When a facelift is performed, do surgeons just pull the skin or both the skin and muscles in the face?

A properly done facelift should provide a natural appearance without evidence of excess tension on the skin.  The supportive mechanism of the face is a network of muscular and connective tissue called the SMAS and this is what is repositioned upward to eliminate jowling, neck laxity and descent of facial soft tissues.  The skin is then tailored to remove excess but not stretched.

Thanks for your question; it's one I get often, and with so many “minimally invasive” options out there, it's easy to become confused about what a full facelift actually entails. A facelift goes deeper than the skin, lifting and repositioning the underlying tissue of the lower two-thirds of the face. Also, adjustments are made laterally (up) instead of horizontally (out). As you've noted in your answer, this produces a much more natural-looking (and long-lasting) result than procedures that are more focused on lifting only sagging skin. When you are ready to undergo a facelift, make sure you consult with a board-certified plastic surgeon who specializes in this procedure to be sure that your facelift is customized to address your specific physical characteristics and desired outcomes. 

Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. The LiteLift™ is an innovative facelift developed by board-certified plastic surgeons Dr. Larry Nichter and myself which benefits many male patients. The goal of the #LiteLift is to provide a less invasive natural looking option for both men and women desiring to refresh their appearance with less downtime and risks. The LiteLift® is a “real” facelift, which does address the underlying muscle, tissue and overlying skin.The technique requires limited incisions and takes a vertical lifting approach, in contrast to the traditional facelift, which requires extensive incisions and lifts or pulls the face towards the ears horizontally. The modern techniques used allow us to perform most LiteLift® procedures in the office under local anesthesia. Also, removing the risk of general anesthesia opens the door for more people to pursue facial surgery. All too often people do not move forward with undergoing the desires facelift surgery due to their overwhelming fear of the risks associated with general anesthesia.This is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.The best candidates for #LiteLift are non-smoking patients 35-60 years old with stable skin elasticity, well-defined bone structure but showing early changes of the lower face and the neck. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™. All in all, Lite Lift™ surgery is individualized for each patient.

Your question is very perceptive. The techniques used for facelift vary widely. What is most important is the skill and experience of the surgeon you choose, a decision that should be based on experience, patient reviews, credentials, and examination of before-and-after pictures. That being said, I believe that a procedure that relies on thorough release of the deeper layer attachments (sub-SMAS, or deep plane dissection) repositions the most superficial muscle layers and the subcutaneous layers that relax as part of the aging process.  The deeper layers are made very snug after thorough release, and the skin is not made any tighter than the underlyng tissues. This will give a result that is completely natural without uneven tension or skin tightness, the two hallmarks of an operated-on appearance.

For the most natural result, the SMAS (superficial muscular aponeurotic system) will be pulled and tightened in both an upward and outward direction. The SMAS is composed of deep-layer facia and muscle. The skin will be pulled in a similar direction and excess skin will be removed. These layers are then fastened with deep sutures to hold the lift in place. Fillers or fat grafting can be added to restore volume to the cheeks. I hope this helps.

There are a number of ways to get a good result with a facelift.  Good surgeons typically get good results, almost regardless of the details of the method they use.That being said, I prefer an "extended SMAS" facelift.  This works on the skin layer, and also on the SMAS layer in the cheek (between skin and muscles) and the platysma muscle layer in the neck, giving a nice, natural looking correction to everything from the cheekbones on down to the neck.  Sometimes, fat grafting or skin resurfacing can benefit the result, as well.Best to have a consultation with a facelift expert in person!

Thank you for your question. The general public has the perception that there is a single facelift technique, whereas in truth, techniques vary greatly from surgeon to surgeon. Even the terminology is different from surgeon to surgeon. One person's mini-facelift may be similar to another person's full facelift, and some surgeons pull the skin more than is typical, and others elevate skin very little and pull on the SMAS (or supporting layer) more. It's therefore vital that you communicate with your surgeon regarding what type of facelift he or she tends to do. Some surgeons are also well versed in many facelift techniques and tailor their operation according to the clinical situation. Typically, the SMAS (deeper) facelifts put everything back where it used to be, and you get a more natural appearance.

A facelift procedure varies widely between surgeons. Some do skin only tightening. Others would do muscle (SMAS) tightening along with skin tightening. It is generally accepted that tightening the muscle will give a more corrected, longer lasting, result. That does not necessarily mean that you will looked pulled, but it can be difficult to get a good result without the deeper muscle tightening in the neck and lower face.

There are many ways to do facelifts.  The best result will come from freeing up the underlying muscle-fascia layer, tightening it and then removing extra skin.  The pull should not be on the skin.  I looks unnatural and leads to unsightly scars. All the tension should be on the deeper layer.  It is a more challenging surgery but the result look nice and last far longer.

This is a fantastic question and one that I think all patients should understand when learning about facelift surgery. To help, I added an article I wrote on the technique involved in a facelift. I think if you take a look, you may gain some knowledge about a facelift and it will likely answer some of your questions. I hope you find it helpful,James P. Bonaparte

Faceless can be very limited or very extensive depending on the problems being addressed by the operation as well as the philosophy of the surgeon. You can visit my website to see the technique that I use in the vast majority of my patients. Regardless, when you choose your surgeon the future make certain you understand the specifics of how the procedure will be performed.