Hello, everyone. I'm from Jayjun Plastic Surgery. I'm Dr. Ha Ki-young, a plastic surgeon. Nice to meet you. What's today's topic? Today, I'd like to briefly walk you through the history of facelifts.

The history of facelift surgery? Yes. It actually has a fairly short history. So it's quite straightforward. If you look at the slides I prepared, this is a brief timeline.

Only 120 years? That's quite recent. That's right. It's relatively short in the history of surgery. It's said to have begun secretly in Berlin in 1901. That's one account. But

facelift surgery really began to take its modern form with Hamra's deep plane technique. That was in the early 1990s. He's known as the father of facelift surgery. He's known as the father of facelift surgery. That's right.

This is when Hamra's work entered the picture, and when the procedure really began to develop. So, in practical terms, its development began in the 1990s. That really wasn't long ago. It's only been a little over 30 years.

Since Hamra, the father of facelift surgery. Exactly. That's when progress began to accelerate. Basically, until the 19th century, facial surgery was mainly reconstructive. Operating for cosmetic purposes

was something people in the 1800s simply did not accept. The same was true in the West. The biggest drivers of surgical progress were advances in antibiotics and anesthesia.

There were two particularly important milestones: general anesthesia and aseptic surgery. Those were crucial developments, too. It wasn't just ordinary local anesthesia; patients could undergo general anesthesia. And rather than simply using antibiotics,

there were sterile operating rooms. That allowed plastic surgery, especially reconstructive surgery, to advance greatly. There's another note on the slide: why documentation came so late. At the time, having a facelift was considered shameful,

so nobody documented it. Even today, medical care isn't exactly inexpensive. It would have cost even more back then. Few doctors could perform these operations properly. So the patients were probably extremely wealthy noblewomen.

Naturally, they would have wanted to keep it secret. That's why little of the history was recorded. Then and now, natural-looking results seem to come at a premium. That's right. "Please make sure nobody can tell." "Please don't let even my husband find out."

Exactly. "Not even my husband." That kind of request already existed in the 19th century. So, in fact, the records often appeared only decades later. "When I was in my thirties,

I operated on a certain noblewoman." Then, when the doctor was around sixty, he would finally write it down. Because the patient had passed away. Because the patient had passed away. "I performed this operation about 20 years ago,

and these were the results." That's how those accounts were recorded. A few of those records have survived to this day. So who performed the first facelift, and when it was first done, are still matters of debate.

We can't really establish that conclusively. The earliest procedure described dates to 1901. During the period that followed, up until World War I, these procedures were mostly performed in secret, and documented much later.

The early records describe removing only a little skin. That's what was recorded. Removing some skin and pulling it tighter would produce a modest lifting effect. That's how the procedure is said to have begun. Earlier, we said it first began in 1901,

but that account was actually published in 1932. As I mentioned, it was documented after the patient had died. The patient the doctor had operated on, that is. That's one way to understand it. There's also an account of a procedure in Germany in 1906.

That account, too, was only reported in 1931. Then the procedure was performed in the United States. Essentially, it began in Europe and spread to America. That's the overall picture. Next, we come to Paris in the 1920s. One historically significant development

was the effort to conceal incision scars. From a plastic surgery perspective, that's a very important point. All plastic surgery leaves some scarring. Surgery cannot be completely scar-free. The key is to place scars where they're least noticeable.

Those efforts began around this time. Even then, local anesthesia was still used. Since only a small amount of skin was removed, local anesthesia was sufficient. A term appears here:

"petite opération." This is when the word "petite" appears. "Petite" is French, and means small. So the term "petite opération," or minor surgery, appeared. Right. At the time, it was considered a minor procedure.

Facelift surgery itself, that is. But this was after World War I had ended. World War I was a major historical turning point. Because it caused casualties on an enormous scale.

Bombs and firearms were used on a massive scale. That led to mass casualties. And many soldiers who survived were left with devastating injuries. From this point, surgical specialties advanced across the board.

Plastic surgery, including flap techniques, underwent rapid development around this time as well. During this period in Paris, techniques designed to make surgical scars less visible began to emerge.

Next is the period from the 1930s to the 1950s. The surgical approach was still essentially the same: removing skin alone. But another major event occurred during this period: World War II. Surgeons worked through that era.

And across every specialty, surgery itself underwent another period of rapid progress. Still, no matter how much you did, removing skin alone wasn't very effective. If you pulled the skin tightly,

without lifting the underlying tissues, forces would eventually act to stretch the skin downward again. The incision scars would then widen. And because the original downward forces remained, the sagging would return.

So, from the 1960s, surgeons began asking, "Can we go deeper?" "Which areas require extra caution?" "And where should the incision lines be placed to establish a standard approach?" Those discussions began to take place.

Then came a major turning point: the identification of the SMAS. The SMAS is a somewhat complex concept. But, put simply, it's a firm structure that can be lifted effectively. That's an easy way to think of it.

By lifting this relatively firm SMAS tissue, you address more of the structures causing the sagging, which can help prevent it from recurring. Also, with this approach, you don't need to remove as much skin. So the extent of scarring can be smaller, too.

This is a simplified diagram. Many nerves run beneath the SMAS. Their course varies somewhat by region, but many run below this layer. That's the basic idea. So surgeons can lift the tissue to this level

relatively safely, provided they avoid the nerves. Above them, surgical access is somewhat easier. So the idea was, "This level is relatively safe." "Let's dissect to this level,

elevate the tissue, and lift it for the patient." That concept began to develop around this time. Next came the discussion of the neck. Before then, neck lifts weren't performed. The approach was simply to remove and tighten facial skin. But once the SMAS was identified,

surgeons found structures extending downward from it. And toward the forehead, there are structures continuous with the SMAS as well. Those include muscular layers. In any case, they identified these continuous structures. It would make sense to lift them together.

That's when neck lifts entered the discussion. The incision lines became a little longer, too. Next, from the 1980s into the 1990s, we come to Hamra's deep plane facelift. As we saw in the diagram earlier, the approach involves identifying the SMAS layer

and lifting it. Then, in 1992, the composite lift was introduced. Initially, the SMAS was separated completely. The layers were separated and lifted individually. But with a composite lift,

they are elevated together as a single unit. That means the fat and skin above the SMAS are lifted together as well. So the skin and underlying fat aren't placed under direct tension. The lift comes from beneath the SMAS, not from above.

That reduces distortion from surface tension, the overly pulled look you can get from excessive tightening. You can achieve firmness without much of that distortion. These techniques began to develop around this time. But as deep plane surgery developed, a new concern emerged:

the nerves. As I mentioned earlier, I said the level of the SMAS was relatively safe. The issue is that you have to elevate the SMAS just above the nerves. Ideally, you would identify the nerves precisely.

But their size and color vary from person to person. But their size and color vary from person to person. But their size and color vary from person to person. One momentary slip... You still have to dissect the tissue, don't you? Yes, you do.

So that's where surgical skill comes in? Exactly. Before this, there weren't many technically demanding aspects to the procedure. You simply removed skin and pulled it tighter, then hoped the scars would heal well.

But from this point on, the surgeon's technical skill became extremely important. How do you identify and distinguish these small nerves, then elevate the SMAS without damaging them? That became a crucial part of the operation. Because you have to dissect broadly before lifting.

So it's a battle with the nerves. That's right. It's a battle with the nerves. You have to lift everything necessary while avoiding injury. Next is the period from the 1990s into the 2000s.

This is when endoscopic forehead lifts, lateral SMASectomy, and MACS lifts entered the picture. We usually perform forehead lifts endoscopically. That approach was being discussed. Lateral SMASectomy refers to the outer area here.

When you lift the SMAS, you get some excess tissue, right? You remove some of that excess and tighten the remaining tissue. A MACS lift is a more limited approach. Sutures are used to tighten and secure the SMAS. Tightening those sutures produces a lift.

So, compared with deep plane surgery, it doesn't provide the same degree of lifting. But the risk of nerve injury is relatively low. That allows for a safer approach. And when the sagging isn't severe, there may be no need to take on greater risk.

In those cases, a MACS lift can be a useful surgical option. So, from this point, the procedures became more differentiated. Deeper and more superficial approaches began to be distinguished in the early 2000s.

At first, surgeons removed only skin. Then they gradually worked deeper, identified the SMAS, and developed deep plane techniques. But as we entered the 2000s, the approach began to branch out into several different surgical techniques.

So this is when the refinements began. Exactly. This is when the details became important. Another development during this period was a more detailed focus on volume. Fat grafting began to become much more common.

And if you think about when fillers became popular, it was right around this period. Surgeons began recognizing the importance of volume. Facial volume is also affected by gravity, so its distribution shifts over time. Some areas gain volume,

while others lose it, as we age. Naturally, areas with excess volume need reduction. And areas that have lost volume may need it restored. Lifting alone can't address all of that.

Many people also lose a lot of facial fat as they age. When that loss affects the whole face, overall volume restoration may also be necessary. This is a simple illustration I drew. Essentially, it shows aging fat shifting downward.

That's the basic idea. It doesn't actually descend exactly like this, but the drawing makes it easier to understand. As volume became a major topic, adding substantial amounts of volume became increasingly popular.

But after focusing so much on adding volume, surgeons revisited the older approaches. Volume correction alone wasn't enough. So they returned to lifting techniques. In the 2010s and 2020s, deep plane facelifts came back into focus.

Just like fashion, medicine also goes through cycles. Now we generally consider three categories: skin texture, volume, and sagging. We assess all three together and choose the treatments the patient needs.

These days, facelifts are often combined with fat grafting or fillers as part of the overall treatment. Usually, the lower face actually has excess volume. So, during a facelift, we may use liposuction in the lower face or otherwise reduce volume there.

If there's a lot of volume here, these other areas often have relatively little. Likewise, there may be excess volume in one area and too little in another. Remove volume where there's too much, and add it where needed. Remove volume where there's too much, and add it where needed.

So the approach often combines surgery with volume restoration. Another direction that began to develop was slowing the progression of sagging. Helping it happen more gradually. That led to treatments such as

laser-based lifting and, more recently, Ultherapy. The field is evolving to address these issues together. So, looking back at the history, we can see the changes we've just discussed. In fact, most developments in facelift surgery

have taken place over the past 30 years. It's a procedure with a very short history. That's how you can think of it. I've mentioned this before: right now, you're at your youngest and most beautiful for the rest of your life. Giving up on the present just to have surgery later

may not be the best choice for your life. So I think it's helpful to consider what you can do at your current stage. If the sagging is truly mild, a mini facelift may help. But if surgery is warranted,

I personally think a deep plane facelift is appropriate. If the sagging isn't severe enough for that, laser lifting, thread lifting, or other nonsurgical treatments can also be reasonable options. Just don't overdo it.

For example, avoid excessively high energy settings or inserting too many nonabsorbable threads. I think it's best to avoid that kind of overtreatment. Today, we briefly reviewed the history of facelift surgery.

Next time, we'll look at the types of facelifts and the indications for facelift surgery in a little more detail. I'll see you again in that video. That's all for today.

See you next time. Thank you.

안면거상술의 120년 역사를 한번에!! SMAS층을 당기게 된 이유!