Rhytidectomy

Rhytidectomy, also known as face lifting, is a surgical procedure aiming to reposition facial soft tissues to achieve a more youthful and harmonious appearance. Now a common procedure, it was relatively unknown in the early 20th century because of negative public perceptions towards cosmetic surgery and secrecy among surgeons regarding their techniques. The first documented facelift was performed in 1901 by Eugene von Holländer, which involved excision and reapproximation of excess skin with minimal undermining. After World War I ended in 1918, the demand for reconstructive surgeries increased, and so did the Western cultural acceptance of plastic surgery as a whole. However, it was not until after World War II, with the advent of antibiotics and the evolution of anesthesia, that a more aggressive approach to face lifting became practical. In 1969, Swedish plastic surgeon Tord Skoog was the first to report a facelift procedure by dissecting along the superficial fascia of the face, leading to a longer-lasting rejuvenation. This fascia was later termed the superficial musculoaponeurotic system (SMAS) in an anatomical study by Mitz and Peyronie in 1976, which ultimately led to the development of the surgical technique now known as "SMAS rhytidectomy."  This approach involves either plication or imbrication of the SMAS, the former consisting of folding and suspending the SMAS, while the latter involves excision of excess SMAS and closure of the gap with overlapping of the cut edges and suspension of the fascia. The "tri-plane rhytidecomy" was introduced by Hamra in 1983 to include subcutaneous elevation of cervical skin to improve neck contouring. These approaches, however, do not address the melolabial fold or laxity of midface soft tissues. In 1990, Hamra introduced "deep-plane rhytidectomy" to further dissect zygomaticus musculature and ligaments to reposition the malar fat pad and hence efface the melolabial fold (MLF). In 1991, Hamra further modified his technique into the "composite rhytidecomy" to include the orbicularis oculi muscle in the dissection to improve the eyelid and cheek profile, allowing repositioning of the suborbicularis oculi fat (SOOF) to correct hollowing of the orbits from previous facelift procedures. Today, there are myriad variations of facelift techniques designed to address patient-specific priorities, from jowls to melolabial folds, platysmal banding, and length of the scar.