Facelift: Then and Now

NEW YORK, NY (July 31, 2002) — According to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), nearly 120,000 Americans had facelift surgery last year. With the "coming of age" of the Baby Boomer generation, that number is expected to increase significantly during the next decade. But getting "nipped and tucked" was not always so socially acceptable. In fact, until the late 1960s, facelift surgery was an operation shrouded in mystery - both for the public and most surgeons as well.

"Up until that time, face lifting was not considered a legitimate pursuit for any well-trained plastic surgeon and was done mostly behind closed doors," says ASAPS President Franklin DiSpaltro, MD. "It wasn't until ASAPS was founded, 35 years ago, that plastic surgeons began to talk about these things openly and share their ideas and techniques. ASAPS provided the first, and for many years the only, opportunity for cosmetic surgery education in a national forum."

Facelift Techniques: How Far Have We Come?

It is interesting that, even today, there is no clear answer to the question, "Which facelift technique is best?" Variations of the "classic" skin flap technique, used in its basic form as early as the 1950s, still are preferred by some plastic surgeons. Technical refinements including, more recently, the option of less extensive incisions for appropriately selected patients have enhanced the results. The ideal candidate is someone who has loose facial skin with minimal sagging of the deeper structures underneath.

In the early days of face lifting, additional procedures to improve the neck were done in a separate operation at a later time, because surgeons feared compromising the blood supply to the facial skin flap. Today, a facelift and neck lift usually are performed simultaneously. Over time, surgeons learned to design their facelift incisions and suturing techniques so as to relieve the high tension that inevitably resulted from pulling and securing the tissues. The "wind tunnel" look of older-style facelifts was replaced by more natural-looking results.

The classic facelift technique changed little until the early 1970s, when a Swedish surgeon, Tord Skoog, MD, presented and published his work. Skoog said that getting rid of excess skin was not enough, and that tightening the underlying structures of the face and neck -- the so-called SMAS (superficial musculoaponeurotic system) — was the key to better and longer-lasting results.

In the late 1970s, some plastic surgeons began to use lipoplasty (liposuction) as a method of sculpting the area beneath the chin and jaw line, as well as "spot suctioning" other areas of the face in conjunction with a facelift. Around the same time, surgeons recognized the value of repairing the muscles of the neck (platysma) to help eliminate vertical neck bands.

The SMAS-lift is the most commonly performed facelift technique today. In addition to the skin flap facelift and SMAS technique, the evolution of modern techniques includes the deep-plane facelift, subperiosteal facelift, endoscopic facelift and others. Each of these methods has its noted proponents, but nowhere has it been conclusively shown that any one technique is superior. Despite the ongoing controversy, there are at least a couple of points that most plastic surgeons agree on. Facial shaping by removing, repositioning or adding fat -- not simply tightening the skin and muscles -- is key to achieving optimal results in facial rejuvenation. And no single formula is right for everyone; the surgical plan must be customized for each individual patient.

About ASAPS
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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