Q: My friend who just had a facelift had a slim face before and it’s even slimmer after the facelift. I am considering a facelift but I don’t want to lose any volume in my face or lose my round face. I think a round face keeps you looking younger. I have that St. Bernard look and is why I want a facelift. Could you explain better the SMAS part of a facelift? I want to have the volume that is now around my mouth back up in my cheeks without having that “alien” look (inverted triangle). That to me is the tell tale sign of a facelift. I want a smoother transition between my cheeks and my lower face and not all the fat in my cheeks. In other words, I don’t want to lose my round face. Would you mind explaining this some more to me please. The best facelifts I have ever seen is when the volume is added to the outside of the cheeks (side closest to ears) making the face wider hence more volume. Is it possible to ask the doctor where to reposition the fat as he marks up my face next week for my nip tuck?
A: A facelift fundamentally works by pulling the skin and the underlying tissues back up along the jaw line and neck towards the ear. In thin faces, tightening these tissues can often make it look even slimmer or more gaunt. That is a simple function of having very little subcutaneous fat between the skin and the muscle. It definitely can give the impression of being pulled too tight even though it really isn’t.
The SMAS part of a facelift is the separation and lifting of the tissue layer between the skin and the muscle. It s usually lifted up in a more vertical direction than the way the skin is moved back. (which is up and back at about 45 degrees) It can help add volume to the side of the face if the SMAS layer has enough bulk. In thin-faced patients, it is quite thin.
In really round faces, a significant slimming effect will not happen after a facelift…even if you wanted it too. It will make the neck and jawline better shaped (which is the lower face) but it will not change what most people interpret as the ‘meaty’ part of the face, the cheeks and side of the face. The change in the neck is what creates the impression that you have lost weight, which is what many people comment on afterwards. (provided they didn’t know you had a facelift)