By Dr. Scott J Turner, Specialist Plastic Surgeon | Published: 16/06/2025
The journey of facelift surgery represents one of the most fascinating stories in modern aesthetic medicine. What began as a simple skin removal procedure in 1901 has evolved into sophisticated surgery that can restore a youthful appearance while preserving individual facial characteristics.
For patients considering facelift surgery in Sydney, understanding this evolution provides valuable insight into why modern techniques achieve such superior results compared to procedures performed decades ago.
The Pioneer: Dr Eugen Holländer’s First Facelift (1901)
The story begins in Berlin, Germany, where Dr Eugen Holländer performed the first documented cosmetic facelift. His patient, an elderly Polish aristocrat, requested that he “lift her cheeks and corners of the mouth.” Dr Holländer’s approach was straightforward by today’s standards—he removed an oval-shaped piece of skin around the ears and stitched the incision closed.
Whilst rudimentary, this procedure established the foundational concept of surgical facial rejuvenation, marking the birth of modern facelift surgery.
The “Skin-Only” Era: Early Challenges and Limitations
For nearly seven decades following Holländer’s pioneering work, facelift surgery remained limited to manipulating only the skin layer. Surgeons would make incisions, pull facial skin tight, remove excess portions, and stitch the remaining skin together.
This “skin-only” approach had significant limitations:
- Artificial appearance: Patients often developed what became known as the “wind tunnel look”
- Temporary results: Because only elastic skin was addressed, results would fade as skin stretched back over time
- Distorted features: Natural facial characteristics could be altered, particularly around the mouth area
These consistent shortcomings drove surgeons to seek more effective methods, underscoring the need for a deeper understanding of facial structure.
The Revolutionary 1960s: Understanding Deeper Facial Structure
The true turning point came in 1968 when Swedish plastic surgeon Dr Tord Skoog introduced “subfacial dissection.” His profound insight recognised that effective facial rejuvenation required addressing deeper tissue layers rather than relying solely on skin tension.
Dr Skoog’s technique involved working with the deeper layers of facial tissue in continuity with the neck muscles, then repositioning these deeper layers to stable structures. This breakthrough fundamentally challenged the prevailing approach and laid the groundwork for all modern facelift techniques.
The SMAS Discovery: A Scientific Foundation
The pivotal moment that solidified Dr Skoog’s breakthrough occurred in 1976 when French surgeons Mitz and Peyronie published their landmark study describing the Superficial Musculoaponeurotic System (SMAS).
The SMAS is a specialised network of muscle and connective tissue beneath the skin that enables the lifting techniques used in modern procedures, including vertical facelift approaches that focus on upward repositioning of facial tissues.
This specialised network:
- Extends continuously from temples through midface to the neck
- Plays a crucial role in facial ageing and tissue descent
- Enables dynamic facial expressions
- Provides the foundation for modern facelift surgery
This discovery transformed facelift surgery from simple “tightening” to precise “repositioning,” delivering more refined appearances and significantly longer-lasting results.
The Deep Plane Revolution: Dr Sam Hamra’s Innovation
Building on SMAS techniques, Dr Sam Hamra revolutionised the field in 1990 with the introduction of deep plane facelift techniques. This approach distinguishes itself by working below the SMAS layer, allowing direct release of key facial supporting structures.
Advantages of Deep Plane Facelifts:
- Maximum mobilisation of facial tissues as one cohesive unit
- Tension-free skin closure for refined outcomes
- Direct addressing of midface sagging and jowling
- Results lasting 10-15 years
- Preservation of facial expressions
This technique repositions the entire facial unit to achieve truly comprehensive and harmonious rejuvenation.
Modern Innovations: Personalised and Minimally Invasive Options
Today’s facelift surgery offers diverse approaches tailored to individual patient needs:
Mini (Short Scar) Facelifts
For patients with earlier signs of ageing, mini facelifts or Minimal Access Cranial Suspension (MACS) lifts provide:
- Shorter, strategically placed incisions
- Reduced recovery times (1-2 weeks)
- Focus on the lower face and jawline improvement
- Refined upward lift without “overdone” appearance
Volumetric Approaches
Modern understanding recognises that ageing involves both sagging and volume loss. Contemporary facelifts increasingly incorporate fat grafting to:
- Restore structural fullness in cheeks, temples, and jawline
- Improve overall skin quality through stem cell-rich treatments
- Create balanced, harmonious facial profiles
- Provide long-lasting results through fat cell integration
Why Choose an Experienced Specialist Plastic Surgeon?
The evolution from simple skin procedures to sophisticated deep plane techniques demonstrates the increasing complexity and specialisation required for optimal results. Modern facelift surgery demands:
- Extensive knowledge of facial structure
- Advanced surgical skills
- Artistic understanding of facial aesthetics
- Experience with multiple techniques to customise treatment
When considering facelift surgery in Sydney, it’s essential to choose a specialist plastic surgeon with comprehensive training and experience in modern techniques.
Conclusion: A Testament to Medical Innovation
The remarkable journey of facelift surgery—from Dr Holländer’s pioneering skin removal to today’s sophisticated procedures—represents over a century of continuous refinement. This evolution has been driven by the pursuit of refined results, improved patient safety, and enhanced satisfaction.
Modern facelift surgery offers patients the opportunity to achieve subtle, refreshing rejuvenation that enhances their features whilst maintaining their unique facial characteristics. The combination of advanced surgical techniques and artistic expertise continues to set new standards for facial rejuvenation.
For patients considering facelift surgery, this rich history of innovation provides confidence that today’s procedures represent the culmination of decades of scientific advancement and surgical refinement.
Important Note: This information is provided for educational purposes. Individual results may vary, and a thorough consultation with a qualified specialist plastic surgeon is essential to determine the most appropriate treatment approach for your specific needs and circumstances.
