Over 110 Years of Facelifting

Who performed the first face lift? It is somewhat debatable, because in the early 1900’s there was a taboo about performing surgery for the sake of vanity. Rees in McCarthy’s textbook on plastic surgery gives a nice review of the history (1).

Lexar claimed he performed the first “lift” in 1906 on an actress and was not aware of anyone else doing such a procedure (1,2). But Holländer reported performing a skin-tightening procedure on a Polish aristocrat as “a victim of the arts of feminine persuasion” in 1901 (1,3). Other surgeons soon followed with their claims and publications of their skin-pinching techniques such as illustrated by Passot below (4), Figure 1.

In 1921 Madame Suzanne Noël, a French surgeon who was performing surgery to reduce the wrinkles of some of the wealthy Parisian women, published La Chirurgie Esthétique: Son Rôle Social (5) and the popularity has been ever increasing. In the United States, C.G. Miller and Kolle were in New York performing many cosmetic procedures during this same period (1).

It was all done in secret since surgery for non-function cosmetic reasons was considered a waste of resources. However, the methods soon caught on, and now 110 years later, the modern facelift is no longer taboo, but an accepted way to stay younger looking.

The facelift also technically known as a rhytidectomy (pronounced ri-tid-ectomy) progressed as medicine progressed in general with improvement in anesthesia, instruments and sutures. The various skin-pinching incisions were extended and connected around the ears producing one long incision, Bettman, 1920 (5). But the skin was merely pulled backwards without actually lifting it which limited the amount of correction.

Then the technique evolved by using reconstructive methods learned in WWI to move and transposition tissue. This advancement made it acceptable to actually lift the skin off the underlying fat layer and pull it tighter as described by Bames in 1927 (6). This undermining technique is similar to lifting and sliding a bedspread over the underlying sheets to remove folds and wrinkles. The results were greatly improved.

These two things, extending the skin incision around the ears and elevating the skin off the fat layer, were the basis for all facelifts up to the 1960s (1). Then in the ‘60s surgeons began to contour the fat along the jawline and under the chin. By the early ‘70s the muscle began to be addressed with tightening sutures. Then Skoog published his technique for lifting the muscles of the face in 1973 and in 1976 Mitz and Peyronnie published the anatomical description of this fascia and muscle layer (1, 7). The Mitz and Peyronnie study was actually organized by Dr. Paul Tessier in Paris, France (8)—the father of craniofacial surgery who also had a large cosmetic practice.

Many other variations of the lift have been described. Most of these involve modification in the incisions, location of the incisions in the ear or in the hairline, the method of tightening the muscles and special suturing techniques. One other advancement came as a result of the craniofacial surgery which included lifting the layer of tissue at the bone level for more specific types of aging problems in the cheeks, mouth, eyes and forehead. This lift Dr. Tessier called the “Masklift.”

Other technologies that have been applied to the facelift operation include fat contouring with liposuction, fat injection to return fullness, laser dissection to reduce swelling, endoscopic technology for minimally invasive surgery and ultrasonic skin-tightening procedures. The interesting thing is that most of the technologies have not changed the basic facelift substantially since the Skoog.

In most cases patients, men and women, want to remove the jowls along the jawline, reduce the fat and skin under the chin, and tighten the vertical wrinkles in the cheek. The surgery requires the patient to take about two weeks off from work for most of the bruising and swelling to resolve.

The surgery is performed under a general anesthetic or IV sedation and takes about three hours. Patients usually go home the same day. The procedure is not particularly painful and most patients feel the initial tightness for 7-10 days as a little confining. The incision starts in the hairline above the ear and then extends downward partially within the ear. It then goes around the earlobe behind the ear and then back into the hairline (Illustration 2).

Stitches are removed in one week. The cosmetic scars are red for six months and then begin to fade. The deep set of stitches dissolves on its own below the skin.  Patients are allowed to shower within 48 hours after surgery.

Possible complications include scarring, infections, numbness, asymmetry and facial paralysis. The facelift usually makes the patient look 7-10 years younger and lasts about 7-10 years before a second touch-up facelift is considered. The facelift operation may be combined with other facial surgery such as a browlift, eyelid lift, or nasal surgery. It can even be combined with body contouring in some cases.

The key to successful surgery is making sure the desires of the patient are realistic. The lift must be tailored specifically for the patient. The average age for a lift is between 45-65. Some patients state that the reason they want the surgery is that they feel younger than they look, they are starting to look like their parents, they have to compete in the job market with younger workers, or they are wanting a new outlook on life. The author had one patient who decided to have a facelift after he was given a senior discount on a cup of coffee at McDonald’s.

Cosmetic surgery will not restore a job or a relationship, but it can restore confidence and self-esteem. These are the same reasons patients sought the facelift 110 years ago from the early pioneers of cosmetic surgery, but now the operation is more predictable and safer.

Figures

Figure 1

Figure 2

Source Unknown

Figure 3

“Over 110 Years of Facelifting” Notes

1. Rees T, S. Aston, C Thorne. Blepharoplasty and Facialplasty, Chapter 43 in Plastic Surgery, Vol 3, Part 2. Editor Joseph McCarthy.  W.B. Saunders. Philadelphia, 1990.
2. Lexer E: Die Gesamte Wiederherstellungs Shiurgie, Liepzig, 1932, Johann Abrosius Barth, Vol. I, p. 551.
3. Rogers, BO, The development of aesthetic plastic surgery: A history. Aesthetic Plastic Surgery 1:3, 1976.
4. First illustration of facelift procedure and basis of “minilift”. From Passot, R:  Presse Med. 27:258, 1919.
5. Bettman, AG. Plastic and cosmetic surgery of the face. Northwestern Medicine, 19:205, 1920.
6. Bames HO.  Truth and fallacies of face peeling and face lifting. Medicine Journal Reconstruction, 126:86, 1927.
7. Mitz V and M Peyronie. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area.  Plastic Reconstructive Surgery 58:80, 1976.
8. Personnal Communication, Dr. Paul Tessier, Paris, France, 1990.