How are muscles repositioned in a facelift, are they cut & reattached or repositioned with stitches?

Dear Maggie,
Thank you for your question. When performing deep plane facelift, or any facelift, the muscles are preserved as they are essential to maintain facial expression. The soft tissue complex called SMAS and the fat compartments are the ones lifted during traditional facelift. With deep plane facelift, there are key facial ligaments needed to be released to elevate the compartments more effectively and therefore, longer-lasting and more natural.
It is an important question you have raised because muscles are not addressed during surgical facelift but there is a machine in our clinic called Emface that directly targets the muscle, improving the muscle tone on the face and neck, to compliment or prepare our patients for surgery. It is a 2-in-1 device that also targets skin texture and quality using radiofrequency.

I perform what is known as a deep plane facelift. In general, the facial muscles of animation are not re-positioned. It is the SMAS, which is a fibro-fatty tissue layer, which is re-positioned and bears the tension which allows for the "lift". The facial ligaments are first detached, allowing for maximal mobility of the facial soft tissue. In the neck, the platysmal muscle is lifted both centrally and laterally in order contour the neck and jawline. This is a complex multi-layer technique which allows for a significant but natural result.

Thank you for your question. During a facelift, the deep fascia tissue and muscle is tightened and then lifted upward toward the cheek and outward in the neck area. The tissue is then secured with barely-visible sutures and any excess skin is removed.
If you are considering a facelift, please schedule an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to answer any question you may have and help you decide on the best course of action to help you achieve your aesthetic goals.

Hello, and thank you for the great question! This would be something best answered by your actual surgeon, as the truth is that it very much depends on the technique that is used. However, in general the muscles are never cut. Instead the fibrous layer called the SMAS which envelops and attaches to the muscles of the face is cut and repositioned with sutures, thus also lifting or repositioning the muscles as well. The way that the SMAS is treated is highly variable depending on the technique.

Hi and thanks for your question! The details depend on which technique the surgeon uses but the main options are to fold the muscle onto itself and suture it in place (SMAS plication) or to cut the muscle, dissect underneath it and then reposition the muscle and sew it into its new position (SMASectomy, deep plane facelift, composite facelift).

In a standard facelift, most of the work involves lifting and removing stretchy skin and fat. This may include lifting and stitching the fascia layer along the surface of fat and muscles if needed in the cheeks. Any neck ridges (platysma muscle bands in the front) are usually corrected by stitching the muscle borders together and upward, possibly with removal of a small wedge of muscle below the suturing. Some surgeons may perform a "deep plane" facelift in which dissection below the muscle layers separates their attachments and repositions the muscles higher. You should discuss your surgeon's techniques so you understand the risks and benefits of various approaches.

This question really lies at the core of how you describe a facelift. There are a myriad of facelift types, such as: smas-ectomy, smas plication, deep plane, etc..... They differ by how the superficial most muscle layer of the face, the "SMAS" is treated. Historically older facelifts started by separating the skin from its underlying muscle and tugging on the skin to lift. This left faces with a pulled unnatural skin look without much effect on the jowels and turkey neck. Most facelifts nowadays separate the skin from the smas, then somehow pull the smas up: in the smasectomy, some of this muscle and fibrous tissue is cut out then the gap is sewn together. In a smas plication, the muscle it just folded/bunched onto itself with sutures. The most advanced facelifts are those in the Deep Plane, whereby the skin is left connected to the smas, and the surgeon gets into the tissue layer underneath the smas, using the smas muscle to do the lifting, taking tension off the skin. In the extended deep plane approach the ligaments that are teathering the undersurface of the smas are also released so the smas muscle and skin dont need to be pulled at all, just resuspended into their natural position vertically, leading to a longer lasting, more robust tighter jawline and neck. Recovery and scarring after a deep plane lift also proceeds quicker as the skin is left connected to its blood supply and incisions heal without any tension on them. Hope you find this long winded answer useful and not too confusing!

Most of the sutures used for face and neck lift is to elevate, tighten and shape SMAS structures of the neck and face. Some are used in anterior portion of the neck to rearrange platysma muscle, the other in posterior neck and in front of ears, to lift and tighten that portion of the SMAS. You can get a better idea watching understand.com on our ASPS website. Good luck.

That’s a good question. There are many muscles in the face. In general aging does not really affect the muscles themselves but rather the support ligaments and tissue directly above the muscles. There are many different techniques that are designed to lift and move the support layers in the face. Some times moving these support structures will pull the muscles just a little. There are some exceptions to this, specifically with deep lower eyelid / midface / cheek surgery. Many of these procedures specifically identify the orbital muscles and tighten them. It gets complicated so I wouldn’t get too caught up in the weeds. Let your surgeon do that! Your job is to pick the surgeon that makes sense to you! Good luck.

There are multiple methods used. The one I use is elevating a flap consisting of the platysma muscle and SMAS tissue which is an extension of the platysma on the cheek area. Once lifted the muscle and SMAS is positioned higher and sutured there. The skin is the redraped, excess cut, and sutured.