The Modern Facelift: How the Operation Evolved

A definitive patient reference on the history, anatomy, and evidence behind modern facelift surgery — from the operation's origins in early-twentieth-century Europe to the current state of the field.

Modern facelift surgery is the product of more than a century of surgical evolution. It was first described in continental Europe in 1901, refined through three distinct surgical eras across the twentieth century, and transformed by a sequence of anatomical discoveries between 1974 and 2010 that produced the operation commonly performed in academic centers and cosmetic private practices. More recent waves of technical refinement further shifted facelift surgery toward the natural, structurally precise, and increasingly undetectable results that now define elite facial rejuvenation practices in Beverly Hills. The modern facelift is a structural operation — it repositions the deeper anatomical layers of the face, while the skin is redraped passively over a corrected foundation. This differs fundamentally from the skin-tightening procedures that defined the cultural image of the facelift throughout much of the twentieth century. Much of the confusion surrounding facelift surgery today comes from failing to distinguish between these two very different operations.

Why this history matters

A reasonable patient question is whether any of this matters. Why should the history of an operation be relevant to choosing one today?

The answer is that surgical training is generationally transmitted, and the floor of the field — the operation a typical patient receives from a typical surgeon — has shifted decisively over the past fifty years, and even more so in the past 5-10 years. A surgeon trained in 1985, in a residency program that taught a primarily skin-based operation, may or may not have updated their conceptual frame to match the modern literature. A surgeon trained in 2015 has likely been taught a “modern” (now outdated) operation as the default. A surgeon preaching one single “best” labeled technique may be performing an operation closer to what their residency director was doing in 1990 than to what is being published and quietly taught in more nuanced contemporary specialty circles today. The technique label on the consent form is not the operation; the conceptual frame in the surgeon's hands is the operation.

The history is also relevant because the cultural memory of the facelift — the stretched, pulled, glassy face that defined the operation in entertainment and tabloid culture through the 1990s — is not invented. It is the accurate signature of a specific surgical era that the field has now largely moved beyond. Patients who carry that image into consultation are not paranoid; they are remembering a real operation. The modern facelift is a very different procedure, performed in a different anatomical plane, with different mechanical properties and a different long-term trajectory.

What follows is a comprehensive, sourced history of how the operation became what it is now — and an honest, evidence-based account of where the field stands today.

The early era: 1901–1960

The first generation in Berlin, Vienna, and Paris

The facelift, as a discrete cosmetic operation, was invented in continental Europe at the turn of the twentieth century. Eugen Holländer, working in Berlin, is generally credited with the first documented facelift in 1901 — a discreet operation performed on a Polish aristocratic patient, with elliptical excisions in front of and behind the ears. Holländer's published description appeared decades later, by which point the operation had quietly diffused through European cosmetic practice. His textbook Die kosmetische Chirurgie (1932) remains a striking historical document of the early field.

Erich Lexer, also in Berlin, performed and described his own version of the operation in the early 1910s, with a more extensive incision pattern. In Vienna, the broader European interest in cosmetic surgery — driven in part by reconstructive demands following the First World War — produced parallel refinements through the 1920s. The operation was small, private, and unbranded; surgeons treated it as a technical extension of reconstructive practice rather than as a category of its own.

In Paris, Suzanne Noël — one of the first women in modern surgery and a remarkable figure in the early history of cosmetic medicine — refined the operation in her own private practice through the 1910s and 1920s, performing it under local anesthesia in a discreet salon setting between her morning hospital rounds. Her 1926 monograph La Chirurgie Esthétique: Son Rôle Social was the first sustained patient-facing book on cosmetic surgery, and it argued for the operation as a means of restoring the social and professional confidence of women returning to public life. It is worth reading today; her clinical conservatism, her insistence on identity preservation, and her caution about over-promising results are positions a modern surgeon would still recognize.

In the United States, Charles Conrad Miller of Chicago published among the earliest American descriptions of cosmetic surgery in 1907, with refinements through the 1920s. Adalbert Bettman, in Portland, described what is recognizably a modern facelift incision pattern — extending around the earlobe and into the postauricular sulcus — in 1920. By the late 1930s, the operation had been described in Europe, the United States, and South America; it remained, however, a small and largely undisclosed practice, performed in private offices and rarely discussed publicly.

What distinguished the first-generation facelift was its conservatism. It was a skin-only operation, performed under local anesthesia, with limited dissection and modest excision. Recoveries were short. Results were modest. The operation produced a mild improvement that, in most patients, lasted only a few years. The first generation of surgeons did not claim more than that, and the early literature is striking for how openly it acknowledges what the operation could not do.

The mid-century: 1930 through 1960

Through the 1930s, 1940s, and 1950s, the operation refined incrementally without changing in concept. Gustave Aufricht in New York, Herbert Conway in New York, Vilray Blair in St. Louis, and a generation of surgeons transitioning from reconstructive to cosmetic practice extended the dissection, refined the closures, and addressed adjacent issues — eyelid surgery, brow procedures, neck skin excision. The post-war years brought general anesthesia, antibiotics, and improved instruments, all of which made longer operations safer and more reliable.

The operation remained, however, a skin-flap procedure. The deeper anatomical structures of the face — the SMAS, the named retaining ligaments, the discrete fat compartments — were neither named nor systematically engaged in the operative literature of this era. This was not a failure of skill; it was the conceptual horizon of the field. The structural anatomy that would later define the modern operation had not yet been described in surgical terms.

It was a competent enough operation, then, for its era. It produced modest, time-limited improvements in selected patients. It did not have a structural rationale for what it was doing, because the structural anatomy of the face had not yet been mapped.

The skin-flap era: 1960–1974

The 1960s and early 1970s were the period in which the facelift entered American mass culture. Hollywood patients, television figures, and a broader segment of affluent American women began to seek the operation. It was practiced extensively in New York, Los Angeles, Chicago, Dallas, and Miami. The general approach — broad subcutaneous dissection of the cheek and neck, with the lift held by skin closure under tension — was a refined version of the same skin-flap operation that had been described at the turn of the century.

A generation of practitioners pushed the operation as far as the skin-flap concept could go. Dissections became wider. Tension was held more aggressively at the temporal hairline and the postauricular sulcus. Skin excisions became larger. Patients were sold not on the modest, time-limited improvement of the early-twentieth-century operation, but on a more comprehensive transformation that the technique could not reliably deliver.

The results aged poorly. By two to four years, the visible improvement diminished as the dermis relaxed under sustained tension. Distortion patterns became recognizable across the era — the flattened lateral cheek, the forward-displaced earlobe (the "pixie ear"), the visible lateral pull, the temporal alopecia from over-aggressive hairline incision design, the neck that aged independently of the face. By the 1980s, this era had produced the cultural archive of "operated" faces that, in the public memory, still defines what a facelift looks like.

The surgeons of that era were performing the operation as best as the field then understood it. The conceptual limit of the work was that the structural anatomy of the face had not yet been mapped, and the deeper layers that carry an aging face's descent had not yet been named or systematically engaged.

Some surgeons in that period started experimenting with deeper dissections. The innovative work that would later lead to the first revolution had quietly begun, while the general floor of the field - the operation a typical patient received - was still skin-based.

That floor changed in 1974.

The first revolution: the SMAS, 1974–1976

Skoog and the sub-platysmal plane (1974)

Tord Skoog, working in Uppsala, Sweden, published Plastic Surgery: New Methods and Refinements in 1974. Within it was a description that quietly redefined the field: a dissection plane carried beneath the platysma muscle of the neck, which lifted the neck's structures as a continuous unit rather than only treating the skin envelope. Skoog had recognized — and demonstrated operatively — that the lifting plane could be moved beneath the skin and the superficial fascia, with the lift held by deep structure rather than skin tension.

His monograph had limited initial reach. It was published in English by an American press; it described a meticulous, anatomically demanding operation; and it described it without the marketing apparatus that would later promote subsequent innovations. But the surgeons who read it understood that something significant had been articulated: the lifting plane was not, in fact, the skin. The face — and the neck — could be operated on at a deeper anatomical level, and the aesthetic result of doing so would behave differently than the skin-based operation had behaved.

Skoog died in 1977, before the implications of his work were fully developed by others. He is, in retrospect, the figure that began the modern era of facelift surgery, even though the operation he described would itself be refined and extended within a generation.

Mitz and Peyronie name the SMAS (1976)

Two years after Skoog's monograph, two French surgeons working in Paris — Mitz and Peyronie — published the paper that would give the modern facelift operation its anatomical foundation. In The Superficial Musculo-Aponeurotic System (SMAS) in the Parotid and Cheek Area, published in Plastic and Reconstructive Surgery in July 1976, they named and characterized the continuous fibromuscular layer that envelops the muscles of facial expression and connects them to the platysma below and the temporoparietal fascia above.

The Mitz and Peyronie paper did three things. It gave the field a name for the layer at which subsequent operations would be performed. It described the layer's continuity, which meant that the face and the neck could be treated as a single anatomical system rather than as adjacent regions. And it established that the SMAS could be elevated and repositioned independently of the skin envelope above it.

This was the conceptual basis on which the next twenty years of surgical innovation would unfold. The deeper structural layer had a name; it was visible; it could be operated upon and manipulated directly. The field could now ask a question that had been impossible to formulate in the skin-flap era: not how much skin should we remove, but where and how should the SMAS be repositioned?

The Mitz and Peyronie paper is one of the two or three most influential papers in the history of facial aesthetic surgery. Fifty years after its publication, it is still the reference cited at the beginning of nearly every modern paper on facelift technique.

The deep plane era: 1990–1995

For approximately fifteen years after the Mitz and Peyronie paper, surgeons experimented with how best to engage the SMAS layer. Various approaches were described and refined: SMAS plication (folding the layer onto itself), SMAS imbrication (overlapping the layer), and SMAS flaps of varying extents. Each approach worked, more or less, in selected patients. None had yet produced what the field would later call a deep plane operation.

That changed at the beginning of the 1990s, in three papers published within a single eighteen-month window — work that, taken together, defined the operation now performed at academic and high-volume practices across the world.

Hamra: the deep-plane rhytidectomy (1990) and composite rhytidectomy (1992)

In July 1990, Sam Hamra published The Deep-Plane Rhytidectomy in Plastic and Reconstructive Surgery, reporting a series of more than four hundred patients. The paper described an operation in which the SMAS was not folded or plicated, but elevated as a continuous flap with its overlying fat compartments and skin attached. The lifting plane was carried beneath the SMAS, releasing it from the malar and zygomatic ligaments, and the entire composite — SMAS, fat, and skin — was repositioned as a single unit.

The conceptual shift was decisive. In a deep-plane operation, the SMAS, its overlying fat compartments, and the skin moved together. The skin was no longer being asked to provide the lift; it was a passive layer carried along by the deeper repositioning. Tension was absorbed by the structural layer. The natural relationships between the cheek, jawline, and lateral face were preserved because the layers had been moved in continuity rather than independently.

In July 1992, Hamra extended the approach in Composite Rhytidectomy, also published in Plastic and Reconstructive Surgery, which integrated the orbicularis oculi muscle and lower eyelid into the lifted unit. The composite operation was technically demanding and not adopted universally, but the deep-plane operation described in 1990 became one of the foundational pillars of modern facelift surgery.

Stuzin, Baker, and Gordon: the relationship of the fasciae (1992)

In March 1992 — months before Hamra's composite paper appeared — Stuzin, Baker, and Gordon published The Relationship of the Superficial and Deep Facial Fascias: Relevance to Rhytidectomy and Aging in Plastic and Reconstructive Surgery. The paper defined the precise anatomical interval between the SMAS and the deep fascia in which the deep-plane operation could be safely performed without injury to the facial nerve.

This is, in many respects, the paper that made the deep-plane operation reproducibly safe. It established the operative interval — below the SMAS, above the deep fascia in which the facial nerve travels — with anatomical precision. It explained why the deep-plane operation was, paradoxically, often safer than older subcutaneous techniques: the nerve plane was identified and respected at every step, rather than worked around blindly. The Stuzin paper is one of the most cited works in the history of facial plastic surgery for this reason.

Barton: the high-SMAS approach (1992)

Also in 1992, Barton published refinements that established the high-SMAS technique, in which the SMAS was incised at a more superior level to allow elevation of the malar fat pad along with the SMAS-fat-skin composite. The high-SMAS approach became one of the principal alternatives to Hamra's deep-plane operation, and the two techniques together — with various hybrid forms — defined the major variants of the structural operation through the 1990s.

By the mid-1990s, the field had its answer to the question Mitz and Peyronie had implicitly raised in 1976. The SMAS could be elevated as a continuous flap; the dissection plane could be carried below it; the named retaining ligaments could be released; and the entire composite could be repositioned with the skin as a passive layer. The what of the modern operation had been articulated. What remained was a more detailed map of where, at the level of the individual face.

The anatomical mapping era: 1993–2010

The decade and a half after the deep-plane papers were published was the period in which the anatomical detail of the modern operation was filled in. The conceptual breakthrough had been made; what was still required was the precise mapping of the structures the breakthrough operated upon.

Owsley and the malar fat pad (1993)

Q. James Owsley's 1993 paper, Lifting the Malar Fat Pad for Correction of Prominent Nasolabial Folds, in Plastic and Reconstructive Surgery, formalized the recognition that the midface — and specifically the malar fat pad — was a distinct anatomical territory with its own descent pattern, requiring its own surgical attention. Operations that ignored the midface were leaving an anatomical area uncorrected; the prominent nasolabial fold, in many patients, was a midface problem rather than a lower-face problem.

Owsley's contribution, like much of the most useful work in this era, was less an invention than a clarification. He gave the field a precise anatomical language for what the deep-plane operation needed to address in the midface, and he made the case that any complete operation had to engage that territory.

The surgical anatomy of the midcheek (2002–2013)

Through a series of cadaveric and clinical anatomic studies in Plastic and Reconstructive Surgery and Clinics in Plastic Surgery between 2002 and 2013, the layered anatomy of the midcheek was systematically mapped: the named soft-tissue spaces (the prezygomatic space, the premaxillary space, the buccal space), the named retaining ligaments (the zygomatic, masseteric cutaneous, and mandibular complexes), and the precise surgical intervals in which each could be safely engaged. The 2002 paper by Mendelson, Muzaffar, and Adams in Plastic and Reconstructive Surgery and the 2008 paper by Mendelson and Jacobson in Clinics in Plastic Surgery are the most useful single anatomical references for the modern midface operation.

What this body of work added was specificity. The deep-plane operation as described in 1990 was a conceptual breakthrough, but the precise anatomical landmarks for ligament release — and the safe planes in which to release them — required a level of mapping that the earlier literature had not provided. The midcheek anatomy literature of the 2000s made selective ligament release a precise, anatomical maneuver rather than an empirical one.

The fat compartments of the face (2007)

In 2007, a landmark paper in Plastic and Reconstructive Surgery used cadaveric methylene-blue injection studies to demonstrate that facial fat is not a single uniform tissue, but is organized into discrete compartments — superficial and deep, with named anatomic boundaries — that age along independent trajectories.

This was the anatomical basis for the modern approach to volume in facelift surgery. Some compartments deflate (the deep medial cheek, the temporal hollows). Others descend with the SMAS to which they are tethered (the nasolabial and jowl compartments). Treating them uniformly — by removing fat, by adding fat, or by ignoring it — produced predictable failure modes. Treating them by compartment, with selective preservation, repositioning, and restoration, allowed an operation that addressed volume and structure together.

By 2010, the modern operation had its complete anatomical foundation. The SMAS had been named (1976) and lifted as a composite (1990). The safe operative interval had been defined (1992). The midface had been mapped in detail (2002–2013). The fat compartments had been characterized (2007). An operation could now be planned, in advance, on the specific anatomy of the individual patient — at the level of the layer, the ligament, and the compartment.

The integration era: 2010–2020

The 2010s were the period in which the techniques that had been articulated in the 1990s and refined in the 2000s converged into a coherent operative repertoire. The decade did not produce a single new conceptual revolution; it produced a generation of refinements that, taken together, defined the operation as it is now performed at academic and high-volume practices.

Short-scar structural variants

A class of short-scar structural variants — most prominently the minimal access cranial suspension (MACS) lift, with its abbreviated incision and vertical-vector approach to the SMAS — was refined and disseminated through teaching courses and a sustained body of journal publications in the 2000s and 2010s. The MACS lift and several related variants established that a structurally driven operation could be performed through a shorter incision in carefully selected patients with early-stage anatomy.

Extension of the deep-plane dissection

Across the 2010s, the deep-plane dissection was systematically extended across more of the midface and along the lateral face, with corresponding extensions of selective ligament release. The extended deep-plane operation that resulted is one of the common forms of the modern facelift in current practice.

Vertical-vector refinements

Through the 2010s, the vector mechanics of the modern operation were refined toward a vertical or vertical-oblique direction of repositioning that more closely matched the original direction of soft-tissue descent. Vertical-vector technique reduced the lateral pull that had defined earlier eras and produced results that read more naturally in motion. The cumulative effect of this work was to retire the horizontal "back-and-up" pull that had been the default of the skin-flap and early SMAS eras.

Deep-neck refinements

Attention to the deep neck — the subplatysmal fat, the anterior digastric muscle bellies, and the submandibular gland — became a standard part of the operation through the 2000s and 2010s. The recognition that incomplete neck work was the most common reason for an otherwise excellent facelift to read as incomplete drove the deep-neck dissection into the standard repertoire of fellowship training, and into the default operative plan at many high-volume academic and private practices.

Patient-specific planning

By the late 2010s, the field had begun to converge on the principle that the technique label is less important than the calibration of the operation to the individual patient. Vector, depth of dissection, extent of ligament release, fat management, and incision design are all variables — and a modern operation chooses each variable based on the patient's specific anatomy, not on a uniform technique. This principle is one of the most useful corrections that the integration era has made to the marketing of the previous decade.

The current frontier: 2020–present

The contemporary state of the field is one of refinement rather than revolution. The structural foundation of the modern operation — operating in a defined anatomical plane on named anatomical structures, with the skin as a passive layer — is unlikely to be replaced. What is being refined is the precision and nuance with which it is applied and how it is adapted to each patient’s individual anatomy.

Extended deep-plane and deep-neck integration

The current consensus, with regional variation, favors an extended deep-plane facelift or SMAS facelift, with concurrent deep-neck dissection — performed as a single coordinated operation rather than as separate face and neck procedures. Most major fellowship programs now teach one or both of these integrated approaches as the standard for moderate-to-advanced anatomy.

Vector individualization

Vector planning is increasingly individualized — chosen for the patient's specific descent pattern rather than applied uniformly. Vertical and vertical-oblique vectors dominate in modern practice; the lateral pull of earlier eras has largely been retired.

Adjunctive volume

Structural fat grafting is now performed at the same operation in a meaningful share of cases, particularly in patients with significant deflation or with post-weight-loss facial anatomy. Hyaluronic acid filler and biostimulators continue to play complementary roles, generally at refinement visits if desired for maintenance after primary healing rather than as primary interventions in the surgical plan.

Regenerative adjuncts

Platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and various biologic adjuncts are used in some practices, with mixed evidence regarding incremental benefit. The honest position is that the structural operation remains the dominant determinant of the result; regenerative adjuncts may modestly improve healing or skin quality at the margins, but they do not change the anatomical correction. Nanofat is emerging as a preferred alternative to PRP and PRF.

Imaging and planning

Three-dimensional imaging, photographic morphometry, and patient-specific computational planning tools are entering the field. They are most useful in research and in revision planning at present; their clinical role in primary cases is still being defined and is unlikely to displace careful preoperative anatomical assessment and physical exam.

What is honestly speculative

Robotic-assisted dissection, augmented-reality intraoperative guidance, exosome and stem-cell protocols, and various growth-factor adjuncts are being explored at the margins of the field. None has established a settled clinical role at the time of writing. A patient should approach claims about these technologies with the same caution they would bring to claims about any technique that has not yet accumulated long-term evidence. Innovation is welcome; speculation marketed as innovation is not.

What the evidence actually shows

Patients reasonably ask not just what is being done, but what does the evidence show about how well it works. The honest summary is that the evidence base is meaningful, but with limits worth understanding.

Patient-reported outcomes

Patient-reported outcomes — measured most rigorously through the FACE-Q instrument developed at Memorial Sloan Kettering Cancer Center and McMaster University — are the most patient-relevant evidence. FACE-Q has been validated across multiple languages and patient populations and has produced a body of evidence on facelift outcomes that did not exist a generation ago.

Modern series using FACE-Q have reported satisfaction with the decision to undergo facelift surgery clustering around 90% (with cohort means typically in the 85–95% range), and statistically significant improvements on every FACE-Q scale at six and twelve months postoperatively. Self-reported gains are most consistent in the lower face, jawline, and cheek regions, and somewhat more variable in the neck and submental area. Patient regret rates in modern series are low. These findings are consistent across academic centers and high-volume private practices in the United States, Europe, and Australia.

Longevity

Longevity is harder to study rigorously because it requires long-term follow-up that few surgeons publish. The available evidence — including studies of malar height retention at five years, photographic comparisons at ten years, and revision rates in longitudinal series — supports the clinical observation that a modern, structurally driven facelift typically holds for ten to fifteen years before structural change becomes meaningful again. Earlier skin-based operations consistently relapsed at two to four years in comparable cohorts.

The single most useful framing is that longevity is a structural property determined intraoperatively, not a marketing claim made afterward. A facelift held by deep structure ages differently than a facelift held by skin tension. The mechanism of the operation determines the trajectory of the result.

Complications

In modern series at high-volume centers, the principal complications have been consistent across the era. Hematoma is the most common — reported across the modern literature at rates between approximately 1% and 9%, clustering in most major series at 2–4%, with higher rates in male patients and in patients on perioperative antithrombotic regimens or with poorly controlled blood pressure. Seroma is uncommon, generally under 1%. Infection is rare, well under 1%. Skin slough and flap necrosis are rare in non-smokers operated upon under low-tension closure.

Motor nerve injury was characterized in a 2025 systematic review and meta-analysis of sixty-seven publications and more than fifteen thousand patients across the modern era. The pooled rate of motor nerve damage was approximately 0.66% (95% CI 0.5–0.9%); the pooled rate of permanent motor nerve damage was approximately 0.05% (95% CI 0.0–0.1%). Rates varied modestly by technique — high lateral SMAS and composite rhytidectomy reported the highest transient rates (approximately 1.5–1.9%), with SMAS plication and standard sub-SMAS approaches at the lower end — but the rate of permanent injury did not differ meaningfully across techniques. The marginal mandibular and frontal (temporal) branches are the most commonly affected. Sensory nerve disturbance — most often of the great auricular nerve — is more common but generally resolves over months. Hypertrophic scarring is uncommon when closures are performed under low tension; visible scarring is, in modern technique, more often a function of incision design than of inherent biology.

These rates are consistent across major series and have remained stable across the modern era. They are not principally a function of the technique label; they are a function of patient selection, surgical technique, and operative discipline.

Comparative evidence: deep plane versus SMAS

The direct comparative evidence between deep-plane and SMAS techniques is real but limited. Several cohort and matched-comparison studies suggest improved long-term retention of midface position with deep-plane and high-SMAS techniques compared with SMAS plication, particularly in the malar region. The comparative literature is, however, mixed, and any honest reading concludes that the most important variable is surgical execution rather than technique label. A meticulous SMAS operation can produce excellent results in well-selected patients; a poorly executed deep-plane operation can produce results inferior to a thoughtful SMAS plication. The label is not the operation.

The limits of the evidence

The facelift literature has structural limits worth understanding. Randomized controlled trials in this domain are rare, both because patient blinding is impractical and because the surgical variables are difficult to control. Most evidence is observational — large case series, registry studies, and longitudinal cohorts. Publication bias favors successful technique descriptions over failed innovations. Long-term follow-up beyond five years is uncommon. The patient populations in published series often differ from the patient populations in real-world practice. And the outcome measures used vary across studies, which limits direct comparison.

These limits do not invalidate the evidence base; they qualify it. The honest position is that the modern facelift is a well-described operation with consistent reported outcomes, but the comparative claims of any single technique should be read with appropriate skepticism, and the absence of a randomized controlled trial does not prove that one technique is inferior to another. Most of what is known about facelift surgery is known from careful observation and published cohort studies, accumulated across many surgeons and many years, and that is a respectable form of evidence when paired with advanced anatomical studies, within the constraints of the current state of this field in particular, even when it is not the form of evidence available in some other surgical fields.

What the modern facelift still cannot solve

A history of how the field has improved is not a claim that everything has been solved. The modern operation has clear limits, and acknowledging them is one of the markers of operating in good faith.

The modern facelift does not change the biology of the dermis. Surface concerns — fine lines, pigmentation, dermal thinning — are addressed at a separate layer, by skincare, lasers, peels, and microneedling.

The modern facelift cannot replace lost volume on its own. Volume restoration, when needed, is performed through structural fat grafting alongside the lift, not by repositioning alone. A face that has lost volume cannot be made full by lifting (although preservation and repurposing of redundant tissue is possible to a certain extent); the structures lifted have to have something to be lifted toward and around.

The modern facelift does not stop aging. It repositions anatomy at a single moment in time. Aging continues from the new baseline, more favorably than it would have without surgery, but not on a different schedule. Retaining ligaments will continue to soften. Skin will continue to thin. Bone will continue to remodel over the years. The effect of gravity naturally continues as well.

The modern facelift cannot compensate for unstable health, weight, or lifestyle. Smoking, active weight fluctuation, untreated obstructive sleep apnea, and unmanaged metabolic disease all degrade the operation it would otherwise be. The plan accommodates the patient's biology; it does not override it.

And the technique label alone is not a guarantee. A surgeon performing a deep-plane operation poorly produces worse results than a careful surgeon performing a well-indicated SMAS operation. The label is a necessary frame; it is not sufficient. Surgical judgment, case volume, and patient selection still determine the result.

How to recognize a modern facelift in consultation

The technical history is interesting; the practical question for a patient is how to tell, in a consultation, whether the operation on offer is modern in approach or traditional in execution. Surgeons rarely describe their own work as "old-fashioned" or "skin-based." Recognition has to come from the substance of the conversation and the before and after results shown, not from the label.

The following recognition markers, in my experience, separate a modern operation from a traditional one in the way it is described and the way it is planned.

The lift is described as held by deep structure, not by skin closure. A surgeon who can articulate where the tension of the lift is absorbed — at the SMAS, at the platysma, at specific anchor points — is describing a modern operation. A surgeon who emphasizes "skin tightening," "removing excess skin," or "trimming and pulling" is describing an older one.

The named retaining ligaments are part of the conversation when relevant. A surgeon who can speak specifically about the zygomatic, masseteric cutaneous, and mandibular ligaments — and the role of selective release in the operative plan — is operating in the modern era. A surgeon who avoids the topic, or treats it generically, may not be.

The neck is included as part of the same operation in most cases, particularly in the context of aging or significant weight loss. A modern facelift addresses the platysma directly. A traditional one often did not. If the neck is described as "optional" or as a separate procedure performed under different circumstances, the operation in question may not be a complete modern operation.

Volume is addressed as well as repositioning. A modern operation considers fat compartments — whether to preserve, reposition, or, in deflated zones, restore through fat grafting. An operation that proposes only to lift, with no consideration of volume, is missing a layer of the modern conversation.

Skin is described as a passive layer. A surgeon who describes the skin as being redraped following repositioning and lifting of the deeper tissues, with conservative skin trimming under no tension, is describing a modern operation. A surgeon whose mental model places skin at the center of the lift is describing a traditional one.

Vector is discussed in anatomical terms. Modern technique uses a vertical or vertical-oblique vector that matches the original direction of soft-tissue descent. A surgeon who describes the lift as a posterolateral or "back-and-up" pull is describing the older horizontal-vector approach.

Identity preservation is the explicit goal. A modern operation is described in terms of restoring the patient's own earlier anatomy. A traditional one is sometimes described in terms of "improving" features or "fixing" anatomy that is not fundamentally pathological. The difference in framing is meaningful.

The named anatomical references appear. Surgeons working in the modern era are generally comfortable referencing the surgical literature — the deep-plane rhytidectomy papers of 1990, the fascial-relationships paper of 1992, the malar fat pad paper of 1993, the midcheek-anatomy literature of the 2000s, the fat-compartments paper of 2007 — and the anatomical concepts those papers established. This is not pedantry. It is the vocabulary of the field.

These are not interview questions to ask the surgeon. They are markers to listen for in how the surgeon talks about the operation. If most of the markers above are present, the conversation is a modern one. If most are absent, it is worth asking why.

The cultural history: how the facelift entered public memory

A complete history of the facelift includes its cultural trajectory, because the cultural memory of the operation continues to shape how patients think about it.

The facelift entered American mass culture through Hollywood in the 1950s and 1960s, when actresses and entertainment-industry figures sought the operation as a professional necessity. Through the 1970s and 1980s, it spread to a broader affluent population, and was performed, in that period, with the techniques and limits described above. The visible signatures of that era — the lateral-pulled face, the unnatural skin texture, the recognizable surgical look — entered the popular vocabulary through tabloid photography, comedy, and eventually social media. Comedians built routines around it. Entire films were structured around its visible failures. Magazines ran annual photographic catalogues of celebrity facelifts gone wrong.

By the 2000s, the cultural conversation around the facelift had become almost entirely about its visible failures. The successful modern operations performed in academic and high-volume practices were, by design, invisible — patients who underwent excellent surgery did not become public examples of facelift surgery, because no one knew they had had one. The cultural archive of the operation was, paradoxically, almost entirely an archive of its worst examples. The best-performed operations of the modern era are, almost without exception, anonymous.

This continues to shape the consultation conversation. A meaningful share of patients who arrive in my Beverly Hills practice carry, as their default mental image of a facelift, a result that no contemporary surgeon would consider acceptable. Their concern that a facelift will make them look "different" or "operated" is not unreasonable; it is a memory of a real surgical era. Part of an honest consultation is explaining that the operation has changed substantially, and showing what a modern, identity-preserving operation actually looks like — including, when the patient agrees, photo, video, or in-person results from patients whose surgery is invisible enough that no one in their lives knew they had had it.

The shift in cultural conversation, in turn, has begun to track the shift in technique. As the modern operation has matured, a quieter cultural register has begun to replace the tabloid one. Patients describe the goal of facelift surgery now in terms of looking "rested" or "recognizable," not necessarily in terms of looking "younger" or "lifted." This is the same correction the early-twentieth-century surgeons would have understood — and it is the cultural counterpart to the field's return to its own founding conservatism.

The marketing-era detour: lunchtime lifts, weekend lifts, and branded mini-procedures

While the surgical scientific literature was establishing the modern deep-layer facelift operation, the consumer marketing of facelift surgery moved in a different direction. Beginning in the late 1990s and accelerating through the 2000s, a class of branded, abbreviated procedures appeared — "lunchtime lifts", "weekend lifts", thread lifts, branded mini-lifts of various names — promising the result of a facelift with the recovery of an office visit.

These procedures were not all dishonest. Some — particularly carefully selected mini-procedures performed on early-stage anatomy — addressed a real, narrow patient population well. Others were skin-tightening operations re-marketed under modern-sounding names, performed on patients whose anatomy required the deep operation those procedures could not deliver.

The cultural effect of this era is still with us. A meaningful share of patients who consult about facelift surgery today have read about, considered, or undergone one of these abbreviated procedures, and many arrive in consultation with a confused mental model — uncertain whether the operation they are considering is "really" a facelift, uncertain whether their friend's "lift" is comparable to a deep plane operation, and uncertain how to evaluate the difference, or what it is that may have caused suboptimal results they may have seen on others or may have experienced themselves.

The honest framework: a quicker procedure that promises the same outcome as a longer one is generally a more limited procedure with a more limited outcome. There are appropriate roles for shorter operations, and they should be presented honestly — as smaller operations producing smaller and less durable changes, not as equivalents to a complete deep plane or advanced SMAS operation in a patient whose anatomy requires it.

The pre-modern lessons that remain true

For all that has changed in the operation, several principles articulated in the early-twentieth-century literature remain accurate today and are worth preserving.

The operation should be conservative. Suzanne Noël's emphasis on doing less rather than more, and on preserving the patient's identity, was correct in 1926 and is correct now. The most successful facelift is the one that returns a patient to an earlier version of themselves, not the one that creates a different face.

Recovery is part of the operation. The mid-century surgeons who emphasized careful postoperative management, low-tension closure, and respect for healing were correct; the modern operation has refined these principles, not replaced them. A facelift is a real operation with a real recovery, and the marketing language of "weekend recoveries" understates what the operation requires of the patient.

Patient selection and how the technique is adapted to individual patient anatomy matters more than technique label. The most consistent observation across more than a hundred years of facelift surgery is that excellent results come from well-selected patients with reasonable expectations, operated on by careful surgeons with appropriate experience and skill. No technique replaces this. The deep-plane revolution of the 1990s and 2000s did not change this principle; it gave careful surgeons more diverse and sophisticated tools.

The operation cannot do everything. The early surgeons did not promise that a facelift would address every aspect of facial aging. They presented it as a focused operation with focused goals. The modern era's most useful corrective to its own marketing has been a return to this honesty.

Frequently asked questions

What makes a facelift "modern"?

The modern facelift is defined less by a single technique label than by a philosophy of structural repositioning: the SMAS-platysma envelope, the named retaining ligaments, and the discrete fat compartments are the targets of the operation, while the skin is redraped passively over a corrected foundation. The key conceptual shift, from skin tightening to deeper structural repositioning, is what separates the modern operation from the procedure as it was practiced through the 1980s and 1990s.

Who invented the facelift?

The first documented facelift is generally attributed to Eugen Holländer, working in Berlin, in 1901. The operation was developed in parallel by several European surgeons in the early twentieth century — Erich Lexer in Berlin, Suzanne Noël in Paris, and others — and was independently described by Charles Conrad Miller and Adalbert Bettman in early American practice. The operation as a discrete cosmetic procedure dates to that turn-of-the-century European tradition.

When did facelift technique change from skin-based to structural?

The shift began in 1974 with Tord Skoog's description of sub-platysmal dissection, was given its anatomical foundation by Mitz and Peyronie's 1976 paper naming the SMAS, and became broadly defined by Sam Hamra's deep-plane rhytidectomy in 1990. The anatomical detail that completed the modern operation was filled in by the work of Owsley on the malar fat pad, Stuzin and colleagues on the safe operative interval, the Mendelson group on midcheek anatomy, and the 2007 Plastic and Reconstructive Surgery paper on the discrete fat compartments. The modern operation has been the standard at major academic centers and private practices since roughly the early 2000s, though adoption across the field and implementation of advanced technical refinements has been uneven.

Who was Suzanne Noël, and why does she matter?

Suzanne Noël was a French surgeon who practiced in Paris in the early twentieth century. She was one of the first women in modern cosmetic surgery, and her 1926 monograph La Chirurgie Esthétique: Son Rôle Social is the first sustained patient-facing book on cosmetic surgery. Her clinical conservatism, her emphasis on identity preservation, and her caution about over-promising results are positions that a modern surgeon would still recognize as correct — and her work is a useful corrective to the assumption that the early facelift era was uniformly aggressive or naive.

Why does my mother's facelift look different from a recent facelift performed today?

Almost certainly because the operations were different. A facelift performed in 1985 was, in most cases, a skin-based operation with limited deep structural work. A facelift performed in 2025, by a competent surgeon, is a structural operation with the skin as a passive layer. The two procedures share a name and a goal, but they differ at the level of the dissection, the layer engaged, the vector of repositioning, and the way tension is distributed. They age differently for the same reason.

Are mini-facelifts and weekend lifts the same as a modern facelift?

Sometimes, and sometimes not. A carefully selected mini-procedure performed on early-stage anatomy by a surgeon who works in the modern operative plane can be a small, well-indicated version of the modern operation. A "weekend lift" or "lunchtime lift" performed primarily on the skin envelope, marketed as equivalent to a deep-plane operation, is generally a re-branded skin-based procedure that will not perform like a modern facelift over time. The honest test is whether the operation engages the deeper structural layer or stops at the skin.

How do I know whether a surgeon is offering a modern Facelift operation?

By the substance of how the operation is described, and by the quality of their results — not by the label. A surgeon describing a modern operation can articulate where the tension of the lift is absorbed, name the retaining ligaments and the role of selective release, integrate the neck as part of the same procedure, address volume as well as repositioning, describe the skin as a passive layer, and reference the anatomical literature that defines the field. A surgeon whose conversation centers on "skin tightening" and "trimming excess skin" is describing the older operation, regardless of what it is called.

Is "deep plane facelift" the same as "modern facelift"?

Not exactly. The deep-plane facelift is a specific technical approach within the broader category of modern facelift surgery — characterized by sub-SMAS dissection at the level of the named retaining ligaments and lifting of the SMAS-fat-skin composite as a single unit. There are other modern approaches — high-SMAS, extended-SMAS, dual-plane variants — that share that philosophy without using the deep-plane label specifically. There are also other techniques like the MACS, SMAS plication, or SMAS-ectomy that engage the deep SMAS layer without necessarily dissecting the sub-SMAS plane and have an important role when properly adapted to the right patient anatomy.

Was every facelift before the deep plane a "skin facelift"?

No, but the language of the field was less precise. Sub-SMAS techniques were being practiced from the late 1970s onward, and many surgeons in the 1980s and 1990s performed structurally informed operations. The shift was uneven across practices. The point of the historical distinction is not that every older operation was inadequate; it is that the floor of the field — the operation a typical patient received from a typical surgeon — was, on average, more skin-based then than now.

Why are some surgeons still performing older Facelift techniques?

Surgical training is generationally transmitted, and not every surgeon retrains as the field evolves. Some surgeons continue to perform the operation they were taught in residency two or three decades ago; others have updated parts of their technique without restructuring the conceptual frame. The result is that the floor of the field today still includes operations that would not be recognizable as modern in approach. This is one of the practical reasons careful surgeon selection matters more than technique label.

What does the evidence show about facelift complication rates?

In modern series at high-volume centers, hematoma occurs at rates reported between approximately 1% and 9%, clustering in most major series at 2–4%, with higher rates in male patients and in patients with perioperative high blood-pressure or antithrombotic factors. Seroma is uncommon, generally under 1%. Infection is rare, well under 1%. A 2025 systematic review and meta-analysis of more than fifteen thousand patients reported a pooled motor nerve injury rate of approximately 0.66% (95% CI 0.5–0.9%) and a pooled permanent motor nerve injury rate of approximately 0.05% (95% CI 0.0–0.1%); rates varied modestly by technique but the rate of permanent injury did not. Sensory nerve disturbance — most commonly involving the great auricular nerve — is more common but generally resolves over months. These rates are consistent across the modern era and are principally a function of patient selection, surgical technique, and operative discipline rather than of the technique label.

What does the evidence show about patient satisfaction in Facelift Surgery?

Modern series using validated patient-reported outcome instruments — most notably the FACE-Q — report patient satisfaction with the decision to undergo facelift surgery clustering around 90% (with cohort means typically in the 85–95% range), and statistically significant improvements on every FACE-Q scale at six and twelve months postoperatively. Self-reported gains are most consistent in the lower face, jawline, and cheek regions and somewhat more variable in the neck and submental area. Patient regret rates in modern series are low.

How long does a modern facelift last compared to older techniques?

A skin-based facelift typically relapsed at two to four years. A modern, structurally driven facelift typically holds for ten to fifteen years before structural change becomes meaningful again, and many patients never seek a second operation. The face does not stop aging in either case; what changes is the durability of the correction and the trajectory from which subsequent aging proceeds. Longevity is a structural property determined intraoperatively, not a marketing claim.

Are there randomized controlled trials of facelift surgery?

Randomized controlled trials (RCTs) in this domain are rare, both because patient blinding is impractical and because the surgical variables are difficult to control. Most evidence is observational — large case series, registry studies, and longitudinal cohorts — supplemented by validated patient-reported outcome instruments. The absence of RCTs does not invalidate the evidence base, but it qualifies it. Comparative claims about specific techniques should be read with appropriate skepticism.

What is the SMAS, and who named it?

The SMAS — the Superficial Musculoaponeurotic System — is the continuous fibromuscular layer that envelops the muscles of facial expression and connects them to the skin. It was named and characterized by Mitz and Peyronie in their July 1976 paper in Plastic and Reconstructive Surgery, which remains one of the most influential papers in the history of facial aesthetic surgery. The modern facelift is, in many respects, an operation built on the anatomical layer that paper described as well as the tissue planes deep and superficial to it.

What are the named retaining ligaments of the face?

The principal retaining ligaments engaged in facelift surgery are the zygomatic ligament, the masseteric cutaneous ligaments, the mandibular ligament, and the cervical retaining ligaments. They were progressively named and mapped in the surgical anatomy literature from the 1980s through the 2000s — most influentially by Furnas in the 1980s, Stuzin and colleagues in the early 1990s, and the midcheek-anatomy literature of the 2000s. The ligaments anchor specific zones of soft tissue to deeper bony or fascial structures, and their selective release — when the patient's anatomy requires it — is one of the principal mechanical advantages of the deep-plane operation.

What is the malar fat pad, and why does it matter in Facelift Surgery?

The malar fat pad is a discrete subcutaneous fat compartment over the cheekbone. It descends in a predictable pattern with age, contributing to the prominent nasolabial fold and the loss of midface fullness. Owsley's 1993 paper in Plastic and Reconstructive Surgery formalized the recognition that the malar fat pad was a distinct anatomical territory requiring its own surgical attention, and subsequent midcheek-anatomy work mapped its relationships in detail. A modern facelift addresses the malar fat pad as part of the midface; an operation that ignores it is incomplete.

How does post-weight-loss (GLP-1) facial anatomy change the Facelift operation?

Rapid weight loss — common today through GLP-1 agonists, bariatric surgery, and sustained lifestyle change — produces a face with both descent and deflation simultaneously. A skin-based facelift could address neither well; it could only tighten a skin envelope that had already lost the volume beneath it. The modern facelift operation pairs deep structural repositioning with selective volume restoration, typically through autologous fat grafting in the same setting.

Will the modern facelift be replaced by something newer in the next decade?

Refinement is ongoing, but the structural foundation of the modern operation — operating in a defined anatomical plane on named anatomical structures, with the skin redraped as a passive layer without tension — is unlikely to be replaced. Adjunctive technologies, regenerative therapies, and patient-specific planning tools will continue to develop alongside the operation. The operation itself will probably evolve more in the precision of its individualization than in its underlying philosophy. Robotic-assisted dissection, augmented-reality guidance, and various stem-cell or growth-factor protocols are being explored but have not yet established a settled clinical role.

Key takeaways

• The facelift was first described in 1901 in Berlin and refined through three distinct surgical eras across the twentieth century before reaching its modern form.

• The first generation of facelift surgery was conservative, skin-based, and modest in claim — and Suzanne Noël's 1926 emphasis on identity preservation remains correct today.

• The skin-flap era of the 1960s and 1970s produced the cultural memory of the facelift; its visible failure modes are the result of asking the skin to do work it cannot durably do.

• The first revolution came with Skoog (1974) and Mitz and Peyronie (1976), who established that the lifting plane was beneath the skin, in a deep layer the field could now name and engage directly.

• The deep-plane revolution of 1990–1992 — Hamra's deep-plane rhytidectomy, the Stuzin–Baker–Gordon paper on the safe operative interval, and Barton's high-SMAS work — established the operation as it is now performed: a structural repositioning of the SMAS-fat-skin composite at the level of the retaining ligaments.

• The anatomical mapping era of 1993–2010 — Owsley on the malar fat pad, the Mendelson group on the midcheek, and the 2007 Plastic and Reconstructive Surgery paper on the fat compartments — filled in the surgical detail of the midface, the retaining ligaments, and the discrete fat compartments.

• The integration era of the 2010s converged the techniques into a coherent, individualized operative repertoire — extended deep plane, vertical-vector mechanics, deep-neck integration, and structural fat grafting.

• The current frontier is refinement rather than revolution; the structural foundation of the modern operation is unlikely to be replaced in the foreseeable future.

• The evidence base supports patient satisfaction clustering around 90% in modern FACE-Q series, a pooled motor-nerve-injury rate of approximately 0.66% (with permanent injury approximately 0.05%) across more than fifteen thousand patients, hematoma rates clustering at 2–4% in major series, and longevity in the range of ten to fifteen years for structurally driven operations. The evidence has limits — rare RCTs, observational dominance, publication bias — but is consistent and meaningful within them.

• The cultural memory of the facelift is a memory of one specific operative era, whereas the modern operation is, by design, invisible.

• Recognition of a modern operation in consultation comes from the substance of how it is described, and from the quality of the results (natural and identity-preserving), not from the technique label.

Elie Ramly, MD is a Harvard-trained plastic and reconstructive surgeon practicing in Beverly Hills. His clinical focus is the modern facelift (deep plane and advanced SMAS techniques), neck lift, and advanced rhinoplasty, with particular interest in identity-preserving facial rejuvenation. He maintains active surgical privileges at Cedars-Sinai Medical Center.

Dr. Ramly's practice serves patients who value discretion and surgical excellence, and is built around the principle that the most successful facelift is the one that preserves and celebrates your unique facial identity and personal charm through undetectable techniques.

Schedule a private consultation

Selected references and further reading

This article draws on the established surgical literature of the field. The following references are organized chronologically and thematically for readers and colleagues seeking primary sources.

The early era

• Holländer E. Die kosmetische Chirurgie. Berlin, 1932.

• Lexer E. Die gesamte Wiederherstellungschirurgie. Leipzig, 1931.

• Noël S. La Chirurgie Esthétique: Son Rôle Social. Masson et Cie, Paris, 1926.

• Miller CC. The Correction of Featural Imperfections. Chicago, 1907.

• Bettman AG. Plastic and cosmetic surgery of the face. Northwest Medicine, 1920.

The first revolution: the SMAS

• Skoog T. Plastic Surgery: New Methods and Refinements. W.B. Saunders, Philadelphia, 1974.

• Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plastic and Reconstructive Surgery, 1976; 58(1):80–88.

The deep plane revolution

• Hamra ST. The deep-plane rhytidectomy. Plastic and Reconstructive Surgery, 1990; 86(1):53–61, discussion 62–63.

• Hamra ST. Composite rhytidectomy. Plastic and Reconstructive Surgery, 1992; 90(1):1–13.

• Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plastic and Reconstructive Surgery, 1992; 89(3):441–449, discussion 450–451.

• Barton FE Jr. Rhytidectomy and the nasolabial fold. Plastic and Reconstructive Surgery, 1992; 90(4):601–607.

The anatomical mapping era

• Owsley JQ. Lifting the malar fat pad for correction of prominent nasolabial folds. Plastic and Reconstructive Surgery, 1993; 91(3):463–474, discussion 475–476.

• Mendelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plastic and Reconstructive Surgery, 2002; 110(3):885–896, discussion 897–911.

• Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plastic and Reconstructive Surgery, 2007; 119(7):2219–2227, discussion 2228–2231.

• Mendelson BC, Jacobson SR. Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments. Clinics in Plastic Surgery, 2008; 35(3):395–404, discussion 393.

The integration era

• The MACS-lift and short-scar structural variants are described across a sustained body of journal publications and textbook chapters from the early 2000s onward. Readers seeking the technical literature are directed to the Plastic and Reconstructive Surgery and Aesthetic Surgery Journal archives for primary papers on short-scar structural rhytidectomy.

• The extended deep-plane technique, vertical-vector refinements, and deep-neck dissection are similarly described across journal publications and CME proceedings of the 2010s in Plastic and Reconstructive Surgery, Aesthetic Surgery Journal, and Facial Plastic Surgery Clinics of North America.

Patient-reported outcomes

• Klassen AF, Cano SJ, Scott A, Snell L, Pusic AL. Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plastic Surgery, 2010; 26(4):303–309.

• Pusic AL, Klassen AF, Scott AM, Cano SJ. Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale and adverse effects checklist. Clinics in Plastic Surgery, 2013; 40(2):249–260.

• Klassen AF, Cano SJ, Schwitzer JA, Scott AM, Pusic AL. Measuring outcomes that matter to face-lift patients: development and validation of FACE-Q appearance appraisal scales and adverse effects checklist for the lower face and neck. Plastic and Reconstructive Surgery, 2014; 133(1):21–30.

Complications and comparative outcomes

• Facelift Surgery and Nerve Injury: A Systematic Review and Meta-Analysis. Aesthetic Plastic Surgery, 2025. (Pooled motor nerve injury 0.66%; pooled permanent motor nerve injury 0.047%, across 67 studies and over 15,000 patients.)

• A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthetic Surgery Journal, 2019.

• Preoperative Risk Factors and Complication Rates in Facelift: Analysis of 11,300 Patients. Aesthetic Surgery Journal, 2016.

• How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications. Aesthetic Surgery Journal Open Forum, 2021.

This article is general medical education and is not a substitute for in-person surgical consultation. Treatment recommendations are made on the basis of individual anatomy, medical history, physical exam, and goals, and should be discussed with a qualified plastic surgeon. The complication and outcome ranges cited reflect modern series at high-volume centers and may differ in other settings.