.
  4. The SMAS facelift has a lower risk of facial nerve injury than the deep plane facelift and recovery from swelling is significantly shorter.
  5. Perhaps the only really increased risk relative to other techniques is the risk of bleeding or hematoma. The creation of two flaps of tissue can result in an increase risk of bleeding. But these small blood clots under the skin are still infrequent and ultimately resolve.
  6. All facelift procedures have risks to the sensory and motor nerves of your face. This technique does not have the same risks as a deep plane for motor nerve injury.
  7. A SMAS facelift does not address the forehead (Brow lift) or the lower lid bags (Blepharoplasty) but they are often performed together.
In the end, the SMAS facelift is an ideal procedure when performed in a vertical fashion. Find a board certified plastic surgeon with experience in performing this technique.

If you would like more information on facelifts, please read my book " A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Facelift techniques

Dear Netalia,

  • It would be best to get the answer out of your surgeon
  • If you have seen before and after pics of patients that have similar anatomy, then this may be indicated
  • For a full facelift, we usually tighten the skin and muscle to get the most natural result
  • A second opinion may help you get piece of mind

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

SMAS vs Skin-only Facelifts

I believe that most plastic surgeons perform some variation of a SMAS facelift. This gives more longevity to the procedure.  Skin only facelifts can be performed for minimal corrections and this shortfall of skin only facelifts should be discussed with patient prior to any surgical intervention.

Earl Stephenson Jr, MD DDS FACS

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.