History of a Facelift

Michael Elam, MD

Article by
Orange County Facial Plastic Surgeon

History of a Facelift

It is not known exactly who attempted the first face lift, but there is little doubt that the operation was being done in the early 1900’s by many surgeons in Europe and by a few in America. Most of the early attempts were mainly in the nature of a “mini-lift,” that is, excision of strips of skin in front of and behind the ears. Extensive undermining of skin flaps was not done until probably the 1920’s.

In the early 20th century many of the European physicians that were attempting these surgeries were extremely secretive. The individual techniques of these physicians were jealously guarded. This secretive attitude is the reason that not more is known about the early history and development of facelift surgery.

The secrecy that surrounded face lift surgery occurred for several reasons. There was a large public disdain for surgery that catered to vanity. This forced surgeons and patients to seek anonymity. Much of these surgeries were done “underground” or in hidden private offices and small nursing homes. Another reason for such secrecy was that most leading surgeons felt face lift surgery to be dishonorable. Any surgery that was not used to help save a life or alleviate a crippling deformity was frowned upon. Many considered cosmetic surgery to be trivial, unnecessarily risky and against the laws of nature. The widespread social demand for such surgery, as well as the improvement in results and safety of the procedure, has done much to dispel the older misguided attitudes. The face lift soon started gaining wide acceptance.

During World War I there were many tragic facial injuries that needed major reconstructive procedures. Physicians from around the world came to the aid of their countrymen and helped restore their faces. After the war several physicians came back to the United States, and led a major advancement of facial plastic surgery in this country. Many of these physicians who emerged after World Wars I and II practiced face lifting to a large degree yet they were still hesitant to publish on the subject.

As anesthesia became safer and techniques improved, the extent of the face lift operation became more radical. The amount of skin undermining became more extensive, reaching well down into the neck and toward the corners of the mouth. As stated earlier the first lifts were simply strips of skin removed with minimal undermining. These very conservative techniques were as ineffective then as they are today, making it difficult to understand the resurgence of the mini-lift. The very ineffectiveness of such operations and their limited period of benefit were what caused surgeons to undertake more extensive undermining in the first place. These achievements in the face lift procedure allow the patient a more lasting result.

In the early 1970’s, superficial muscular aponuerotic system (SMAS) surgery became a routine part of face lift surgery for many surgeons. The tightening of this muscle layer beneath the skin produced a better result by enabling less visible scarring and much more longevity to the face lift. In the 1990’s, surgeons began to focus on an additional component of the aging face, loss of volume. Such devices as cheek and chin implants, as well as lipo transfer or fat grafting became common procedures in face lifting. Today the modern surgeon has a gamut of techniques to choose from and each is applied to the individual patient as needed. Not only is the skin pulled and lifted, the muscles are tightened and volume is added to the necessary areas of the face.

Although the face lift operation has been practiced for at least ninety years there is no question that the demand for this procedure has risen sharply. I have many more requests in my practice for face lift surgery than ever before. This is due on part to the consistency of the result, safety of the operation and the loss of the past social stigma that was placed on this procedure.