The Six Layers of the Face and What Reaches Each One
Medically reviewed by
4 independent reviewers
Andrew Conrad Barile, PT, DPT
Doctor of Physical Therapy (DPT) | Licensed Physical Therapist (PT) | CEO and Founder, Xtreem Pulse LLC
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Dr. Andrew Conrad Barile is a Doctor of Physical Therapy and the CEO and Founder of Xtreem Pulse LLC, the engineering company behind PureLift. He earned his Doctorate in Physical Therapy from Daemen College and is a licensed physical therapist.
He brings over two decades of clinical and entrepreneurial experience across physical therapy, craniosacral therapy and medical device innovation, built on a working knowledge of human anatomy and muscle physiology.
For PureLift LAB he reviews how current is delivered across all ten levels, from sub-sensory nanocurrent and skin-level microcurrent to motor-level EMS, and how the Infuse pass fits into the same ten-minute routine.
Bertica M. Rubio, M.D.
Board-Certified Physician, Dartmouth Medical School | Medical Director, Antiaging Regenerative Medicine Clinic
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Dr. Bertica M. Rubio is a board-certified physician and Medical Director of the Antiaging Regenerative Medicine Clinic in Redlands, California. She earned her Doctor of Medicine from Dartmouth Medical School and completed her pediatrics residency at UC Irvine Medical Center.
With decades of clinical experience, she specialises in age management medicine, regenerative medicine, wound healing and growth factor therapies, and her practice integrates evidence-based medical science with advanced aesthetic treatment.
For PureLift LAB she reviews articles for medical accuracy across the whole dial, from the gentle nanocurrent and microcurrent settings through to muscle-level EMS and the Infuse pass.
Daniel Grinberg, MD, FACS
Board-Certified Otolaryngologist | Head and Neck Surgeon | Fellow, American College of Surgeons | Mount Sinai
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Daniel Grinberg, MD, FACS is a board-certified otolaryngologist and head and neck surgeon at ENT and Allergy Associates in West Nyack, New York. He earned his medical degree from Columbia University College of Physicians and Surgeons.
He completed his otolaryngology residency at New York University Medical Center, serves as Assistant Clinical Professor at Mount Sinai School of Medicine, and is a Fellow of both the American College of Surgeons and the American Academy of Otolaryngology.
For PureLift LAB he brings a wider clinical lens, connecting at-home facial stimulation from microcurrent to EMS to the anatomy underneath, with the same rigour we apply to every device specification.
Prof. Dr. med. Ivo Buschmann
Chair of Angiology, Medizinische Hochschule Brandenburg | Clinic Director, University Clinic for Angiology
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Prof. Dr. med. Ivo Buschmann is Chair of Angiology at the Medizinische Hochschule Brandenburg Theodor Fontane and Clinic Director of the University Clinic for Angiology at the Brandenburg University Hospital.
He trained at the University of Hamburg, was a Max Planck Society Fellow at the Max Planck Institute for Heart and Lung Research, and held senior consultant posts at the Charite Universitatsmedizin Berlin before his appointment as Chair in 2016.
One of Europe's leading authorities on arteriogenesis, with over 150 peer-reviewed publications and US and EU patents, he reviews for PureLift LAB how the evidence on electrical stimulation is read and where its limits lie.
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The face is a stack of layers, and every treatment ever sold reaches one or two of them and no others.
This article explains what is actually happening, such as:
- Layer one, the epidermis
- Layer two, the dermis
- Layer three, the fat compartments
- Layer four, the SMAS
- Layer five, the muscle
and many more!
It also explains why a product that worked brilliantly for a friend did nothing for you; you were treating different layers.
Key Points:
Epidermis is where cleansers, exfoliants and most of what you feel happening live.
Dermis holds collagen and elastin, and retinoids and heat-based treatments target it.
Fat sits in discrete compartments and only fillers replace what leaves.
SMAS is the layer a surgical facelift repositions and nothing at home reaches it.
Muscle is the layer EMS works, and it is the deepest layer any home device touches.
Layer one, the epidermis
The outermost layer, roughly the thickness of a sheet of paper, replacing itself continuously. It is the barrier, and it is where dullness, flakiness and surface texture live.
Cleansers, exfoliating acids, moisturisers and sunscreen all act here. So does most of the immediate satisfaction of a skincare routine, which is why a good moisturiser feels transformative for an evening and changes nothing structural.
Infusion is the technology aimed at getting past this layer; it opens temporary routes through it so that what you apply can travel further, and Prausnitz and colleagues set out the mechanism (10.1073/pnas.90.22.10504).
Layer two, the dermis
Below the epidermis and far thicker, holding the collagen and elastin that give skin strength and recoil, plus the blood supply and the lymph vessels.
This is the laxity layer. Collagen production falls from the mid-twenties and ultraviolet exposure accelerates the loss, and skin that stretches and stays stretched is a dermal change rather than a surface one.
Retinoids reach it, which is why they have the best evidence of anything over a counter. Radiofrequency and focused ultrasound reach it with heat, provoking a wound-healing response. Nanocurrent and microcurrent are discussed in the literature at this level, for cellular activity, fibroblast signalling and dermal circulation.
Layer three, the fat compartments
Facial fat is not an even blanket; it sits in discrete pads, and they do not all shrink at the same rate or stay where they started.
The upper compartments tend to lose volume while the lower ones hold on, which produces the pattern of a hollow upper cheek and a heavier lower face at the same time.
Nothing you apply and no current replaces what leaves. Fillers do this job and it is a clinical decision, which is worth knowing before you spend three months trying to fix a volume problem with a device.
Layer four, the SMAS
A continuous sheet of fibrous tissue and muscle fibres running through the face, connecting muscle to skin so that a contraction becomes an expression. In the lower face it continues into the platysma down the neck.
It stretches and its anchoring points descend, and it is the layer a SMAS facelift lifts and secures, which is what separates a modern facelift from the pulled look of a skin-only lift.
Nothing at home reaches or repositions it. What a device can do is work the muscle attached to it, which supports the structure without moving it.
Layer five, the muscle
Facial muscles differ from muscles elsewhere in that many attach into the SMAS rather than to bone at both ends, and they lose tone with age like any other muscle.
EMS is the only home category that reaches here, because reaching muscle means crossing the motor threshold, the current level at which a nerve fires. Ward's work sets out that threshold alongside the two below it (PMID 19095805).
Kavanagh and colleagues measured an 18.6 percent increase in cheek muscle thickness over 12 weeks with motor-level stimulation (10.1111/jocd.12007). On PureLift, levels 1 and 2 sit in the dermal-mechanism bands and levels 3 to 10 reach this layer.
Layer six, the bone
The facial skeleton remodels with age; eye sockets widen, the midface loses projection, and the jaw angle softens.
Everything above drapes over that frame, so a change in the frame changes everything. Nothing non-surgical alters bone, and the only reason to know about this layer is so that you do not try to treat it.
Using the map
Name the layer first. Dull, flaky or rough is epidermis. Crepey and slow to spring back is dermis. Hollow where it used to be full is fat. Descended as a whole is SMAS and muscle together. Changed in shape rather than in surface is bone.
Then buy the intervention that reaches that layer, and be sceptical of anything claiming to reach four of them at once.
For which PureLift technology sits at which level of the dial, see how the nine PureLift technologies work, and for more on the fourth layer specifically, the SMAS layer and the jawline.