Reconstructive surgery was done by the ancient Romans and ancient Indians as far back as 800 B.C. The records that have survived describe mostly repair of the ears and nose, loss of which were common war injuries as well as punishments.
The British first learned how to repair noses during the Mysore Wars of the late 18th century, which were fought between Indians and British. It happened that some Indian soldiers, who had helped the British, were re-captured by the Indians and had their noses cut off as punishment, after which they were sent back to the British. A little later, the English commander noticed that a merchant he was doing business with had a scar on his forehead and an odd-looking nose. It turned out that the merchant’s nose had been cut off as punishment for adultery. So the Englishman sent for the Indian doctor who had rebuilt his nose, and asked him to repair the noses of those soldiers who’d been sent back to him. The subsequent surgeries were watched by two English doctors and reported in the Madras Gazette.
Sixteenth century Italians also performed nose repairs and plastic surgery became known throughout Europe. We now refer to surgery on the nose as rhinoplasty. Plastic surgery thus began as reconstructive surgery, which is still done, and now it has also extended into cosmetic surgery.
Facelifts are a type of cosmetic surgery, done for aesthetic reasons rather than for repair. The first facelifts were done in the early 1900s and up until the 1970s, not much improvement was made in how they were done. It was a surface-only operation, called a subcutaneous facelift, where the skin was separated from the underlying tissue, pulled back and up, excess skin was cut off, and the new edge was stitched into place. This created that old “stretched” look and after a few years, the skin again began to sag.
The next layer below skin is the superficial musculoaponeurotic system (SMAS). This is fibrous tissue which encases the muscles. All the muscles in our bodies are enclosed within these fibrous sheets of collagen, which extend beyond the ends of the muscle fibers and connect them to other tissues. Below the SMAS layer are the muscles themselves, and below them are the bones, which are connected by ligaments (tough white fibrous tissue) to other structures such as muscles.
Going below the skin
In 1974 the first significant improvement was devised. It was to work not only on the skin, but also on the SMAS. By tightening this SMAS system as well as the skin over it, a more natural result was obtained which also lasted longer, since the collagen sheets, or fascia, are tough and give good fibrous support to the skin.
The subcutaneous lift is still sometimes done, e.g. for a person who’s already had the SMAS facelift and now needs some follow-up, or a thin person with good facial bones.
Since the late 1980s, surgeons have also worked on the muscles and ligaments below the SMAS layer to achieve an even more natural and long-lasting outcome. This current approach is one of facial sculpting, and includes a wide variety of separate procedures which can be selected and combined according to the individual’s needs and desires (and wallet). Scars and excess fat can be removed, ears and nose reshaped, bones enhanced, color bleached, skin re-surfaced.
Facial aging is thought to occur in 3 zones:
- The upper third (forehead and upper eyelids;
- The middle third (nose, cheeks and lower eyelids); and
- The lower third (lips, jawline and neck)
Strictly speaking a facelift addresses only the middle and lower areas, from the nose to the neck. But the term is also used more loosely to include procedures done on any combination of the components which make up these 3 areas. In other words, facelifts are now customizable and can also be done in pieces (segmental facelifts), rather than all at the same time. Most often, only local anesthetic is used and recovery time is counted in days. Incisions are barely visible when healed, bleeding is minimal, and risks are low. The risks are especially low if you take the responsibility to seek out a true professional.
Examples of facelift segments
Corrugator Frown Muscle Excision
This procedure takes about an hour. From a small incision in the inside corner of the upper eyelid, the frown muscles are snipped and don’t grow back. At the same time, frown wrinkles can be removed by a chemical peel or laser technique and excess skin and fat can be removed from the eyelids.
Through an incision several inches long which follows the hairline, the ligaments holding the eyebrows down are released and any excess scalp is removed. It takes less than an hour.
This takes about two hours and can be done in two ways. If artificial filler material is used, tiny incisions are made at the inside corner of the upper and lower lips and the filler is injected. Alternatively, a larger incision can be made inside the lips and the natural tissues can expand.
From an incision inside the hairline, loose skin and sagging eyebrows can be pulled upwards and excess skin and scalp removed. It takes about an hour.
This takes about an hour for each eye. From incisions made in each upper eyelid and below the lower eyelashes, excess fat and skin are removed, and the muscles tightened. At the same time, wrinkles can be removed by chemical peel or laser technique.
There are many other procedures, such as cheek implants or reduction, ear reduction, lip reduction, and liposuction of the face and neck.