What happens if you have poor tissue quality in the facial muscles after a facelift. Does it fall down quickly?

What a great question! In order to fully understand the answer to this question we need to first go over the layers of tissue in the face:- Layer 1: Skin- Layer 2: Subcutaneous Fat- Layer 3: Superficial musculoaponeurotic system (SMAS): fascial layer that lays on top of your facial muscles above nerves & other critical structures- Deep to SMAS: facial nerve, facial muscles, parotid & submandibular glands There is a misconception that facelift surgeons are using the skin to tighten and give the desired result. The truth is that face lifting techniques have evolved tremendously over the last decade, and there is a growing understanding of the most durable approaches for facelift longevity. We never want to use the skin to lift the midface and provide shape to the neck. All of the work is done in the deeper anatomical layers. The skin and subcutaneous layers are draped over the deeper work on the SMAS. That is one of the secrets to beautiful, imperceptible scars. The SMAS layer is elevated off the deeper structures with great care and it is then repositioned in a more elevated position. This is the deep plane facelift. The SMAS is dissected into the neck (here it turns into the platysmal muscle) and after many technical maneuvers are performed deep to the SMAS to debunk glands and to retighten the platysmal muscles corset, the SMAS is laterally repositioned to provide a beautiful angle of the jawline lift and tightening.
We never use the facial muscles for the facelift tightening. In general all of the facial muscles and there nerves of the face are carefully protected during the dissection and left alone. The only muscle used for tightening is the platysmal muscle in the neck. The platysmal is a very think muscle that lays along each side of the neck. Sometimes it meets in the midline neck and sometimes it doesn’t based on a person’s anatomy and aging. It is really important as a facelift surgeon to carefully dissect out the platysmal and not to shred it as it is key for the necklift shaping. If the platysmal is damaged from previous surgical manipulation or non-surgical damaging procedures then unfortunately the longevity of the necklift correction can be compromised. If this is the case, I would recommend finding a facelift surgeon who is skilled in revisionary procedures for correction.

Hi,

Poor tissue quality in the facial connective tissues which are the main support structure of the face, poor skin quality with too much solar damage, attenuated SMAS (Superficial Musculoaponeurotic System) layer can indeed impact the longevity of a facelift.

When the underlying muscles and connective tissues are weak, they provide less support for the lifted facial structures.

This can lead to a quicker recurrence of sagging or drooping, as the foundational support isn't robust enough to maintain the results. However, advanced surgical techniques can mitigate this issue.

By reinforcing or repairing the deeper tissue layers during the facelift, we can enhance structural support and improve the durability of the outcome. It's essential to assess tissue quality during the preoperative evaluation to tailor the surgical approach accordingly.

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.

Muscles, alone, do not have a great deal of strength to hold sutures. The strength layer in the face which allows elevation and smoothing of the facial contours during a facelift is due to the fascial layer, which is intimately associated with the facial muscles. This layer, called the SMAS, lies directly underneath the skin. There are a variety of ways that surgeons suture this SMAS in order to improve a patient’s neck, jawline and facial contour during the facelift, and none of these have proven superior to the others. However, some type of suturing/elevation of the SMAS should be done to give the longest lasting result from a facelift. This is because simple tightening of the skin can give an early improvement, but the results did not last because the skin is not a support structure, it is a covering. The support structure is the SMAS which needs to be elevated to its correct position and then covered with the skin. As a general rule, people’s skin and other tissue quality is better when they’re younger than when they’re older. These tissue qualities also very according to patient’s prior weight, smoking history, diabetes, overall general health, and prior sun exposure, to name a few. A detailed consultation with the plastic surgeon can clarify any other issues. Best wishes.