facelift answers from a plastic surgeon – dr. mark duncan-smith

 Although facelift is common for cosmetic purposes, I have also done it in the past for reconstructive purpose such as unilateral facial nerve palsy. A facelift should be better considered a face and neck lift as both areas should show significant improvement.

When Dermal Fillers & Wrinkle Relaxers are not enough

Cosmetic indications are as expected individual but generally revolve around the patient subjectively looking significantly older or more tired than they really are. This often relates to lack of cheek fullness, jowling and anterior neck banding.

Fat injection to the face is routinely undertaken as part of a facelift to assist in correcting cheek fullness for example.

With the common use of dermal fillers and wrinkle relaxers, facelifts can be a progression after dissatisfaction with ongoing or non-long term results with these modalities.

Common simultaneous procedures can include eyelid and brow surgery, rhinoplasty, liposuction, breast and body surgery.


  1. Skin only – very unusual and in fact I have never done one.
  2. SMAS facelift – most common type of facelift that can involve suspending and quilting of the deeper tissues
  3. Sub-periosteal – uncommon and typically reserved for reconstructive cases as I have used in the past for correction of severe lower eyelid ectropion for example.

The SMAS stands for SUPERFICIAL MUSCULO-APONEUROTIC SYSTEM and was described by two French Surgeons in 1976 (1. Mitz and Peyronie , 1976). This represents the vestigial layer of subdermal muscle, panniculus carnosus, that is found in animal and allows the horse for example to move its skin independently. Elevation and repositioning are undertaken via this layer avoiding direct tension on the skin. The platysma in the neck also represents this layer and therefore, if you pull on the SMAS and reposition it, you also pull on the neck and can get improvement in the contours of the anterior neck even though no direct surgery is undertaken there.

Facelifts can involve and incision in the submental area if there is significant anterior platysma banding, or can just be liposuction to the area if there is fullness only.

I do not recommend thread lifting as it is not a true alternative to surgical facelifts. The conclusions of a recent review article stated that thread lifting “demonstrated at best a very limited durability of the lifting effect. The two positive studies were sponsored by the companies that manufacture the thread-lift sutures (2. Gülbitti et al, 2018).”


Minor complication can occur and swelling and bruising are expected. Major complications are rare, but can include damage to underlying sensory and motor nerves.


After overnight stay in hospital usually, the patient recovers at home over a week. I advise the patient that if they want to be presentable to people with them knowing any surgery has been undertaken, then they need to avoid social contact for 2 weeks.

References for this article:

  1. Mitz V, Peyronie M.

The superficial musculo aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. 1976;58(1):80–88.

  1. Gülbitti HA1, Colebunders B, Pirayesh A, Bertossi D, van der Lei B.

Thread-Lift Sutures: Still in the Lift? A Systematic Review of the Literature

Plast Reconstr Surg. 2018 Mar;141(3):341e-347e.




About Dr Mark Duncan-Smith (MBBS (WA) FRACS(PLAST SURG) MAICD)

Dr Mark Duncan-Smith is a plastic and reconstructive surgeon with international training in cosmetic surgery of the face, breasts and body. He is a former President of the West Australian Society of Plastic Surgeons and former Head of Department at Royal Perth Hospital.


Special interests

Dr Duncan-Smith performs the following procedures:

  • Body: post-weight loss, abdominoplasty, body lift, arm and leg reduction, chest reduction/thoracoplasty, liposuction, skin lesions/cancers.
  • Breast: augmentation, reduction and lift, gynaecomastia.
  • Face: face and neck lift, eyelid surgery, rhinoplasty, brow lift, wrinkle relaxers and fillers.


Contact Details CosMedicWest

369 Bulwer Street, WEST PERTH WA 6005, AUSTRALIA

(08) 9228 2188