The Natural Facelift

In my last post, I wrote about recently having the pleasure of teaching at the Riga Stradins University in Latvia, where I was asked to perform two facial rejuvenation procedures, give two talks on facial rejuvenation, and review a video of the facial procedures I had performed to an audience at the Latvian Association of Plastic Surgeons meeting.

What follows is a brief summary of the introduction to my first presentation, outlining the history of aesthetic facial surgery.

Plastic Surgery: The Early Years

No one knows who performed the first facelift procedure, but by 1910 they were being performed by a few German surgeons and the rare surgeon in the USA. These procedures were associated with much secrecy for a number of reasons.

First of all, there was much public distain for surgery performed for vanity reasons, both by the general public as a whole and by the well-known surgeons of the day.

Academic vs. Aesthetic Surgeons

The top academic plastic surgeons, as late as the 1980s, frequently published numerous articles about reconstructive surgery, but rarely published articles on aesthetic surgery. Yet these same surgeons not infrequently performed aesthetic procedures to supplement their income. These academic surgeons were less than complimentary toward surgeons who chose to pursue a career doing solely aesthetic surgery.

In the early 1990s, there was also a secretive attitude by aesthetic surgeons – in part because of a desire to avoid the wrath of plastic surgery leaders, but also in an effort to keep their surgical techniques a secret from other surgeons! This combination of factors caused aesthetic procedures to be performed in private nursing homes and clinics, far from the eyes of peers or young plastic surgeons trying to learn the trade.

Tord Skoog’s “Natural Facelift”

Relatively few articles appeared in the plastic surgery literature about facelift surgery prior to the 1970s. From a technical point of view, a rather primitive, skin-only procedure was performed by most surgeons until the mid 1970s. At that time, a very forward-thinking Swedish plastic surgeon, Tord Skoog, analyzed the aging face and came up with the understanding that the main culprit in sagging facial tissues was a drooping of underlying muscles and deeper tissues. So he came up with the idea of lifting these underlying muscles in an effort to produce a more long-lasting, natural facelift procedure. Unfortunately, Dr. Skoog did not live long after this ground-breaking article and did not get to see how he revolutionized the field of facial rejuvenation.

A Plethora of Plastic Surgery Techniques

During the last 35 years, there has been an explosion of articles and textbooks on facial aesthetic surgery. Now many top plastic surgeons openly have decided to pursue careers in aesthetic surgery, and aesthetic surgery is being openly taught in university centers to plastic surgery residents.

Today, a plethora of techniques exist to address the aging face, ranging from mini-lifts such as the “Life Style Lift” to skin-only facelifts and a variety of deeper plane procedures, which address the underlying sagging muscles.

Achieving Long-Lasting, Natural Results

Interestingly, most of the procedures can produce significant facial improvement but they vary greatly in longevity of the results. Yes, a lot depends on patient expectations, but most of my patients do expect a longer-lasting result and a natural appearance. This can only be achieved if the underlying muscles are lifted and repositioned where they were in youth.

With so called mini-lifts or “Life Style” lifts, a small area is undermined around the ear and the skin pulled back for a very temporary improvement, but the muscle sagging is not addressed. We see many patients who have chosen these lesser procedures and then are in to see us a year later because the jowls have recurred or neck laxity has returned—understandably so, since the sagging muscles causing theses issues have not been repaired.

In order to achieve a long-lasting and natural-appearing facelift, we believe it is necessary to elevate the skin, replace the muscles where they were in youth, and resect excess skin—but NOT to pull the skin tight. Young people do not have sagging muscles, but they do not have tight skin!

The following examples illustrate our approach to facial rejuvenation: