Introduction The earliest recorded contributions to the field of facial plastic surgery come from ancient Egypt and India over 2500 years ago. In 1901, surgeons in Germany performed the first modern facelift, or rhytidectomy (G. rhytis, a wrinkle). In these procedures, they excised ellipses of facial skin without any tissue undermining. After World War II, following the advent of antibiotics and better tolerated anesthesia, the field of cosmetic surgery began to develop significantly. Facelift techniques advanced to include the creation of subcutaneous skin flaps and the excision of redundant skin, with some later techniques also featuring the suspension of the superficial fascia with sutures [1]. A major breakthrough in rhytidectomy occurred in 1974 with Skoog’s [2] publication of his technique of dissecting beneath the superficial fascia of the face and neck. This fascia, which is continuous with the platysma muscle, was coined the superficial musculo-aponeurotic system (SMAS) by Mitz and Peyronie [3]. During the past 30 years, various modifications and changes to these traditional SMAS facelift techniques have been devised. These have varied in scope, incisions and level of tissue dissection. Considering the wide variety of techniques currently available, there is significant debate amongst surgeons as to the optimal surgical technique for each type of patient. Before attempting to address this question, it is useful to review a classification of facial aging and the current variety of facial rejuvenation procedures. Baker’s classification of facial aging is listed in Table 1 [4]. His classification scheme rates patients based on how good a candidate they are for rhytidectomy. Although these authors consider this a useful evaluation tool, they prefer to consider these characteristics as the sequential temporally related changes of the aging face. As the patients move up in class, there are more issues to be addressed by the procedures. Also, this classification system does not address the issue of loss of facial volume with aging, which can be due to soft-tissue or osseous changes. Volume is also an important consideration, as we have all been in public and observed people who have obviously had facial-tightening procedures but still look old due to volume changes.