Why does skin relax more in a skin only facelift versus a deep plane facelift?

A skin only facelift is not a good procedure. A true facelift lifts the deeper tissues which is really the long lasting part of the procedure. Doing skin only does not give long lasting results, especially in heavy cases because the skin can loosen with time, and the deep tissue is not tightened. It can also result in bigger scars and you can still get a hematoma with a skin only procedure. If you're in good health, you should have a great result with a more traditional facelift with an expert provider.

There's a big difference between a skin-only facelift and a deep plane facelift, or SMAS facelift. The main problem with a skin-only facelift is that the result isn't optimal. Pulling only the skin creates tension in the scar, and it's very likely that not only will you not get a good result, but the scars will also become thick and noticeable. No plastic surgeon expert in facial surgery would recommend a facelift where only excess skin is removed. I recommend you find a good plastic surgeon who is an expert in facial surgery, with whom you can be sure of good results. The risk of hematoma is also present in a skin-only facelift (the approximate risk of hematoma in a Facelift is 2%).

Thanks Sensible253192 for your question! The surgeon's main goal in a typical, skin-only facelift is to redrape and remove extra skin. Because the underlying support structure (the SMAS and deeper tissues) isn't addressed, the skin may relax and sag again quite fast, even though this may initially provide the appearance of tighter skin. Comparable to tightening a slack clothing without modifying the underlying structure, the fabric may appear taut for a time before sagging once more.
The SMAS (Superficial Musculoaponeurotic System), a layer of tissue covering the facial muscles, is released and repositioned during a deep plane facelift. The surgeon can accomplish a longer-lasting and more natural-looking lift by targeting this deeper layer. After that, the skin is redraped over this enhanced foundation, which relieves tension and lessens the chance of premature skin relaxation.
The lifespan of any facelift, whether deep plane or skin-only, depends on a number of variables, including as skin elasticity, lifestyle, and heredity. After a facelift, it's normal to worry about possible side effects including hemorrhage, stiffness, and hardness. Although the incidence and severity of these adverse effects might vary based on the type of facelift and personal circumstances, they are absolutely feasible. Deep plane facelifts include greater manipulation of deeper tissues and blood vessels, which increases the risk of hematoma.
While skin-only facelifts have a lower risk, it's not entirely eliminated. Following any facelift, hardness and stiffness are often expected as the tissues settle and heal. However, if there is a lot of strain on the skin, which is more likely to happen with skin-only facelifts if the underlying support isn't addressed, excessive tightness and persistent hardness may result.
Although your worries are legitimate, getting a skin-only facelift just to stay away from these hazards might not be the best course of action. Weighing the possible advantages and disadvantages of each procedure is crucial, as is having a full conversation about them with a skilled board certified plastic surgeon. They can evaluate your particular situation and suggest the best course of action to meet your objectives while lowering risks.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Skin tends to relax more quickly after a skin-only facelift because the deeper structural layers of the face—particularly the SMAS (superficial musculoaponeurotic system)—are not addressed. In a skin-only facelift, the lift relies solely on the skin, which is elastic and less capable of holding long-term tension, especially in individuals with sun damage or reduced collagen. This often leads to earlier recurrence of sagging, particularly around the jawline and midface. In contrast, a deep plane facelift repositions the SMAS and deeper tissues, redistributing volume higher on the face and reducing strain on the skin itself. By lifting at a deeper level, the skin is better supported, resulting in more natural, longer-lasting results and less post-operative relaxation.

A skin-only mid-facelift typically provides results that last a shorter time compared to deeper facelift techniques. On average, the improvements may last 1 to 3 years because the skin alone does not have enough structural support to maintain long-term lifting. Since skin naturally loses elasticity over time, relying only on tightening it can lead to a faster relaxation of results, sometimes creating an unnatural or pulled appearance.
In contrast, a deep plane facelift addresses not only the skin but also the underlying SMAS layer, repositioning tissues to a more youthful position. By restoring each layer to its proper place, this technique creates a more natural, long-lasting result, typically lasting around 10 years or more, depending on individual factors such as skin quality, aging process, and weight stability.
If concerns about hematomas or tightness are the reason for considering a skin-only approach, it’s important to note that modern deep plane facelifts are designed to minimize excessive tightness and tension on the skin, reducing the risk of an unnatural look or complications. Choosing the right technique for you should be based on both your aesthetic goals and long-term satisfaction.

Skin is designed to permit stretch. Pulling on skin only does not work in facelift surgery. We have known this for a long time ever since the original skin only procedures by Passot. We also saw the problems with placing tension on the skin in Sam Hamra's deep plane rhytidectomy that was originally described. The "deep plane" procedure today is actually an excellent procedure because it places the tension on the more robust, deeper tissues and skin follows along (because the skin is not delaminated off the deeper structures). Long story short, the "deep plane" procedures pull on more robust, stronger, less elastic structures compared to skin. I would go see an American Board of Plastic Surgery certified surgery who has experience in facial rejuvenation. This ensures that your surgeon has done proper accredited real plastic surgery training.

Hi,

A skin-only facelift focuses on tightening and repositioning the skin without addressing the deeper facial structures. Since the skin bears the tension of the lift, its natural elasticity can lead to relaxation over time, causing the results to diminish more quickly.

In contrast, a deep plane facelift repositions not just the skin but also the deeper layers like the SMAS (Superficial Musculoaponeurotic System), fat pads and even the underlying facial muscles.
By lifting these foundational structures, the tension is distributed more evenly, the fat pads and soft tissues will be repositioned to restore better shape and proportions, hence the skin isn't solely responsible for maintaining the lift.

This approach results in more natural-looking outcomes and longer-lasting results because it counteracts the root causes of facial aging.

My comments and recommendations are solely based on your text and are subject to change. I always recommend a face-to-face consultation with a specialist to plan the treatment.

Best wishes, Dr. Surmeli.

Mid-face lift focuses on the lower eyelid and cheek areas. This procedure elevates that area vertically to elevate cheek position from the eyelid area or from the temple and inside the mouth. It definitely works on that area really well and for some patients it's a perfect option.
Facelift works the the folds by the nose/cheek areas and jowl areas. Standard facelifts do ok but deep plane facelifts address specific problems of those areas of concern in a much better way- that's why deep plane facelifts last longer. The neck areas are bit different but that must not be an area of concern for your specific case. I hope that helps. An in person visit with a board certified plastic surgeon who offers all those procedures is a good place to start. Best Wishes!!

While a skin only facelift might sound like a good idea, as you have said it does not tighten the lower face and neck as much as we want it to. I would also say two years is an optimistic guess, most likely within about 6 months the skin will stretch back to its original position and the benefit would be very minimal.
The “deep plane” layer which is a very hot topic right now and being thrown around a lot is the layer that invests the facial muscles, but is also contiguous with a muscle in the neck that should also be tightened during a facelift (platysma muscle). Something should be done to this layer to resuspend the descent that happens over time (I won’t touch on volume loss here which also can play a role). What’s done to this layer is variable among surgeons with no “best way”, whether it’s a plication of that layer, cutting a strip out and tightening it, or going deep to it and undermining that layer to tighten it.
This layer that I’m talking about is a fascial layer with strength. So by tightening this in some way you increase the longevity of the face and necklift. Skin has elastic properties by nature (pinch your skin and pull it away from your body just to prove it!), so if you only try and pull this as tight as you can, just with gravity alone it will stretch back to its original position. This is also why during the facelift the skin should be closed without tension, because the tightening properties of the facelift come from the deep layer, not the skin. I hope this helps answer your question.

These are good questions and concerns. First, it's important to understand that a skin only facelift can also have hematoma, hardness, and tightness. That is a risk with any facelift procedure.
A skin only facelift has a greater tendency to relax more quickly and scar poorly because there is no additional support or lift from the deeper SMAS layer, which is the strength layer for a good face and/or necklift.
Not every patient needs a "deep plane" facelift. There are many different techniques, which one is best for you is a conversation to be had with the surgeon who can assess your individual needs.