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The quest for the best facelift has had patients searching long and far. Qualities that patients seek in a facelift are to look natural, like themselves, all with improvement in their face and neck area. Earlier on, surgeons tried to use the lift and pull skin technique. This technique seems intuitively logical and effective. However, simply cutting and lifting skin led to poor aesthetic results, poor facial appearance, and often time little to no change. Tension was placed on the skin, which led to poor scars. In addition, the skin is not biomechanically strong enough to hold the face up, creating little to no change.
In 1972, Thomas Skoog discovered the SMAS, short for supra muscular aponeurosis system, which is the fascia or fibrous layer on the face. He found that if he pulled the SMAS fascia tight enough, faces and necks could be improved so that tension could be placed on this fascia layer rather than on the skin of the face. While this represented a major advance in facelifting, many patients still had mixed results. The SMAS facelift still led to a windswept look in the face and often times pulled look.
More recently, Dr. Anil Shah of Chicago Illinois coauthored a study on the platysma muscles's impact on the face. His research helped identify another critical link in facelifting, the platysma muscle. This muscle is classically thought to be a neck muscle, as depicted in respected anatomy textbooks such as Gray's Anatomy or Netter. However, as Shah discovered this muscle actually has a major contribution to the face. Pulling and lifting this muscle can lead to a smoother and younger face, while avoiding a pulled look. The study, which was published in the Archives of Facial Plastic Surgery, helped add another missing link to the quest for the best facelift.
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