History of Facelift Surgery

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For patients interested in the history and evolution of a Face Lift, NYC residents can find all the information they need below.

A Facelift (Rhytidectomy, literally meaning a surgical removal of wrinkles) is a surgical procedure used to give a more youthful appearance to an aging face by repositioning the facial skin.

The history of the earliest Facelifting procedures is somewhat unknown due to unavailability of literature, mostly because Facelifting was viewed as an unnecessarily risky procedure (considering it started out in the pre-antibiotic era). Progress of this procedure was quite slow as the attitude at the time rejected vanity as an indication for surgery. Physicians who performed the Facelifting procedure were ridiculed and therefore were not eager to openly discuss their techniques and publish their work on the subject of Facelifting.

The first Facelifts were performed in the early 20th Century mostly by German and French surgeons (Dr. Giles, Dr. Joseph and Dr. Lexer, Dr. Passot, among others). The first Facelifting procedures were simply excision of an elliptical area of skin at the hairline and closure primarily in the preauricular region, without undermining of the skin (which is where the name Rhytidectomy arose).

Dr. Lexer is generally credited with performing the first Facelift in 1906. Dr. Joseph performed his first Facelift operation in 1912. Lexer later described his technique for undermining and redraping of the skin of the aging face in 1916. Lexer’s and Joseph’s excision techniques developed into the modern Rhytidoplasty (wide undermining out to the Nasolabial fold and down to the lower neck). In 1919 Dr. Passot published one of the first known papers on Facelifting (which consisted mainly on elevating and redraping of the facial skin, after which many others began to write papers on Facelifting in the 1920s.

In the 1930s the undermining of the skin was described as part of the Face Lift procedure. Surgeons in the U.S. and England started being more courageous with the extent of their undermining (they began developing a procedure which became known as “la grande operation”). Gradually the flaps became longer and longer until the 1950s when the “classic” Facelift was in use.

It wasn’t until the late 1960s and early 1970s that Dr. Peyronie, Mitz and Skoog described the SMAS (superficial musculo-aponeurotic system) technique of Facelifting, which came to be the most commonly used Facelifting technique even to this day. In 1968 Tord Skoog, of Sweden, developed a flap to elevate the platysma muscle of the neck and lower face without detaching the skin. This development was the first innovation in Facelift Surgery. Skoog eventually published his work in 1974, before he died in 1975. In 1978 Dr. Lemmon and Dr. Hamra presented their Skoog Facelifting technique at an Annual Meeting of the American Society of Aesthetic Plastic Surgeons.

In later years of the 1970s, various SMAS techniques were developed after Dr. Mitz and Dr. Peyronie published their work featuring the SMAS Facelifting technique. The SMAS concept soon emerged as the leading Facelift technique. Since then numerous authors have reported variations of the SMAS Facelifting technique, but the only real modifications have been the extent of undermining and direction of pull. The Facelifting procedure has since evolved and has become relatively simple to perform while producing a better jawline with a low incidence of postoperative complications. A Mini Facelifting procedure was also beginning to be preferred because many did not believe in extensive undermining practiced by foreign surgeons because it caused much bleeding which in turn resulted in a long healing process, for even up to two months!

Although the Facelifting procedure has been around for a century, Facelifting has attracted the most attention and evolved in recent years. Different procedures have developed, displaying various techniques of correcting the aging face through Facelifting. Dr. Hamra gives a nice summary of various Facelifting techniques in his book titled, Composite Rhytidectomy. His summary includes the “Subcutanous Rhytidectomy,” which is skin reduction only; the “Subcutaneous Rhytidectomy using the SMAS technique” which is skin reduction and platysma repositioning; “Deep-plane Rhytidectomy”, which is skin reduction, platysma repositioning and cheek fat repositioning; and “Composite Rhytidectomy” which is skin reduction, platysma repositioning, cheek fat repositioning and orbicularis repositiong. Names for Facelifting now include Face Lift, Facelift (single word), Cervical Rhytidectomy, and Facialplasty.

Deep-plane and Composite Facelifts, described by Hamra, went through much development in the 1990s. The Deep-plane Facelifting technique described by Hamra was a modification of the Skoog technique to include superolateral elevation of the malar fat pad in addition to the lower facial tissues. In this Facelifting technique, the degree of undermining is limited to that amount necessary for suitable redrapage once the SMAS plane has been elevated and repositioned. Hamra took the Deep-plane Facelifting technique a bit further in the Composite Facelifting technique, which has not gained wide acceptance because of concern for a higher rate of complications.

The 1990s, in general, were very productive in terms of development of Facelifting techniques. This was partly due to the fact that during this decade the social stain associated with aesthetic surgery has faded. Cosmetic Surgery was starting to transform from a luxury of the few to something that is accessible and sought after by persons in every social level. Surgeons of this generation have also placed a premium on a rapid recovery period, which has triggered urgency for more limited techniques placed in the minimally invasive category. Surgeons are striving for smaller incisions and minimal skin excision in Facelifting procedures. A Mini Facelifting procedure not only allows less time off from occupations and daily life activities but it is also a viable option for persons who are especially risk averse by eliminating the need for General Anesthesia.

If you have any additional questions regarding a Face Lift, then please contact our knowledgeable team today.


Hamra ST: Composite Rhytidectomy. Quality Medical Publishing, Inc. 1993
Lexer E. Die gesamte Wiederherslellung schiurgie, vol. 2 leipzig: J.A. Barth; 1931
Passot R. La chirurgie esthetique des rides du visage. Presse med 1919; 27: 258
Joseph J. Nasenplastic und sonstige Gesichtsplastik nebst einem Anhan uber Mamaplastik.
Noel A. la chirurgie esthetique. In: Son Role Social. Paris: Mason et Cie; 1926. p. 62-6.
Skoog T. Plastic and cosmetic surgery of the face. NW Med 1920; 19:205.
Skoog T. Plastic surgery: new methods and refinements. Philadelphia: W.B. Saunders; 1974.

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