Facelift
A facelift repositions the deeper support layer of the face — not just the skin — to restore the jawline and midface. Pulling skin alone is what produced the tight, windswept results of decades past; modern technique works underneath it.
What is a facelift?
A facelift (rhytidectomy) treats the lower two-thirds of the face: the jowls, the jawline and the folds running from nose to mouth. Beneath the skin lies a fibrous sheet called the SMAS, which carries the facial muscles. With age this layer descends; a facelift lifts and secures it, and the skin follows.
It does not treat the forehead, the eyelids or skin texture. Fine lines, sun damage and pigmentation need resurfacing or injectables — which is why a facelift is often combined with blepharoplasty or fat grafting rather than done alone.
Techniques
Who is a good candidate?
- Visible laxity of the jawline, jowls or neck — usually from the late forties onwards
- Reasonable skin elasticity and a defined underlying bone structure
- Stable weight; significant weight loss after surgery undoes part of the result
- Non-smoker, or able to stop for at least four weeks before and after — smoking markedly raises the risk of skin loss
- Blood pressure well controlled, as hypertension is the main driver of post-operative bleeding
- Expectations of looking rested rather than looking like a different person
Preparation
- Photographic analysis from standard angles and agreement on which areas will and will not change
- Blood tests, ECG and anaesthetic review; blood pressure optimised beforehand
- Stopping aspirin, anti-inflammatories, fish oil and vitamin E about ten days before
- Stopping smoking and all nicotine at least four weeks before
- Arranging hair colouring before surgery, not after — dye must wait several weeks
- A companion for the first night and loose front-fastening clothing for discharge
How the operation is performed
The incision starts in the temporal hairline, runs in front of the ear following its natural creases, curves around the earlobe and continues behind the ear into the hairline. The skin is lifted, the SMAS is repositioned and fixed with sutures, excess skin is trimmed, and the wound is closed without tension — tension is what produces a stretched look and widened scars.
A thin drain is often left overnight to prevent fluid collecting, and a supportive dressing is wrapped around the head. Where a neck lift is included, a small incision is made under the chin to tighten the neck muscles directly.
Anaesthesia, duration and hospital stay
- Anaesthesia: general, or sedation with local anaesthesia for limited lifts
- Operating time: 3–4 hours for a SMAS lift; 4–6 hours for deep plane or combined procedures
- Hospital stay: one night, so the drain and dressing can be checked before discharge
- Stay in the country: 10–14 days, until sutures are out and the first swelling has settled
- Time off work: about two weeks for desk work; longer if you are publicly visible
Recovery, week by week
Results and how long they last
A well-executed facelift typically sets the clock back by around ten years, and that advantage is broadly maintained — you continue to age, but from a lower starting point. Most patients are satisfied for eight to twelve years before considering anything further.
Skin quality is not addressed by lifting. Sun protection, and where appropriate resurfacing or injectables, do more for texture and pigmentation than any surgical manoeuvre — and they are what keeps the result looking fresh rather than merely tight.
Risks and complications
- Haematoma — a collection of blood needing drainage; the most common early complication, and strongly linked to uncontrolled blood pressure
- Temporary numbness in front of and behind the ears, resolving over months
- Injury to a branch of the facial nerve — uncommon, usually temporary, rarely permanent
- Skin healing problems behind the ear, markedly more likely in smokers
- Widened, raised or visible scars, particularly with tension on closure
- Changes in earlobe position or hairline if planning was imprecise
- Asymmetry, and the usual anaesthetic and clotting risks of any operation
Cost and what should be included
Price is driven mainly by technique and operating time: a deep-plane lift combined with a neck lift and blepharoplasty is a very different operation from an isolated short-scar lift, and quotes should say which one you are being offered.
- Named surgeon's fee, and which specific technique is planned
- Anaesthesia and the anaesthetist's fee
- Operating theatre and the overnight stay
- Pre-operative tests, ECG and cardiology clearance if required
- Drains, dressings, compression garment and medication
- All follow-up visits during your stay, including suture removal
- The written policy on revision and on treating a haematoma if one occurs
Blood pressure matters more than you would expect
Haematoma is the commonest early complication of a facelift, and uncontrolled blood pressure is its strongest predictor. If your blood pressure is borderline, treating it properly before surgery does more for your safety than any choice between techniques.
Frequently asked questions
Will the scars be visible?
They are placed in the hairline and along the natural creases of the ear, so they are hidden in most views and settle to fine pale lines within a year. They are permanent, however, and become more noticeable if the skin was closed under tension or if you smoke. Ask to see photographs of healed scars, not just front-facing results.
Will I look like a different person?
No — a facelift repositions your own tissue rather than adding anything, so the aim is that people notice you look well without knowing why. The unnatural look associated with facelifts comes from pulling skin sideways under tension, which modern deep-layer technique specifically avoids.
How old should I be?
There is no correct age — it depends on how much laxity you have, not on the number. Most patients are between their late forties and their seventies. Operating earlier, on limited laxity, gives a subtler change and an easier recovery, but does not mean you will never need anything again.
Can I have a facelift instead of fillers?
They solve different problems. Fillers add volume; a facelift repositions tissue that has descended. If your concern is a heavy jawline or a loose neck, no amount of filler will fix it, and repeated filling can make the face look overfull. If your concern is hollowing, surgery alone will not restore volume.
Facelift or thread lift — which do I need, and at what age?
Threads suit mild early laxity, typically between thirty-five and forty-five, and buy you twelve to eighteen months. A surgical facelift repositions the deeper SMAS layer and removes excess skin, which is what genuine jowls and neck banding require; it usually starts to make sense after about fifty. Threads used on a face that needs surgery produce a brief, disappointing change and can make later surgery slightly harder.
How long does a facelift last?
Eight to twelve years for a deep-plane or SMAS lift, and around five for a skin-only lift. It does not stop ageing; it resets the clock, so you continue to age from a younger starting point and generally look about ten years younger than your untreated peers indefinitely. Smoking, sun exposure and major weight swings shorten this considerably. Most patients never have a second lift.
Will I look pulled or artificial?
The pulled look comes from tightening skin alone, which stretches the face sideways and flattens it. Modern deep-plane technique lifts the underlying muscle layer vertically and lays the skin over it without tension, so the change reads as rested rather than stretched. Tell your surgeon explicitly that a natural result matters more to you than maximum tightening — that sentence changes how the operation is planned.
Where are the facelift scars?
They start in the hairline at the temple, run along the front edge of the ear, curve under the earlobe and finish behind the ear in the hairline. Placed well, they follow natural folds and are hard to find once healed. The one to watch is around the earlobe: excessive tension there pulls it downward into a so-called pixie ear, which is difficult to correct and is a hallmark of an over-tightened lift.
How long is recovery, and when can I be seen in public?
Two to three weeks before you look presentable, and three months before the result is settled. Bruising and swelling peak on day three, drains and dressings come off within a week, and stitches at ten to fourteen days. Numbness in front of the ears lasts several months and is normal. Plan a full three weeks away from work and social commitments — this is not a procedure to rush back from.
Is there a risk of nerve damage?
Temporary weakness in a facial nerve branch occurs in a few per cent of cases and almost always resolves within three to six months. Permanent weakness is rare, under one per cent in experienced hands, and usually affects a small branch controlling the lower lip or eyebrow. Numbness of the cheek and ear is far more common and also temporary. This risk is the main reason surgeon experience matters more here than in most operations.
Do I need a neck lift as well?
Usually yes, and most modern facelifts include it as standard. The face and neck age together, and lifting only the face leaves an obvious mismatch at the jawline. If you have vertical bands, a double chin or loose skin under the jaw, ask specifically whether the plan includes tightening the platysma muscle in the midline — that step, not skin removal, is what defines the jawline.
What is the SMAS and why does it matter?
The SMAS is a fibrous layer between the skin and the facial muscles that carries the weight of the cheek and jowl. Because it holds the structure, lifting it is what produces a durable result; a lift that only tightens skin relies on tissue that stretches again within a couple of years. When comparing quotes, ask which layer will be lifted. A cheap facelift is usually a skin-only facelift under a different name.
Related reading
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Facelift or Thread Lift: Which at What Age?
They are not smaller and larger versions of the same thing. Threads move skin for a year; a facelift moves the layer underneath for a decade. A guide by age.
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Get a FREE Second OpinionThis page provides general information about this procedure; it is not medical advice, a diagnosis, or a treatment recommendation. Capital Oncology Group is a care-coordination service and not a medical provider. All procedures are performed by independent, accredited hospitals and licensed physicians, and the decision to operate must be made by a qualified surgeon after examining you individually.