The need for facial skin rejuvenation has led to a wide range of technological advances, including traditional and modern facial lifting and other related rejuvenation procedures, soft-tissue fillers and Botulinum Toxin Injection, laser skin resurfacing, radio frequency skin tightening, as well as chemical peeling, physical resurfacing, and chemical peeling. The old and new technologies, such as laser skin resurfacing and radio frequency skin tightening, as well as chemical peeling and dermabrasion, are all evolving rapidly, but none of them has all the required features. No one technique has all of the desired characteristics. Understanding and appreciating the advantages, disadvantages, and advances of each rejuvenation technique is important to appropriately guide the candidate in their choice. The history of facial rejuvenation treatments begins with the history of surgical wrinkle reduction, dating back 2,500 years to Egypt and India. in 1901, German physicians performed the first modern face lift by simply removing excess skin without tissue separation. After World War II, the facelift evolved from the removal of excess skin with subcutaneous tissue to suspension with superficial fascial sutures, and in 1974, Skoog proposed the landmark subfascial separation of the superficial fascia of the face and neck for wrinkle reduction, and then Mitz and Peyronie named this layer of fascia continuous with the vastus cervicis muscle the superficial musculoaponeurotic system ( superficial musculo-aponeurotic system, SMAS) [1]. Over the past 30 years, there have been many new inventions and improvements based on the scope, incision, and separation levels of the traditional SMAS facelift, and as a result, much controversy has arisen, with the following general history of development and categorization: Traditional superficial musculo-aponeurotic system SMAS lifting surgery The typical traditional SMAS lifting procedure consists of the freeing, lifting, and repositioning of the cervicofacial skin and the repositioning of SMAS/latissimus cervicis muscle as a unit. / broad cervical muscle as a unit of repositioning. The extent of skin incision and release varies from person to person. Regarding incisions, Kridel recommends the shortest possible incision along the anterior ear screen margin, to the temporal turning horizontal, and the posterior incision along the auricular nail; regarding the extent of subcutaneous release, Thomas Baker recommends dissecting the lateral 2/3 of the zygomatic prominence area, reaching forward to the lateral nasolabial folds a few centimeters, to facilitate the tightening of the medial zygomatic skin by rotation of the SMAS; the dissections underneath the SMAS anteriorly reaches the anterior border of the parotid gland, the flap is tightened posteriorly and superiorly, and the posteriorly inferior excess SMAS is fixed to the mastoid process of the temporal bone [1]. Deep and composite face lift In response to the above mentioned shortcomings of traditional face lifts that did not emphasize the correction of zygomatic fat pad sagging, Hamra (1986) proposed a deep face lift including the zygomatic fat pads, cervical vastus lateralis muscle, and skin, which was improved and named as a composite face lift in 1992: a composite flap of tissues, including orbicularis oculi muscle, was lifted from the deep surface of the SMAS with the intra-operative blood supply coming from the facial arteries, the medial canthal artery and the infraorbital artery. The deep surface of the SMAS is lifted to form a thick, blood-supplied tissue flap including the zygomatic fat pad [2].Kamer [3] conducted a prospective study of 100 patients who underwent a deep facelift, and 97% of the patients were satisfied with the results of the procedure.In 167 patients with a composite facelift reported by Hamra [2], there was 1 case of a hematoma that needed to be aspirated, and there were no complications of complications of facial nerve injury. Endoscopic Wrinkle Reduction As more and younger people seek facial rejuvenation procedures, the emergence of endoscopic wrinkle reduction caters to the demand for less invasive procedures, fewer perioperative and postoperative complications, a natural appearance, and a longer maintenance period. The American Society of Plastic Surgeons (ASPS) has conducted a survey showing that about half of the doctors choose to complete the brow lift through the coronal incision, and most of them believe that it can achieve more ideal results than the endoscopic procedure in lifting the brow, reducing the forehead lines and the lines between the eyebrows, and the older the doctor, the more they like to choose the coronal incision. However, with improved fixation techniques, Dayan (2004) designed a rigorous retrospective study and concluded that a one-year follow-up comparison between coronal incision and endoscopic brow lifting suggested no significant difference in the degree of brow elevation, and that the same brow shape and positional sagging was seen after the fifth year of coronal incision debridement. Small-incision facelift While endoscopic wrinkle reduction has evolved, there has been a search for small-incision facelifts with less trauma, quicker recovery, and fewer complications that do not require complex instrumentation. These types of procedures are attractive because they reduce or avoid the postauricular incision, narrow the flap dissection, and can be performed under local anesthesia or local anesthesia + sedation. Serrated (anchored) suture suspension The use of suspension sutures with barbs or anchors to achieve facial lifting by guiding the needle through the soft tissues has recently received a lot of attention.Sulamanidze [9] first described these polypropylene suspension sutures with multiple barbs in 2002.The sutures are placed in the areas that need to be lifted such as the zygomatic buccal region, the tail of the eyebrow, and the lower part of the chin, and the sutures are inserted subcutaneously at a depth of about 1-2 cm. The needle is inserted subcutaneously and exits after traveling through the subcutaneous fat layer at a depth of approximately 1-2 cm. The upper end is lifted and tightened to the desired position, and the ends of the sutures are cut and buried in the skin. The longest follow-up time was up to 2.5 years with good results. Overcorrection and localized dimpling of the skin may disappear on their own. It can be combined with an open approach. Other similar sutures, such as the facial contour molding suture, which was approved by the FDA in 2005; and, for example, the nodular anchor body absorbable suspension suture (PDS or Maxon), reported by Eremia [10] (2006), most of which showed relaxation at the 6-12-month follow-up; as an initial study, the risks of suture exposure, suspension dislodgement, and asymmetry are all complications that are prone to arise Additionally, there is more concern about its long-term efficacy. From the evolution of facial rejuvenation surgery described above, it seems that surgery has moved towards a quest for complete results, but it has also meant increasing complexity and invasiveness, and in recent years, multiple, less invasive and minimally invasive treatments have challenged the trend of this surgical paradigm.Ivy’s prospective, semifacial controlled study of 21 cases (1996) was a randomized study comparing the traditional SMAS wrinkle reduction with extensive composite SMAS wrinkle reduction with separation of the zygomatic fat pads, nasolabial folds, and lifting of the orbicularis oculi muscle. No difference was seen between the six-month and one-year follow-ups of the extensive SMAS composite wrinkle reduction procedure [11].Prado [12] showed no difference in outcomes at one-month and two-year follow-ups between half of the traditional SMAS procedures and the other half of the MACS lifts in a retrospective study of 82 patients between the ages of 42 and 55 years. Skin laxity of the neck and mandibular margin was reproduced in half of both at 2 years postoperatively. More semifacial controlled studies of suspension and conventional wrinkle reduction had similar findings, suggesting the inevitability of more research focusing on minimally invasive procedures. Non-surgical wrinkle reduction techniques Facial rejuvenation has been an increasingly important topic in the field of cosmetic surgery, and traditional wrinkle reduction surgery is no longer a soloist, but has added a number of preludes and accompaniments. The lackluster rise in the amount of literature on traditional wrinkle reduction procedures and endoscopic wrinkle reduction is more related to the development of non-surgical wrinkle reduction techniques. It is precisely because facial skin aging includes not only tissue laxity and displacement and skin wrinkle formation, but also a combination of loss of volume, changes in skin texture and color, and vascular dilation. Therefore, in addition to the use of surgery to achieve skin lifting and tissue (fat) filling and resetting, facial rejuvenation also includes non-surgical treatments such as chemical peels, physical grinding, soft tissue filler materials, botulinum toxin injections, and laser radiofrequency, which are aimed at photodamage of the skin surface, loss of volume and skin laxity, and dynamic vs. static wrinkles, respectively, with the fields of laser, radiofrequency, and plasma being the fastest advancing aspect [ 13]. In the case of radiofrequency, for example, there has been a constant attempt to find a better balance between efficacy and risk, from uni- and bipolar radiofrequency in the past to tri-pole radiofrequency, and from non-invasive electrodes in the early days to the newest invasive and minimally invasive electrodes [14]. In terms of the direction of development, radiofrequency treatments for deep wrinkles and skin laxity, fractional lasers and fractional radiofrequency for skin texture and static fine lines, and plasma skin rejuvenation for skin aging are all a new beginning in the process of non-surgical rejuvenation. Although some treatments have not yet been able to achieve the effect of injectable wrinkle reduction, much less replace surgical wrinkle reduction, the rapid development of technology will inevitably lead to such treatments having an ever-expanding list of indications. How to dynamically recognize and evaluate, scientifically treat the indications of various treatments, and more correctly and objectively serve the aesthetic patient has forced plastic and cosmetic surgeons to slow down and become more involved in and concerned with the skills and advances in the full range of non-surgical rejuvenation treatments. In addition to the need for us to continue to learn and practice and to be fully aware of dynamic technological developments, a variety of factors need to be taken into account when deciding exactly which treatment is appropriate for a particular candidate, taking a detailed history, analyzing the main causes of concern about appearance, examining and considering the anatomical factors associated with facial aging, evaluating the degree and location of laxity, skin and soft tissue conditions, tissue levels involved in sagging, facial soft tissue volume, deep bone tissue contours, previous scarring hyperplasia, gender and personality. On this basis, one can start to consider the choice of treatment options, and it is important to discuss the details of the treatment with the candidates themselves, informing them of the empirical results of the improvement in each area after the surgery [15]. The concept of facial rejuvenation treatment is also evolving, for example, in addition to the resetting of sagging tissues, the improvement of facial soft tissue contour by fat injection and the improvement of overly hypertrophied zygomatic bones after osteotomy can be subjectively and objectively evaluated to obtain a certain degree of rejuvenation of the results. Therefore, the connotation of the treatment will be continuously enriched to include facial rejuvenation treatment in a broad sense. The organic combination and balance of concepts and indications, techniques and equipment, function and aesthetics, maintenance time and recovery time will continue to evolve and continue to achieve results that were not possible in the past. A complete understanding of facial rejuvenation therapy needs to be based not only on a thorough understanding of surgical and non-surgical techniques, but also on the incorporation of a deep understanding of scientific, artistic and social factors by the operator. Ultimately, however, analysis of the results of properly designed prospective studies based on the principles of evidence-based medicine will lead us to a clear consensus.