A description of face lifts dates back nearly one century. It started with skin only lifting, and very little skin undermining. A skin undermining face lift was the only method known in the middle part of the twentieth century until an article by Mitz and Peyronie in 1976 describing the SMAS (superficial muscular aponeurotic system) layer. It was after this time that a description of a combined skin undermining as well as a SMAS undermining and tightening was described. This led to different types of SMAS undermining and SMAS plications, as well as a composite face lifting which encompasses the skin undermining and the SMAS undermining in one single layer. Sub-periosteal face lifting similarly gained popularity in 1980's and 1990's. This form of face lift lifts the entire integument of skin, subcutaneous fat and muscle off the bone and repositions it. Recently face lifts are progressing towards shorter scars and face lifting encompassing the mid face. Classically the face lift encompassed improvement of the lower face which is the naso-labial folds, the jowls and the neck, leaving the periocular (eye) area and mid-face or mid-cheek without any change whatsoever.

Newer techniques have encompassed this and these techniques are still evolving.The shorter scar face lifts I believe will gain in popularity. The MACS lift (minimal access cranial suspension) in particular was described by two young plastic surgeons in Ghent, Belguim, and describes a short scar in front of the ear and around the sideburn which can address the mid face as well as the lower face. This type of lift also differs a lot from normal face lift procedures in that the pull, or vector of pull is completely vertical whereas the normal face lift is backwards and upwards. I believe this gives a more natural result. There are fewer complications in respective of skin undermining and the facial nerve is at less risk than when undermining a SMAS flap. I believe that this type of face lift is excellent for the young and middle age faces and for some elderly patients. I would assess the face and depending on the required result and amount of excess skin, decide on the type of face lift that needs to be performed.

Post-operative Care for Facelift Patients