Face lift surgery trends have moved from tightening to re-draping of skin with volume addition. The Joan Rivers “pulled ear to ear” look can and should be avoided, unless of course, your patient is Joan Rivers. The term “face lift” in my opinion is a bit of a misnomer. The surgery itself does indeed “lift” skin that has fallen due to aging. But modern face lift surgery or SMAS face lift surgery techniques should combine both additive and subtractive components to re-shape the face, not just lift it. That is, the idea of face lift surgery is to SHAPE the face, not lift it. Face lift surgery should restore the SHAPE OF YOUTH, and this cannot be accomplished simply with skin tightening, or even SMAS (superficial Muscular aponeurotic system, the layer of tissue below skin) elevation. Face lift surgery should convert a bottom heavy face (an aged face) into a top heavy face (youthful face). This is accomplished through the elevation of underlying tissues called SMAS, with a gentle re-draping (not tightening) of skin. The subtractive component of face lift surgery includes the excision of jowls and fat deposit along the jawline, with tightening of the muscles along the neck. The additive components include resuspension of underlying tissue (SMAS) to a higher position on the face, and redistribution of fat from baggy under eyes to the junction of the lid and cheek. Lastly, fat grafting (from an unwanted area like the hip) to the cheek and cheek bone and temple area restore balance to a youthful top heavy face. When these components are done together, natural long lasting results can be achieved while avoiding that “done” face tightening look.