What is my Plastic Surgeon Going to Do During Revision?

My plastic surgeon is going to do a face lift revision due to descending jowls and neck banding. This time he said he will "undermine" along my neck and jaw line. What does this mean? Does it include fat removal? Is "undermining" like a deep plane procedure that increases the risk of motor nerve damage?

Doctor Answers 30

What's involved in a face lift?

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 Undermining is a term that describes the act of using scissors or another instrument to go through layers of tissue, underneath the skin, in order to gain access so they can be manipulated (tighten and lift SMAS, Platysma).  It's a standard part of any variation of a face lift. 

 Underming can occur at different tissue layers, in the face, and hence the terms: skin only, SMAS, Deep Plane and subperiosteal face lifts.  These are descriptive phrases that identify at which tissue depth (or layer) the dissection and manipulation will take place. 

 The removal of excess fatty tissue can only occur in the fatty layer which is the one immediately under the skin.  I should also mention that multiple tissue layers can and are undermined during several face lift versions.  Hope this helps.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Undermining lower face and neck skin is required to tighten jowls and neck during Facelift

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Undermining is simply using surgical Facelift Scissors to separate the overlying skin of the face and neck from the muscles and tissues deep to the skin.

Undermining is required to "free up" or loosen the facial and neck skin so that they can be pulled tight at the end of the Facelift and Neck Lift.

Typically the surgeon will also use sutures to tighten the muscles (Platysma Muscle) of the neck with a procedure called a Platysmaplasty. The SMAS-a muscle like membrane that covers the face is also typically tightened by sutures in the neck and cheek.

When the neck area is not undermined during a Facelift and the Platysma Muscles not tightened lax neck skin and banding is common after a Facelift. Simply lifting the upper face is inadequate if significant jowls , neck laxity and muscle banding are present before surgery.

Undermining is safe, the plane of the dissection is above nerves and vital structures if the technique is done properly.

Be sure to discuss your concerns with your doctor BEFORE surgery.

How to facelift: 101

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Exactly what is to be done and how it is done should be explained by the surgeon.  I always do.  Undermining refers to the separation of the skin from the deep layers (muscle and fascia).  I have an office in Beverly Hills and Rancho Mirage.  The desert is resplendent with secondary facelift candidates.  In fact, we rarely do a first-timer.  So I am used to handling bands, adhesions and contour difficulties from previous facelifts.  Never feel that you can't talk to your doctor about anything.  Ask for explanation and definitions.  You will be less stressed if the communication lines are open.

Ritu Chopra, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Face Lift Undermining and Why Do II?

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  Sounds like your surgeon may have been a little conservative the first time. Lifting up the skin (undermining) is a critical and important part of any facelift and must be done to get good results.  Conservative mini lifts with little if any undermining produces mini results that do not please.  Get a few consults from surgeons certified by the American Board of Plastic Surgery and  a Fellow of the Americal College of Surgeons.   Get two consultations.  If comfortable go back to your original surgeon and if not go elsewhere.   Send picture and we can help you more.  My best.   Dr Commons.

Like moving a rug, you first have to lift it from the floor

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Undermining means to separate the skin from the surface underneath it.  This also allows the surgeon to manage the layers under the skin by either shifting them as well (SMAS lift) or adjusting the neck muscle (playsmaplasty) or any one of many other options.

Dr. Mayl

Fort Lauderdale

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon

Secondary facelift

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Undermining, in surgical terms, means to free up tissue by means of surgical dissection.  If you "undermine the cheek area", it means you separate the skin and fat from deeper anatomic structures.

How the surgeon treats the tissues after that is open to debate.  There are several possibilities - so ask your surgeon to explain which technique he will use to treat the deeper structures (SMAS in the cheek, or platysma muscle in the neck).  It's important to understand this, prior to your procedure.


All the best,

What undermining during a facelift means

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Undermining refers to lifting the skin off of the underlying tissues. In and of itself undermining doesn't refer to removing any fat, although your surgeon may be planning this.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

What does "Undermining" Mean in Facelift Surgery?

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Regarding: "What is my Plastic Surgeon Going to do?
My plastic surgeon is going to do a face lift revision due to descending jowls and neck banding. This time he said he will "undermine" along my neck and jaw line. What does this mean? Does it include fat removal? Is "undermining" like a deep plane procedure that increases the risk of motor nerve damage

If you check dictionaries for UNDERMINE you will find preposterous explanations such as :
1. To weaken by wearing away a base or foundation: Water has undermined the stone foundations.
2. To weaken, injure, or impair, often by degrees or imperceptibly; sap: Late hours can undermine one's health.
3. To dig a mine or tunnel beneath.

AND worse. No wonder you are confused. When your surgeon began talking surgicalese you should have called a time out and asked him to return to English. After all, it does not really make a difference how smart or gifted he may be if your surgeon cannot educate you on what he proposes to do to you. Right?

UNDERMINING is Surgicalese for lifting and separating one layer from another. As Plastic surgeons, we routinely go down to a layer of flesh we need to be in (we call then a PLANE) and dissect (ie separate) and lift (ie undermine) at that level.

Not all Face lifts are undermined (lifted) along the same layer (plane). They can be done under the
- skin
- SMAS (most common).
- Deep Plane
- Bone Lining (subperiosteum)

Per your question, all Facelift dissection can uncommonly be associated with nerve injuries. The Deep Plane has the highest such risk and the under the skin dissection, the lowest.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Explaining undermining with a facelift

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Undermining is simply elevation and redraping of the tissues to rearrange them. A simple analogy would be similar to lifting the sheets of your bed down to the foot of the bed ("undermining") and pulling them forward to make them taut and flat.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Facelift Revision

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This is a good question. The most common things that recur after a facelift are jowls and neckbands.  Your surgeon must be skilled at both of these points in face lifting surgery. A mini lift will not correct the jowls or the neck bands. They must be addressed during your surgery properly and attended to correctly during the surgery. The jowls are address usually with a smas type face lift and actually lifting the jowls and removing them.  The neck bands must be addressed separately in the neck area by working on the platysma muscle itself and correcting the bands. They actually need to be removed surgically and make a tight nice neck and jawline.  This is important in any facelifting surgery and the neck must be addressed.  I hope this helps.  Your face is your diamond, polish it brilliantly and you will shine.  Good luck 

Walton Montegut, MD
Newport Beach Physician
4.9 out of 5 stars 47 reviews

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.