Surgical Facial Rejuvenation Techniques: Are They All Scientifically Valid and Anatomically Justified?

Background: Face lift procedures have evolved significantly, largely based on theories such as bone resorption, fat atrophy, fat compartment shifting, and ligament stretching. However, recent evidence questions the validity of these assumptions and, by extension, many current surgical techniques. This review aimed to assess whether existing face lift methods align with the principle of correcting age-related changes while preserving unaffected structures. Methods: A literature review of PubMed, Embase, and Web of Science identified 54 relevant studies published since 2005. These included longitudinal interpersonal studies, as well as cadaver and live subject analyses grouped by age. However, few intrapersonal studies exist, and most available research offers conflicting data with generally low levels of evidence, making definitive conclusions difficult. Results: Despite these limitations, there is reasonable evidence that challenges the anatomical assumptions behind many face lift techniques. Key findings indicate that the facial skeleton remodels rather than resorbs; some fat compartments hypertrophy, and not all migrate or shift; and facial retaining ligaments are robust, nonelastic fibrous structures. Conclusions: In conclusion, a modern understanding of facial anatomy and aging calls for a critical reevaluation of traditional face lift methods. Techniques should be tailored to address true anatomical changes associated with aging, while sparing structures that remain unaffected.