History chronicles the facelift along with warfare and aristocracy. At the beginning of the last century, following so many conflicts impaling faces and necks with caustic liquids, arrows, knives and now bullets, first aid was offered by simply wrapping material over the wound and allowing it to heal with contorted scars. World War I and the advent of anesthesia and antisepsis provides the evolving head and neck surgeons with the time and curiosity to explore the different layers of the tissues under the skin while reconstructing war torn faces.
If you feel you look older than you feel, humans used cosmetics and chemical peels for millennia to rejuvenate but it was in 1901 in Berlin that a surgeon cut out a fold of sagging skin of a patient – aristocrat to appear younger. For 70 years, the differing layers of the skin were discovered, lifted, pulled and removed developing the foundations for today’s “physical” facial rejuvenation.
Video: Dr. Dean Kane During Actual Face Lift Consult Explaining the History of Face Lifts to Patient
The skin and soft tissue laxity associated with the collagen loss of aging redistributes the fat pads of the face and forms waves of skin along the brows, tear trough, nose-cheek (nasolabial), lateral lip commissure and chin-cheek (marionette) / jowl and neck. Plastic Surgery pioneers began diving deeper, separating, suspending, filling the different layers in differing styles modifying the “single facelift” of the 1950’s – 70’s with an incision behind the sideburn onto the front of the ear and extending behind the ear and onto the posterior hairline depending on the amount of skin pull required. Subsequent generations of plastic facial surgeons increasingly offered these techniques to restore the common man and women’s facial aging.
Newly discovered planes of tissues used the SMAS (superficial musculoaponeurotic system) of superficial fascia as a tension suspender allowing less “windblown” appearance due to pulling the skin tight to the ears. This 2 plane technique expanded to the neck with the corset platysmaplasty hammocking the neck bands upwardly as a facial sling further defining the jawline. In the forehead, sagging brows and deep furrows were elevated in 1, 2 and evolving endoscopic deep-plane options.
Decades of SMAS refinements further elevated the jowl tissues back up to the sagging cheeks and the cheek back up under the eyelids. These innovations innovated the need to redistribute and add volume back to the aging face. It also reduced incision / scar lines to the individual units requiring the “lift”: forehead and brows, face and mid-face and neck. Minimally invasive techniques using puncture sites and half-inch incisions generated the post-millennial development of endoscopic deeper elevations and isolated suture suspension (ie Silhouette and EuroThread thread lifts), fat grafting and filler augmentations. Once again, innovations deviated between superficial skin and fascia lifts which I have found to provide excellent physical facial rejuvenation in patients with significant folds and skin laxity versus proponents of deep plane techniques, elevating the soft-tissue descent of the cheeks and brows deep to the muscles of the face in patients with firmer skin and fuller faces.
The Identical Twin Facelift study review of 2009 performed on 10 twins by 4 internationally renown Face Surgeons found that the duration and differences of the SMAS imbrication, SMAS flap, deep plane, and endoscopic facelifts found no long-term differences in comparative observations. The difference was in the skills and experience of the surgeon.
The majority of today’s facelifts use an individualized approach of facial shaping dependent on the underlying skeletal foundation and symmetry, distribution of facial fat, laxity of tissues of the forehead-brown, face and mid-face, neck. 2 planes of tissue, the skin and either the SMAS or deep-plane are redraped in the direction best suited for the individuals lifting needs. Occasionally, an endoscopic “deep-plane will be added to further advance the tissues of the descended cheek in addition to the 2 plane facelift.
Upon my completion of 7 years of general surgery and plastic surgery residencies over 33 years ago. I recognized that the next advancement in facial restoration would be to use the bodies own regenerative powers to reverse and rejuvenate the aging fabric of the re-draped up-lifted skin. At that time, I called it “cosmetic medicine”. Today, it’s called regenerative medicine. Please read more in the MediSpa ZO Obagi pages.
