What the research shows
Before the textbooks. Newly found documents show purely cosmetic face lifting performed out of sight of the medical establishment by as early as 1851, when surgery without a medical reason drew professional censure (Zhang 2026). In the United States, John H. Woodbury, who went by the title of doctor but was not one, ran cosmetic surgery institutes from 1870 to 1909 whose surgeons offered early brow lifts, lower facelifts and midface lifts (Denkler 2015). In Paris, Samuel Pozzi probably performed a face lift but never published it (Glicenstein 2009).
The first published surgeons. Eugen Holländer and Erich Lexer each performed a facelift in Germany in 1901, and Suzanne Noël performed one in France in 1912 (Jung 2024). Holländer only cut out skin. Lexer lifted the skin over several centimeters and stitched to the deep fascia of the temple for a lasting hold, which is why a 2020 history calls him the first pioneer of the modern facelift (Locher 2020). Noël, the first woman cosmetic surgeon, operated under local anesthesia in her salon and argued that cosmetic surgery could help women keep their place in a workplace that discriminated against them (Olivetto 2019). Julien Bourguet, working in the same years, is also named a father of modern face lifting (Vrebos 1990).
From skin to the SMAS to the deep plane. The operation moved from small skin excisions to longer skin flaps, then to flaps of skin and neck muscle with work on the SMAS, and then to deep plane lifts that move skin and SMAS together as one layer (Luu 2021, Charafeddine 2019). Each step went deeper to put fallen tissue back where it started (Barrett 2016). A 2026 paper marks fifty years since the SMAS was first described (Mitz 2026). One program moved to the deep plane to lift the midface, jowls and neck vertically and to remove the signs of an operated face: scars behind the ear, a moved sideburn or hairline, and the swept-back look of tissue pulled toward the ear (Baylis 2000).
The forehead and midface. Lifting the brow has been part of facial rejuvenation for about a century; early attempts largely failed, results improved once surgeons treated the frown muscles, and the endoscope later made it possible through small incisions (Paul 2001). Midface surgery moved from small excisions to dissection in several layers, and its results came down to the direction of lift and restoring volume (Paul 2006).
Today. Extended deep plane and vertical neck lifts carry the release under the neck muscle to give a younger neck and jawline (Luu 2021), and one surgeon's composite deep plane results kept the neck angle improved for more than a decade (Perkins 2024). Across modern SMAS techniques, most patients were satisfied, temporary nerve weakness occurred in under 1 in 100, and one permanent nerve injury had been reported (Mortada 2024).
Where surgeons disagree
- Who did the first facelift. Historians name Lexer (Locher 2020), Bourguet (Vrebos 1990) or Pozzi (Glicenstein 2009), while archival work places cosmetic lifts decades earlier, outside medicine (Zhang 2026).
- How deep to go. No technique is the standard, and in recent decades some surgeons moved back toward less invasive lifts and toward adding volume (Barrett 2016). One practice kept SMAS plication and excision for 25 years with consistent results (Rohrich 2016); others moved fully to the deep plane (Baylis 2000, Perkins 2024).
What is new
- Archival documents push the cosmetic facelift back to the 1850s (Zhang 2026).
- The surgical net, first stitched to prevent bleeding under facelift skin, is now used in gliding brow lifts and the Glidelift and has spread to surgery outside the face (O'Daniel 2025).
- Recent deep plane techniques extend the release under the neck muscle (Luu 2021).
What is still unknown
- The full early record; much of it sits in lay magazines and scattered documents rather than medical journals (Denkler 2015, Zhang 2026).
- Which technique lasts longest. Long-term follow-up is hard to get beyond three years (Rohrich 2016), and many studies do not report every complication (Mortada 2024).
Key papers
- Denkler 2015: the forgotten American cosmetic surgery business of the 1800s.
- Zhang 2026: documents dating cosmetic face lifting to 1851.
- Locher 2020: Holländer, Lexer and the first undermined facelift.
- Olivetto 2019: Suzanne Noël, the first woman cosmetic surgeon.
- Baylis 2000: why one program moved to the deep plane.
- Paul 2001: a century of the brow lift.
- Luu 2021: the path from skin excision to the extended deep plane.
- Mortada 2024: outcomes of modern SMAS techniques.
- O'Daniel 2025: the surgical net from bleeding control to gliding surgery.