Facelift surgeries, like other areas of medicine, have improved over time according to the results, observations, and modifications of each new generation of facial surgeons; here I explain a little.
In the beginning, the skin was simply separated from the tissue beneath it, stretched as much as possible in a lateral direction, and the excess was cut around the ear and along the hairline. The positive result: fewer wrinkles, which gave it the name of “rhytidectomy,” from the Latin “excision of wrinkles.” The negative: the direct traction of the skin frequently generated deformity in the patients’ eyes and mouth, giving them a rather unnatural wind-tunnel appearance, that is, slanted eyes and a Joker-like mouth. Even today, many patients fear obtaining this result, since unfortunately it has been seen in internationally renowned artists over the years.
Subsequently, it was identified that this tissue beneath the skin formed a connective system with the capacity to safely lift the face when traction was applied; it was called SMAS (Superficial Musculoaponeurotic System), and multiple techniques were developed to shorten and traction it. The positive: greater lift of the jowls (jowls), improved definition of the jawline, short surgeries with quick recovery, which earned them the nickname still used today of “minifacelifts”. The negative: renowned facial surgeons and serious scientific studies found limited duration of the results, with approximately half of the patients needing a touch-up or revision just 2 years after surgery.
Finally, U.S. facial plastic surgeons conducted anatomical studies beneath the SMAS, identifying ligaments that restrict its movement when only superficial traction is applied. They developed the deep plane lift technique, in which the surgeon enters below the SMAS and releases it from these ligaments, achieving facial elevation with greater magnitude and precision in a vertical vector. The positives: natural-looking results, as tractioning the SMAS in the appropriate direction does not distort the face; inconspicuous scars, since the support for the lift lies in the SMAS and the skin is closed without tension; greater magnitude of rejuvenation; and longer-lasting results, with effects persisting for up to 10 years.
The downside: a larger surgery involves greater inflammation and a longer recovery time. Why couldn't it simply be perfect? However, do not worry, as there are measures that help make this process shorter and easier to manage. We will discuss these in our next blog.