Facets of Facelifting

Daniel E. Rousso, MD, FACS

Rejuvenation of the aging face has intrigued man since before biblical times. Creams and potions have been used to maintain and restore beauty since the time of the Pharaohs. Of all the tools that we now have at our disposal, the facelift procedure is still the gold standard against which all other techniques are measured. Born as a simple skin excision in the early 1900s, the facelift has evolved into a myriad of forms ranging from simple to complex. Our understanding of the aging process has also evolved. We now speak of the quality of the skin, laxity of the skin and tissues, and loss of facial volume. A comprehensive approach to facial rejuvenation must account for all of these factors. The quality of the skin can be maintained by a healthy lifestyle, judicious protection from the sun and elements, and avoiding cigarette smoking. Rejuvenation of actinically damaged skin can be accomplished by a host of resurfacing procedures including dermabrasion, lasers, chemical peels, radio frequency devices, plasma devices, and others. Neuromodulators and fillers add to our ability to smooth away wrinkles and folds, while fat transplants and facial implants restore lost facial volume.

This monograph will touch on many of the different “facets of facelifting.” We will present the anatomical considerations of the aging face, nonsurgical methods of rejuvenation, and multiple different surgical techniques of facelifting. While there may be as many different face-lifting techniques as there are surgeons performing them, we have presented several state-of-the-art core concepts including superficial muscular aponeurotic system suspension, deep-plane, midface suspension, platysmaplasy, and direct cervicoplasty procedures. Clearly, this exciting field of both art and medicine will continue to evolve.