On a Facelift, How Does the Skin Reattach to the Tissues when It's Redraped?

Within seconds of redraping the skin, the body begins the healing process.  The same wound healing mechanisms that heal a small cut also go to work healing the skin lifted as part of the facelift.  In fact these mechanisms are so effective that they are adapted as the basis for fibrin glue.  In this case you heal using your bodies own fibrin glue.  This matures into the new collagen that provides the long term strength for the facelift.

A multiple layer facelift (SMAS), such as the “Lift & Fill” facelift that I perform, includes “lifting” the deep layers and “filling” the central fat compartments as one has to re-drape and reshape the deep fat compartment layers so they are in harmony and provide a natural and youthful appearance.

Good question:

The skin is only trimmed after the deep layers are tightened and it is trimmed under no tension so there is no risk of the mouth not closing from tension.

The tissues will reattach using the body's natural glue - fibrin.  This adhesion is aided by use of drains that suck the skin down as well as a compression dressing.

Like any other elevated tissue in the body, the facial skin, within a few days after being elevated as with a facelift, will reattach to the deeper supportive tissue, some of which it obtains its blood and nerve supply, as well as its lymphatic drainage to provide a reduction in swelling.  Experience guides the surgeon in determining just how much tissue to excise to achieve an aesthetic but not an unnatural result.

A facelift involves both tightening of the skin and also tightening of the underlying tissues.

When the skin is redraped, it initially seals down with a natural substance called fibrin, the body's glue. Next, collagen, the body's rope and new blood vessels begin to grow and this tightens and establishes a permanent seal of the skin to the underlying tissues.

I hope this helps without being medically technical.

The wonderful healing process of the human body allows skin to be repositioned and then heal in its new location.  This principle is used in rotation and advancement flaps throughout the body.  Soon after the flap is repositioned, the microvasculature reestablishes itself so that tissue integration can take place.  With the facelift, a rotation-advancement flap is used.  Because the incisions are placed so far away from the mouth, the force is such that difficulty with closure of the mouth is virtually impossible.

However, it is important to redrape the skin and close the incision with as little tension as possible.  In order to accomplish this, the majority of the tightening in a facelift takes place in the muscle, fascia, and other soft tissue deep to the skin.  Once this deeper level tightening is accomplished, the skin can be advanced and redraped with little or no tension in its new natural position.  In this way, the scars are as well hidden as possible and the final appearance is as natural as can be.