The History of the Facelift

The Skin-Only Era

The first facelifts, in the early 1900s, did the obvious thing: they lifted and trimmed skin. It made sense at the time, but it had two lasting problems. Skin is elastic. Pull it tight and it stretches back, so results faded quickly. And because all the tension sat on the skin, an aggressive lift could look tight or “wind-blown.” For decades, “facelift” meant a skin operation, with the limitations that came with it.

The SMAS Revolution

The turning point came in the 1970s, when surgeons recognized that the structural layer of the face isn’t the skin at all. It’s the SMAS (the superficial musculoaponeurotic system), the sheet of muscle and connective tissue beneath the fat. You can read more on our facial anatomy page. Lifting the SMAS instead of just the skin meant tension could sit on the layer that actually holds the face up. Results looked more natural and lasted longer. The modern facelift was born.

The Deep Plane Technique

The next advance refined how the deeper layer is handled. Rather than tightening the SMAS on top of still-tethered tissue, the deep plane facelift releases the retaining ligaments that anchor the face and repositions the SMAS and skin together, as a single unit. Because the deep structure is freed and moved as a whole, not stretched over anchored tissue, the deep plane lift reaches the midface and neck that earlier techniques couldn’t, and does it without a pulled look. It asks more of the surgeon, which is why experience and technique matter so much. See how the approaches stack up on our techniques comparison page.

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