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About Face

Chapter Six The Face-lift Lower Face-lift Liposuction The Chin

Lower Face-lift

In the early 1960’s surgeons thought of the face-lift operation as being so long and difficult that it was necessary to do one side of the face one day, then the other side a day later. Dr. Jack Anderson, one of my mentors during my fellowship, told me this years ago. I have never experienced this approach, though I have since seen a slide presentation of a patient whose father died in the middle of her surgery and she had to almost literally get up from the operating room table to attend to the funeral arrangements. For eight months, she went about with half her face-lifted. It became an interesting sort of controlled study of the face-lift techniques back then, because the half lift held up quite well for that eight months.

Prior to the early 1970s, a face-lift was not nearly as effective, or lasting, as it is today, even though it involved more surgery. We had an expression for the extent of the cutting that we had to do: the surgeon and his assistant would “shake hands” underneath the skin beneath the chin by the time dissection was complete. We’d cut all the way down the side of the face, underneath the chin, loosen the skin completely and pull it up. This was known as the full face-lift operation; a simple tightening of the skin over the cheek and upper neck. Although the results were aesthetically pleasing, the extent of surgery performed with this method led to a much higher rate of postoperative complications.

Some surgeons had experimented with techniques that gave support to the underlying structures of the face in the 1960s and 1970s, but the attempts were random and not always effective. The profession had begun to realize that just pulling back the skin wasn’t enough to secure a face-lift. In 1976, an article titled “The Superficial Musculo-Aponeurotic System (SMAS) in the Parotid and Cheek Area,” by Dr. V. Mitz and Dr. M. Peyronie, appeared in The Plastic Reconstructive Surgery Journal, and the face-lift operation was forever changed. The article confirmed that underlying sinew and muscles also needed surgery to make a face-lift last.

In the previous chapter on aging skin, I mentioned that the SMAS fascia, as it is often referred to, is a delicate sheath of connective tissue that lies between the deepest layer of skin (the dermis) and the underlying glands and muscles. In a paper I prepared with Dr. Larry J. Shemen for The Journal of Otolaryngology in 1981, titled “Use of the Fascial Plane System in the Face-lift Operation,” we explained that definitions of the SMAS fascia vary. Some researchers in the field refer to it as loose, connective tissue; others see is as dense, irregularly arranged connective tissue. However it is defined, SMAS fascia is made of large, thick collagen fibers, mixed with thin, wavy elastic fibers, fatty tissue and fibroblasts. Fibroblasts are cells that create connective tissue fibers.

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