Facelift technique: Skin only pull vs Muscle pull

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

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.)

Dear Netalia,It would be best to get the answer out of your surgeonIf you have seen before and after pics of patients that have similar anatomy, then this may be indicatedFor a full facelift, we usually tighten the skin and muscle to get the most natural resultA second opinion may help you get piece of mindBest,Nima Shemirani

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

The modern facelift typically involves two levels of facial "tightening".  The SMAS layer, which is a layer of connective tissue covering the facial muscles is first tightened.  The skin in then tightened as well.  By tightening the SMAS and skin together, a more lasting and natural result is achieved.  Good Luck

Each surgeon may have preferences for which techniques he or she likes to use in a facelift.  I would not perform a skin only lift because the results would be fairly short-lived.  Dealing with the tissue under the surface of the skin (the SMAS technique) produces more long term results and can reduce the tension on the skin when it is closed, which leads to better healing.  

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.More natural lifting of the fascial tissue avoids the windblown or pulled look of many other techniques.Vertical lift adds to the volume of the cheek, removes the jowl and marionette lines to yield a more oval face.Vertical lift often eliminates the malar depression or tear trough.The SMAS facelift has a lower risk of facial nerve injury than the deep plane facelift and recovery from swelling is significantly shorter.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.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. 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".

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.

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.

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