Anatomy

Anatomy of the Face, Facelift Surgery

The Face is composed of multiple structures.  You can think of the face as having several layers.  The top layer is the skin. The skin has itself several layers and is primarily made up of collagen.  The orientation of the collagen and pigmentary changes often determine the quality of skin.  The older we get, the more disorganized the collagen becomes and the more skin discoloration we form.  Bioactive skin care regimens such as the Restore and Renew Skin product lines as well as fractional laser resurfacing are required to treat photo damaged skin.  Sunscreen, smoking cesqsation, healthy diet as well as sun avoidance are extremely important tools in preventing and preserving great skin.

Illustration demonstrating facial proportion

Under the skin, a level of tissue exists that has fat and connective tissue called SMAS (superficial musculoaponeurotic system).  This layer is perhaps the most important layer as it forms the foundation of the face with both structural support for the muscles and skin.  Ligaments pierce through this layer from the bone and muscles to attach to the overlying skin.  The fat compartments generally shrink as we age leading to hollowed appearance that is commonly seen in older individuals.  The SMAS also loosens leading to the formation of deep furrows and jowling.  The SMAS layer is extremely important in face lift procedures in order to obtain long-lasting and structurally sound outcome.  Volume restoration of the fat compartments utilizing multilevel fat grafting or fillers (Sculptra, Radiesse, Restylane, Perlane, Juvederm) is also important in order to restore lost fullness.

Illustration below demonstrating the multiple layers of the face including skin, SMAS, fat, muscle and bone

There are 23 paired facial muscles that reside deep to the SMAS. These muscles of facial expression control facial movement and serve an important role in communication. Facial nerves typically run deep to these muscles and therefore can be avoided if your surgeon understands the right surgical planes during facelift procedures. Facial muscles are the main culprit for “expression lines” that form around the eyes and mouth. Expression lines include: smoker’s lines, crow’s feet, “11 sign”, and forehead wrinkles. Botox and Dysport are often required to improve the appearance of these wrinkles. Surgery typically does not correct the underlying problem.

Illustration demonstrating the location and position of the facial nerve

The facial skeleton is final layer that lies deep to the facial muscles.  Everyone has different aspects to the facial skeleton and thereby our facial appearance significantly relies on the bony framework.  Under-developed cheek (maxillary hypoplasia) and chin (mandibular microgenia) bones can lead to early facial aging and imbalanced facial appearance.  Oftentimes, surgical augmentation of the bones with implants is required to address a recessed chin (microgenia) or under-developed cheek bones (maxillary hypoplasia). 

Marilyn Monroe demonstrating classic beauty with perfect features