Facelift Surgery - Understanding What is Actually Lifted

The plastic surgery treatment of the aging face often involves a facelifting surgery. A facelift is one of the top ten cosmetic procedures performed in the United States. Despite its frequent performance and its recognition by the public, it is a procedure that is usually misunderstood.

The most common misconception of a facelift is that it does very little for much of the face. It is a procedure that has its impact on the neck and jowl areas. The rest of the face is untouched by the operation. While other procedures are often done with it, such as eyes and brows, these procedures are not part of the a traditional facelift operation. A facelift should more properly be called a necklift or a neck-jowl lift.

Another misconception about facelifts is what is actually lifted. Everyone understands that face and neck skin is lifted and moved back, but what goes on underneath the skin layer is a frequent point of misinterpretation. Patients often ask me if I am going to lift and tighten the 'muscles'. From an anatomic standpoint, lifting the facial muscles is an impossibility. Most facial muscles are attached tightly to the underlying bone and moving them would not only be very difficult but would not have any positive benefit. There is only one muscle that is often tightened in a facelift and that is the platysma muscle in the neck, which is often separated due to aging. It is never lifted per se but it is tightened in the middle, from the chin down to the adam's apple, to help sharpen the neck angle.

The layer underneath the skin that patients misinterpret as muscle being moved is actually a different tissue altogether. Between the skin and the muscles is a layer of tissue known as the SMAS. This is an acronym for a more anatomic name but for simplicity of understanding think of the SMAS as another layer of skin underneath. This layer can be raised up off the muscles and re-suspended up higher on the face. The combination of SMAS and skin tightening together generally makes for a better facelift result that may last somewhat longer.

There is great controversy in plastic surgery about how to most effectively deal with the SMAS during the facelift operation. Many facelift surgeons tout their own techniques and may even have their own names for their 'type' of facelift based on their version of SMAS manipulation. While SMAS management in any form of a facelift is a plus, there is no proven superior method of what to do with it. If one single SMAS facelift technique was genuinely best, we all would be using it.

In a facelift, the underlying tissues that are manipulated is the SMAS layer not muscles. SMAS tightening does usually make for a better facelift result that is more durable. However, time and aging will eventually outlast any facelift result no matter how it is done. And the overall goal for most patients is to ultimately outlive their facelift result....or at least I would think so.

Dr Barry Eppley is a board-certified plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com

Facial Analysis Before Plastic Surgery

As a plastic surgeon, analyzing a patient's face before surgery is obviously important. For anti-aging facial plastic surgery, a great detailed analysis of a patient's face is not usually necessary as you are 'nipping and tucking' loose sagging skin...essentially trying to restore their look of years ago. For plastic surgery involving actual changes in the foundation of the face (moving bone or adding implants), however, a detailed analysis is much more important.

Analyzing facial asymmetries or how the face may look after implant augmentation has much greater significance than a typical facelift patient for example. In this type of facial patient, you are really changing the way they look. While that may be what the patient desires, some patients may find the change different or troubling after surgery. I have found this issue to be particularly relevant in the patient who receives multiple facial implants or other foundational facial changes. Over the years, I have had more than one patient who required revisions of facial implants because of changes that they could not accept even though I and others may have found them to be a good improvement.

Any form of facial analysis before plastic surgery that helps the surgeon and patient have a better understanding of potential outcomes is always welcome. I have come across recently a novel website service that provides facial analysis at a very low cost. At Thatsmyface.com, they offer free online facial analysis and facial statues. Based on a frontal and profile view that you upload into their server, they will generate a facial profile which includes your face aged 10, 20 or 40 years, your face in different ethnicities and sexes, your caricature, identify facial asymmetries, give you an attractiveness rating, and compare yourself to others that may look like you. In addition, you can have customized 3-D statues made. All for very reasonable costs of $29 and up.

I find this website service to be potentially very useful for a small subset of my facial patients. Rather than using black and white photographs with hand-drawn grids on them or other methods of tabletop analysis, this form of facial profile analysis is more detailed and accurate with a quick turnaround time. I or the patients can do it themselves.

While no form of preoperative assessment or computer imaging can guarantee any surgical outcome, any method that allows better presurgical analysis or improve surgeon-patient communication and understanding is valuable.

Dr Barry Eppley is a board-certified plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com