The Evolution of the Facelift: Philadelphia Area Plastic Surgeon Timothy Greco, MD, FACS Explains

As we age, the gradual breakdown in the structure and elasticity of facial skin start to become more obvious. To a significant extent, changes in skin texture and fullness can be addressed with nonsurgical treatments such as BOTOX® or dermal filler. But when it comes to correcting greater shifts in skin, fat, and muscle, the gold standard is still a facelift. Philadelphia area facial plastic surgeon Timothy M. Greco, MD, FACS explains how facelift techniques have evolved to the modern approaches used today.

While aesthetic surgery is relatively common in modern society, the early 20^th century beginnings of what we would call a facelift today were very secretive in nature. This is no surprise, as in the pre-antibiotic era, a cosmetic procedure such as a facelift was considered an unnecessarily risky procedure, and the surgeons who performed them were very secretive about their work, going so far as to purposely mislabel the operations in patient records to avoid being discovered and ridiculed.

The first recorded facelift in history was performed in 1901 in Berlin by Eugene von Hollander. His patient was a Polish aristocrat who he claimed had asked him to lift her cheeks and the corners of her mouth. In his records, he discusses excising elliptical pieces of skin from around the ears to achieve these results.

Suzanne Noël, sometimes referred to as Madame Noël, was one of the first French plastic surgeons who became famous for her “petite operation” facelift, where she placed the small incisions along the hairline for suturing just enough skin, making the resultant scars virtually invisible to casual observers.

Up till the 1960s, facelifts were performed mainly by pulling and tightening skin while cutting the excess off. Using only these methods, however, can result in a mask-like appearance due to its one-dimensional approach.

A more anatomical, comprehensive approach involves repositioning not only the top layer of skin, but also the muscle, fat, and tissue sheaths underneath. A small skin flap allows access to a stronger, deeper layer of tissue beneath fat known as the SMAS (superficial muscular aponeurotic sheath).

Tord Skoog is credited as being the first individual to successfully reposition the SMAS through careful manipulation of this flap, achieving a more multi-dimensional approach that lifts the cheeks, defines the jawline, and tightens the neck.

Since then, more attention to minimizing scarring and addressing the volume loss that age inevitably brings with it have led to additional processes or modifications that complement the SMAS facelift. These include improvements in the direction of pull and repositioning of tissue, as well as volumizing procedures such as using grafts made from the SMAS layer or even a patient’s own extracted fat. With such factors introduced, it becomes possible to address age-related volume loss in areas such as the cheeks, nasolabial folds, and lips.

Less invasive options, such as an S-Lift or neck lift (primarily addressing the lower part of the face with a smaller incision) or an endoscopic facelift, may also be considered for patients who may not require a complete facelift to address their particular concerns.

It must be noted that the exact details of a facelift procedure can vary from patient to patient, as each has their own individual concerns, facial characteristics, and unique expectations. Some surgeons opt to include other procedures such as a blepharoplasty (eyelid surgery), eyebrow lift, or laser skin resurfacing to further enhance facial rejuvenation results.

While there are many physicians across the country that perform facelifts, patients must be careful when selecting their surgeon. At the very least, they must ensure that the surgeon is board-certified and specializes in facial plastic surgery. Extensive knowledge and experience with intricate facial tissues and important structures is key in maximizing safe, successful results.

Dr. Greco has been a practicing facial plastic surgeon for over 20 years, and is certified by both the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology – Head and Neck Surgery. He would be happy to advise anyone looking to learn more about facelifts or other options for facial rejuvenation. To learn more, contact his Bala Cynwyd practice online or by phone at (610) 664-8830.