Face lifting is one of the most popular cosmetic surgery procedures we perform today. In terms of rankings, it probably is number 6 overall following such procedures as breast augmentation, liposuction and tummy tuck. A more technical term is rhytidectomy coming from the Greek work for “wrinkles”.
The first reported face lift dates back to 1901 when Engen Hollander of Berlin performed what may have been the first face lift. It was performed on a Polish aristocrat who wanted “her cheeks and corners of the mouth” lifted. This early attempt consisted of taking an ellipse of skin from around her ears. The first text book of facial cosmetic surgery was published in 1907 by Dr. Charles Miller of Chicago and the book was titled “The Correction of Featural Imperfections.”
After World War 1 plastic surgery started to take case. The undisputed father of 20th century plastic surgery was the famed British plastic surgeon Dr. Harold Gillies. In 1919 Dr. Passot published one of the first papers on face lifting which ushered in a new era – his technique involved actual elevation of the skin of the underlying structures pulling it tight and excising the excess. It is interesting to note that one of the earliest cosmetic surgeons was a female, Dr. Suzanne Noel.
One of the big breakthroughs in face lifting occurred in 1968 when a Swedish plastic surgeon developed the concept of sub facial dissection hence suspending the deeper layers rather than relying on skin tension. A classic anatomic study by Mitz and Peyronie ushered in the era of the SMAS (sub musculo oponeurotic system.) This was a term coined by Dr. Paul Tessier – a pioneer in craniofacial surgery and was the tutor for Mitz and Peyronie. This soon emerged as the standard of modern face lifting. Later in the 80’s and 90’s Dr. Tessier started to do sub periosteal face lifts. The idea was to lift all the soft tissue off the facial skeleton and elevate it in mass. I personally have never done this nor would I. The complication rate is higher – there can be prolonged swelling and risk of injury to the facial nerve is greater. I think most surgeons will do some manipulation of the deeper structures such as the SMAS layer. Perhaps the biggest change in my opinion in face lifting is the use of autologous fat to restore more youthful volume to the face because as we age we lose volume. That is one of the reasons fillers are so popular because they replace volume that was lost due to aging. Fillers are expensive and for one filler you can expect to pay $600-$800 per syringe where as in fat grafting I might add 15, 20 or even 70 cc’s of fat.