A facelift, despite being a well known procedure, is frequently misunderstood. The most common misconception is of the actual facial area that is treated. Rather than the whole face, it treats only the lower third of the face, the neck and jowl areas. But the second misconception is what lies under the skin or, more pertinently, what is changed under the facial skin as it is lifted. It is commonly believed and often stated that the facial muscles fall with aging, carrying with it the overlying skin. But this is only partly true at best. The only facial muscle that really changes as we age is the platysma muscle which is a neck muscle not a true facial muscle. Running between the clavicles and the jawline, the platyma muscle splits or separates in the middle as we age. This creates the classic neck bands seen running down the middle of the neck. What one sees is the inner edges of the platysma muscle which makes up the paired neck cords running vertically. It is this muscle that is put back together during a facelift and accounts for the small incision right under the chin for access to do it. There are no facial muscles on the side of the face that can fall. There lies the very big masseter muscle, responsible for chewing, that is densely adhered to the bone. It can never fall with aging or become loose from the bone. Skin and the underlying subcutaneous tissues, known as the SMS, can sag with aging but not the muscles.
Dr. Barry Eppley
Indianapolis, Indiana