Cosmetic surgical procedures, such as face lifts, have been performed for over one hundred years. In the early 1900’s various surgeons maintained busy cosmetic surgery practices, but cosmetic surgery was kept secret. These early facelifts were described as being performed on aristocrats and entertainers with the highest degree of secrecy. Surgeons often disguised their procedures on the operative log for patient privacy. Surgical techniques were often kept secret as well. While facelift, brow lift, and orbital procedures were being performed at the turn of the twentieth century, it was not until the 1930’s that surgeons began to openly discuss their techniques and begin publications on topics such as facelift and blepharoplasty.
Face Lifts in the Past
Early approaches to facial rejuvenation relied on simple excision of redundant skin to tighten the face. In the 1930’s surgeons published many of the same skin incisions still used today. These incisions hide the scars within the hair, or around and behind the ear. While this approach could achieve improvements in skin laxity, it does not address the deeper structures of the face and neck that cause facial aging.
Skin tightening alone without addressing the deeper muscle and structure of the face and neck will have limited benefits and can lead to stigma of facial surgery. In the 1960’s and 1970’s a more comprehensive approach addressed the deeper foundation of the face. Addressing the SMAS, or superficial musculoaponeurotic system, of the face allowed for the plastic surgeon to correct laxity of deeper support structures of the face and restore them in an elevated position correcting the neck, jowls, and midface. With restoration of the SMAS, facelift techniques greatly improved to provide a more natural and youthful appearance.
Face Lifts in the Present
The modern approach for plastic surgeons is to address varied aspects of facial aging. This includes the skin, laxity of facial muscles and ligaments, and restoring volume to the face. My preferred approach to surgical facial rejuvenation is the SMAS lift with restoration of facial volume. Incisions for the facelift are made within the hair and around the ear to hide the scar. Fat grafting to the face is also performed in conjunction with facelift to restore a more youthful volume. Laser skin resurfacing is performed to address sun damage and fine wrinkles of the superficial skin layers.
Nowadays, a variety of non-surgical methods are employed to restore vitality. However, surgical facelift is still the gold standard for correction of facial aging. Each facelift procedure will be designed to the patient’s specific needs and will address rejuvenation around the eyes and forehead. I will often use the addition of laser and light therapies (Halo, NanoLaserPeel, Forever Young BBL) to address skin tone and superficial wrinkles. A combined approach to facial surgical rejuvenation can achieve dramatic results, restoring a youthful and natural appearing rejuvenation to the face.
