By David Jenkins
Few get to change the face of history. But Erich Lexer did – literally. In 1916, the German surgeon- sun-loving, ferociously fit and passionate about his Maybach 12 – performed what Rajiv Grover, president of the British Association of Aesthetic Plastic Surgeons, says was the first facelift: ‘Lifting the [sagging] skin from the underlying fat, drawing it back, re-draping it and then removing the excess.’
Of course, others had had a stab (sorry) at it. Poor Eugen Hollander reported the 1901 appearance of a once-ravishing Polish aristocrat at his Berlin practice, brandishing a drawing that showed how she believed her raddled visage could be tautened. Initially unwilling, Hollander became, he said, ‘the victim of the arts of feminine persuasion’, and did his patient’s bidding. But Hollander only excised skin at the front of the ear and closed the hole; he didn’t lift, as Lexer did – something that was both longer-lasting and more visually pleasing. No wonder Lexer was also an accomplished sculptor; great cosmetic surgeons are Michelangelos of the scalpel.
Where Lexer led, others followed, among them the first female plastic surgeon, Suzanne Noël, who operated on the crème de la crème of Parisian society, and wrote a book, La Chirurgie esthétique: Son rôle social. Secretly social might have been more precise: Dryden’s ‘God did not make his works for man to mend’ was the medical establishment’s watchword, and aesthetic surgery was disdained – though when Fanny Brice, the original ‘Funny Girl’ Barbra Streisand played on film, had a nose job in 1923, it became one of the most talked about and copied procedures in American history. (Not always successfully: the millionaire art collector Peggy Guggenheim’s surgeon gave up halfway through her rhinoplasty and left her with a nose ‘like an eggplant’.)
Amazingly, what Lexer pioneered remained the cutting (sorry, again) edge of facelifting for nearly 60 years, even though it tended to result in a tight, ‘windswept’ look, with giveaway pixie ears, due to the pulling tight of skin. Indeed, by the late Sixties, John Paul Getty, the world’s first billionaire, was a walking illustration of that look. He was a typical client: in this era, it was the world’s rich and famous who opted for the knife, the Duchess of Windsor reportedly among them.
She should have waited for the early Seventies. That’s when Dr Paul Tessier described the SMAS – or superficial muscular aponeurotic system. This, says Grover, his brown eyes alive with enthusiasm, is ‘soft tissue in the face that contains something analogous to muscle but is also surrounded by fat. It’s the layer that goes south as we age, and that’s what changes the shape of the face from heart-shaped or triangular to more square-looking. And unless you tighten more than the skin, you’re not going to change the shape and you’re not going to rejuvenate in a natural and holistic way that’s long-lasting.’
Bingo! The new operation was a SMAS hit, and glamorous surgeons like Ivo Pitanguy – the dashing Brazilian with his own island off Rio and a clientele rumoured to include Salvador Dalí, Betty Ford and innumerable socialites and film stars – prospered. As did skilled practitioners in Harley Street, Beverly Hills and Manhattan’s Upper East Side. (South America loved plastic surgery too, and in Argentina the late President Menem was happy to detail the work he’d undergone.)
But more change was on the way in the early Nineties. In Dallas, Dr Sam Hamra started to popularise the ‘deep plane lift’ – which released the face at an even deeper level than the SMAS lift, and was thus, says Grover, ‘anatomically very clever’. The downside was that it was more invasive, left the patient looking a fright to start with and required one to two months downtime before they began to look normal again. Which wasn’t for everyone – and also didn’t reflect the climate brought about by the advent of Botox and fillers.
Where once there’d been nothing between face creams and a lift, there was now a halfway house. Ally that to what Manhattan’s Dr Daniel Baker was doing, beautifully, by 2001 – essentially SMAS, with the emphasis on quicker recovery, shorter scarring and a clientele who wanted to get back to socialising, working and acting in 10-14 days – and you’re pretty much where the action is these days. Lunchtime lift, anyone?
All this is aided by dramatic improvements in anaesthesia, intravenous-fluid monitoring and what’s called the tumescent technique – a cocktail of fluids injected into the face during surgery that includes adrenaline to reduce bruising, a small dose of steroids to minimise swelling and, adds Grover, ‘an enzyme called hyalase that allows us to dissect with much less trauma’.
The result is what Grover calls ‘pressing the facial pause button. That means that, between the ages of 48 and 68, you can more or less look the same, via a combination of non-surgical maintenance and two to three surgical procedures. It’s slow motion [ageing].’ And not what Carrie Fisher fears: ‘looking like a weird fish with gills’.
So there you have today’s lift: ultra-modern, ultra-convenient and just what that Polish aristocrat would have dreamt of.