Surgical procedures to reverse the appearance of facial aging 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 and 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.
Early approaches to surgical facial rejuvenation relied mostly on simple excision of redundant skin to tighten the face, forehead, and eyelids. Publications on facial rejuvenation in the 1930’s advanced the early approach focused on tightening skin to provide the appearance of a more youthful face. In the 1930’s surgeons published many of the same skin incisions still used today that hide the scars within the hair, around the ear, and behind the ear. While this approach could achieve improvements in skin laxity, excising skin only does not address the deeper structures of the face and neck that lead to appearance of 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 to surgical rejuvenation of the face was advance to address both the deeper foundation of the face to achieve a more natural and youthful appearing result to facial surgical rejuvenation. 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 the facelift technique greatly improved to provide a more natural and youthful appearance to the face than could be achieved with skin excision alone.
The modern approach for plastic surgeons to take for facial rejuvenation is to address varied aspects of facial aging including the skin, laxity of facial muscles and ligaments as well as restoring volume to the aged 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 and laser skin resurfacing is performed to address sun damage and fine wrinkles of the superficial skin layers.
While a variety of non-surgical methods are employed to rejuvenate and restore vitality to the facial appearance, surgical facelift is still the gold standard for correction of advanced signs of facial aging which include neck laxity, jowls where the cheeks descend below the jaw, prominent nasolabial folds, and descent of the midface. Each facelift procedure will be designed to the patient’s specific needs and will address rejuvenation around the eyes and forehead as needed. 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.