Yang Albert J., Hohman Marc H.
University of Nevada, Las Vegas
Uniformed Services University/Madigan Army Medical Center
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.
除皱术，又称面部提升术，是一种外科手术，旨在重新定位面部软组织，以获得更年轻、更和谐的外观。如今这是一种常见的手术，但在20世纪初却相对鲜为人知，原因是公众对整容手术持负面看法，且外科医生对其技术保密。有记录的首例面部提升术于1901年由尤金·冯·霍兰德实施，该手术包括切除多余皮肤并在尽量减少剥离的情况下重新缝合。1918年第一次世界大战结束后，对重建手术的需求增加，西方文化对整形手术的整体接受度也随之提高。然而，直到第二次世界大战后，随着抗生素的出现和麻醉技术的发展，更激进的面部提升方法才变得可行。1969年，瑞典整形外科医生托德·斯科格首次报告了一种通过沿面部浅筋膜进行解剖的面部提升手术，从而实现更持久的年轻化效果。1976年，米茨和佩罗尼在一项解剖学研究中将这种筋膜命名为表浅肌肉腱膜系统（SMAS），这最终导致了现在被称为“SMAS除皱术”的外科技术的发展。这种方法包括对SMAS进行折叠或重叠，前者是将SMAS折叠并悬吊起来，而后者则是切除多余的SMAS，将切口边缘重叠以闭合间隙并悬吊筋膜。1983年，哈姆拉引入了“三平面除皱术”，包括对颈部皮肤进行皮下提升以改善颈部轮廓。然而，这些方法并未解决鼻唇沟或中面部软组织松弛的问题。1990年，哈姆拉引入了“深平面除皱术”，进一步解剖颧肌和韧带，以重新定位颧脂肪垫，从而消除鼻唇沟（MLF）。1991年，哈姆拉进一步将他的技术改进为“复合除皱术”，在解剖中包括眼轮匝肌，以改善眼睑和脸颊轮廓，使眼轮匝肌下脂肪（SOOF）得以重新定位，以纠正之前面部提升手术导致的眼眶凹陷。如今，有无数种面部提升技术的变体，旨在解决患者特定的问题，从下颌赘肉到鼻唇沟、颈阔肌条索以及疤痕长度等。
