Everyone recognizes that a facelift has a lot to do with managing loose jowl and neck skin. Through incisions around the ears, the skin in front of the ears and down and across the neck is lifted, moved up and backwards, and the excess trimmed. Essentially creating a ’skin hammock’ from one ear to the other which is tightened like a sling. It is not uncommon that many people also believe that the facial muscles are also tightened. This belief is only partially true.

The only muscle that is ever manipulated in a facelift is the platysma muscle. The platysma is really like a sheath which completely covers the front of the neck and throat. Running from the collarbones up to and around the lower edge of the jaw, the platysma muscle has two halves which are joined in the middle like a pair of closed curtains. They really wrap around the jawline and blend into those of the face. Its function is to move the head forward but its power is much weaker than other neck muscles, so its role is more cosmetic in how it makes the shape of the neck look. As we age, this muscle almost always separates allowing fat underneath it to protrude and making the neck angle less sharp. The edges of the separated muscle can also be seen as strings or bands which can extend the whole way down the neck to the level of the adam’s apple.

In fuller versions of a facelift, a small incision is made under the chin to deal with the separated platysma muscle. Protruding fat is removed and the edges of the muscle is sutured back together from under the chin down to the adam’s apple. This creates a corset-like effect and tightens and lifts a primary determinant of the middle of the neck angle. There are many variations of how to suture the platysma muscle but none has been shown to be absolutely superior to another. This maneuver may make one’s neck feel a little tighter, particularly when tilting the head back, but this feeling is temporary as one gets used to a unified platysma muscle again. This muscle tightening, combined with the tightened skin hammock, goes a long way towards making a good facelift result with a dramatically improved neck angle.

Not all facelifts need or use platysmal muscle tightening. Smaller versions of facelifts, known as limited facelifts, Lifestyle Lifts, Quicklifts and numerous other names, are more jowl and skin in front of the ear manipulations and do not manipulate this neck muscle. By definition, these are limited procedures and will not be very effective for large neck problems.

Facelifts do lift one muscle and that is in the neck not the face. The concept of moving facial muscles during a facelift is erroneous and is confused with manipulating another facial layer known as the SMAS. The SMAS is not muscle but a layer between the skin and muscles that can be raised and repositioned just like the overlying skin.