History of the development of the method of rhytidectomy (facelift)

Most cosmetic surgery was developed based on operations designed to achieve functional improvement. Therefore, their descriptions, discussions and publications on this issue have a long history. On the contrary, surgery of the aging face - and rhytidectomy, in particular - originate from operations aimed at improving patients' self-image. Initially, aesthetic surgery was negatively perceived by the medical community. Many therapists and surgeons did not consider it right to seek self-esteem in the patient through planned cosmetic surgeries and condemned such practices. Others, recognizing the desire for self-improvement worthy, believed that planned surgery, with inherent dangers, is not a suitable method for achieving this goal.

The founders of face lifting surgery are German and French surgeons. It is believed that in 1906 Lexer performed an operation to correct wrinkles, but the first of such a clinical case reported Hollander in 1912. Other European doctors, including Joseph (1921) and Passot (1919), have developed their own methods of correcting the face changes caused by aging. The names of these founding fathers are still mentioned in any case when it comes to appealing to their wisdom. After the First World War, there was a flourishing practice of reconstructive plastic surgeons. Along with the rapid growth of new ideas and techniques, there was an inevitable increase in interest in cosmetic surgery. Despite the veil of secrecy around her, even the most prominent doctors of the time recognized her existence. It was rumored that many of these recognized leaders performed cosmetic surgery in their own private clinics or offices. Gilles in 1935 noted that "surgery to eliminate wrinkles on the eyelids, folds on the cheeks and fat on the neck are justified with an honest selection of patients."

After the Second World War, with the introduction of new medicines and improved methods of anesthesia, planned surgery became more real. In addition, a rich part of society began to correlate the external appearance with an energetic attitude towards life. However, the mysterious cosmetic surgery, surrounded by bashful secrecy, suspiciousness and greed, did not take into account the development of ideas and progress that were welcomed in other areas of surgery at the time. Therefore, the results achieved by anti-aging facial surgery were limited and short-lived. Sam Fomon, the pioneer of cosmetic face surgery and the founding father of the American Academy of Plastic and Reconstructive Face Surgery (AAFPRS), taught cosmetic surgery to all those interested. He recognized the limitations of facelift (lifting) of the facial skin, saying: "The average duration of a favorable effect, even with the highest technical skill, can not exceed three or four years." At that time, surgical facelift techniques consisted of limited subcutaneous preparation and skin elevation, leading to tension in the parotid areas and, often, the formation of an explicit "operated face". Unfortunately, these methods did not undergo significant changes until the 1970s. The social renaissance of the 60's and 70's led to the impossibility of earlier openness and recognition of cosmetic surgery. This stimulated scientific development and exchange of opinions, leading to improved surgical techniques and results.

The first great contribution in the first half of the last century was made by Skoog, who showed the advantage of subfascial preparation. This made it possible to achieve significant success with interventions in the lower third of the face. The validity of such a preparation was confirmed in 1976 by a landmark article by Mitz and Peyronnie, which gave this fascia the name of a superficial muscular-aponeurotic system (SMAS). Since then, to achieve a more natural appearance, many technical modifications of rhytidectomy under SMAS have been developed. Previously, the preparation for SMAS was carried out to improve the line of the cheeks. However, modern surgeons, given the importance of harmony of the face, focused their efforts on achieving improvements in the middle part of the face and in the area of nasolabial folds. Hamra, a pioneer in deep and mixed rhytidectomy, continues to show good results that can be achieved in the middle part of the face. Other specialists agree that the improvement of the results is possible with deep rhytidectomy. There are still surgeons offering various methods of achieving harmony of the face, including risky interventions in the subspecies. And there are even those who are reviving the subcutaneous preparation, believing that it is a method of choice in individual situations.

The variety of anatomically justified rhytidectomy techniques provides the surgeon with a choice in the fight against the effects of aging. However, along with the latest advances in surgical technology, more attention is paid to recognizing the importance of the individuality of the patient. Each surgical technique has its purpose. The main thing for a reasonable surgeon is an adequate assessment of each patient, both physical and emotional, and applying the right approach for accurate diagnosis.

[1], [2], [3], [4]