What happens if you only pull the skin
It is easy to think of a facelift as surgery that pulls the skin taut. Early methods were indeed like that.
But pulling only the skin creates problems. Skin has the property of stretching, so before long it sags again. Pulling hard makes expressions unnatural and puts tension on the incision line, widening the scar.
That is because the cause of a sagging face does not lie in the skin alone. It is the result of the fascia, fat and the ligaments that held them all loosening together.
So the facelift of today addresses the layers beneath the skin. It is closer to a sequence of lifting the inside back into place and then laying the skin over it.
The layer called SMAS
Between the skin and the muscle there is a thin membrane. It is called the superficial musculoaponeurotic system, commonly shortened to SMAS.
This layer runs across the whole face like a net and is connected to the facial muscles. It is tougher and less stretchable than skin, so when it is pulled and fixed, that state holds.
As aging progresses, this layer loosens and the fat and skin resting on it come down together. The deepening of the nasolabial area and the loss of the jawline come from here.
So the core of a facelift becomes how the SMAS is handled. If this layer is lifted and fixed, the skin settles naturally without having to be pulled excessively.
The methods are divided by the plane of dissection
The difference between methods comes down to which plane the tissue is separated along.
Dissecting above the SMAS has long been used. The skin and the SMAS are separated individually, so the degree of pull can be adjusted differently for each layer. Because the approach is relatively superficial, the burden of nerve injury is described as lower.
The deep plane method dissects beneath the SMAS. Skin, fat and SMAS are lifted together as a single block. Since the layers are not separated, a larger amount of tissue movement can be achieved, and because the skin is not pulled separately, expressions are described as staying natural.
However, going into a deeper plane means passing nerves and vessels. That is why it is treated as surgery requiring anatomical understanding.
Rather than one always being better, the choice differs with the degree of sagging and the condition of the tissue.
| Category | Dissection above the SMAS | Deep plane |
|---|---|---|
| Plane of dissection | Between the skin and the SMAS | The deep plane beneath the SMAS |
| What is pulled | The skin and the SMAS are handled separately | The skin and the SMAS are lifted together as one block |
| Handling of ligaments | Retaining ligaments are generally left in place | Releasing the retaining ligaments is part of the process |
| Recovery burden | Described as a lighter burden | The dissection is broader, so recovery takes longer |
The ligaments have to be released for tissue to rise
Inside the face there are ligaments that hold tissue in place. These ligaments stay attached even as aging progresses.
So if you pull while leaving the ligaments intact, the tissue rises only as far as the attachment points. Below that it stays where it was, and the border can actually become more distinct.
The reason the deep plane method is described as able to achieve a larger amount of tissue movement relates to this point. Releasing the ligaments in the deep plane lets the tissue that was tethered rise along with the rest.
However, handling the ligaments widens the area that has to be addressed and lengthens recovery.
How far to release is part of the surgical design and differs with the degree of sagging and the extent of change desired.
How TheLINE approaches facelifts
TheLINE Plastic Surgery Clinic works primarily with the SVF deep plane facelift. Because it is surgery with a broad dissection, the approach designs the recovery process alongside it.
SVF isolated during surgery is applied to the dissected area. The aim is to support circulation and the recovery process in the widely dissected tissue, and the isolation is carried out in a dedicated laboratory inside the clinic.
The surgery is performed by Dr. Yoosuk Chung, a board-certified plastic surgeon, while Dr. Jaeho Cho handles the harvesting and SVF processing.
Where the degree of sagging is not severe, we also review the mini facelift for the 2030 age group or non-incisional methods. Many TheLINE patients decide on the method based on the condition of the tissue rather than on age.
Incision lines and scars
A facelift is surgery that requires incisions. Checking in advance where the scars will be is an important part of the consultation.
The incision line generally starts along the natural contours in front of the ear, curves under the earlobe and continues behind the ear. It is extended into the hairline as needed. The idea is to choose places that the contours of the face and the hair will conceal.
What widens a scar is tension. Pulling the skin excessively puts force on the incision line and the scar spreads. This is another reason the method of pulling at the inner layer and laying the skin over it is recommended.
Keeping the shape of the ear unchanged is also part of the design. Pulling too hard drags the earlobe downward and looks unnatural.
Why the neck is looked at as well
There are cases where lifting only the face looks awkward, because the neck below the jawline stays as it was.
The same changes occur in the neck. The skin stretches and the thin muscle beneath it loosens, so vertical bands stand out or the area under the chin becomes heavy.
If the face is lifted while the neck sags, the border becomes distinct. That is why the neck is often addressed together in a facelift. Extending the incision line behind the ear is also for accessing the tissue on the neck side.
Conversely, if the changes in the neck are not yet significant, the surgery is sometimes completed on the face alone.
How far to include is decided at the consultation according to the distribution of sagging. As the extent widens, the recovery period lengthens with it.
The recovery process
Because the dissection is broad, recovery takes time.
Swelling and bruising are pronounced early on. This is a period when the whole face is swollen and hard to make out, peaking over a few days and then gradually subsiding.
Some areas become numb. This is because the fine nerves running to the skin are affected during dissection, and sensation usually returns over time.
A feeling of tightness and firmness remains for several weeks to several months. This is the tissue settling into place.
The final appearance is confirmed over several months. Since it takes time for swelling to subside and scars to fade, the result should not be judged by how things look right after surgery.
Limits you should know
A facelift is surgery that raises tissue that has come down, not surgery that changes the quality of the skin. Fine lines, pigmentation and pores require a separate approach.
Lost volume is not restored either. If volume loss is present as well, fat grafting is planned together.
Aging does not stop either. It progresses again over time, so a permanent result cannot be expected.
Smoking is particularly unfavorable for recovery. Because blood flow to the widely dissected tissue matters in this surgery, wound healing is known to be delayed and the risk of complications to rise.
Side effects such as bleeding, hematoma, infection, nerve injury and scar problems may occur. Unexpected inflammation or bleeding may occur, and the degree varies from person to person, so caution is required.
Frequently Asked Questions
What is the difference between SMAS and deep plane?
The plane of dissection differs. One separates the layers above the SMAS and pulls each individually, while the other lifts everything as a single block from beneath the SMAS.
Can thread lifting not do the job?
It depends on the degree of sagging. When tissue has descended significantly, there are limits to the holding force of threads, so incisional surgery is reviewed.
Where do the scars remain?
They start along the contours in front of the ear, curve under the earlobe and continue behind the ear, extending into the hairline as needed. The positions are checked in advance at the consultation.
How long does the result last?
Aging does not stop, so it progresses again over time. That said, a method that fixes the inner layer is described as lasting longer than one that pulls only the skin.
How is a facelift at TheLINE carried out?
TheLINE Plastic Surgery Clinic works primarily with the SVF deep plane method and applies SVF isolated during surgery to the dissected area to support the recovery process. Dr. Yoosuk Chung performs the surgery and Dr. Jaeho Cho handles the harvesting and SVF processing.
