The history of the facelift can be viewed as possibly the epicenter and roots of cosmetic surgery. This article is my understanding of the history of popular face lifting methods. It is not meant to be completely inclusive; it reflects what I feel are some of the most important historical developments.
Early Twentieth Century
The facelift surgical history began by removing a strip of skin in front of the ear, then stitching the skin together with minimal undermining if needed for closure. The skin strip excision method is probably the precursor to “mini facelift.” Here are some of the important first recorded events regarding face lifts and skin strip excision.
- Hollander (Germany, 1901) published a short article about skin strip excision in front of ear.
- Miller (Chicago, 1906) wrote a book on Surgical Treatment of facial imperfections.
- Lexer (Germany, 1910) “natural evolution” of surgery to include maintenance of beauty also stressed cosmetic surgery — unique and complicated, requiring specialty training (no specialty boards then) — he added suturing of subcutaneous tissue. This put him ahead of his time. He also wrote about weakening muscles to reduce frown lines (the reason that Botox was later developed). Surgeons were highly secretive about the procedures they developed at this time; they did not want other surgeons to be able to offer the same techniques. Many surgeons did not even tell their colleagues that they were involved in plastic/cosmetic surgery.
As you can imagine, many surgical “misadventures” at the hands of untrained surgeons led to the formation of both the American Society of Plastic and Reconstructive Surgeons in 1931 and the American Board of Plastic Surgery in 1937. Despite the establishment of these institutions more than 75 years ago, there are still increasing numbers of rogue practitioners extolling expertise and unrealistic promises without training. Incredibly, some of these charlatans still use century-old techniques.
Mid Twentieth Century
- Skoog (Sweden, 1973), Tessier (France), others in USA—developing the use of SMAS technique
- Millard (USA) directly removed fat from neck to improve neck line.
The next major advances in facial plastic surgery gained popularity more than a half century later in the 1970s. To a large extent this was because of advances achieved in general anesthesia and the development of craniofacial surgical techniques, many of which were developed out of the need to reconstruct the casualties from World War II, the Korean War, and the Vietnam War.
Plastic surgeons began to do more extensive undermining and looked at the importance of deeper structures. This included the confluent thin layer of fascia, also called by the acronym, SMAS, covering the underlying muscles and soft tissue that also sags with the aging process. Many surgeons found that lifting this structure with sutures further improved results and longevity. However, it was also found that pulling in an oblique manner often resulted in a swept-away appearance.
Late Twentieth Century
The 1980s – 1990s were the next period of major evolution in face lifting techniques. This period was marked by even more aggressive and invasive approaches to face lifts. For example:
- Hamra (1903) develops deep plane technique, composite facelift and others
These more invasive surgeries often took several hours under general anesthesia, involved longer scars, extensive bruising and swelling, long recoveries often lasting 1–2 months or more. Although results in expert hands were improved the downside of the long recovery, extended scars, and general anesthesia were/are of significant concern to patients and plastic surgeons alike.
Twenty-first Century: Better Results through Less Surgery
- 2000–Present: Modified Facelifts such as the Lite Lift™, MACS, Short Scar facelifts, etc.
The last decade has seen a general movement in all surgical fields to less invasive yet more effective surgery. Dr. Nichter’s and Dr. Horowitz’s main focus during this period, like many other plastic surgeons around the world, was in distilling the essential elements of earlier facelifts while minimizing side effects.
Over and over again our patients have told us what they want during the past 15 years:
- Easier, minimally invasive, and less radical surgery
- Maintenance of youth rather than dramatic changes
- Appearance of natural beauty so that others would not guess surgery was performed
- A natural look without a swept-away appearance
- Shorter scars that are hidden
- Short recovery times
- Option of in-office procedure with local anesthesia and oral sedation without IVs or general anesthesia
The Lite Lift™ meets all of these 21st Century patient desires. The Lite Lift™ is a modified face lift with approximately 40% less scarring than a traditional facelift, with about half the recovery time. It is performed in an office setting with local anesthesia and oral sedation. This is what most patients prefer, but IV sedation or even general anesthesia options are available. The whole procedure takes about two hours. Each surgery is customized to our patients’ needs and desires. Frequently, as needed, other procedures can be performed at the same time such as Eyelid Lifts (blepharoplasty), Neck Tightening (platysmaplasty), Brow/Temple Lift, Fat Transfer, filler injections and/or skin resurfacing (e.g. Obagi Blue Peel). As healing for each of these procedures is simultaneous and not sequential there is still a short recovery time.
—Larry Nichter, MD FACS