Facelift

Published: 07/23/18

If you have been dreaming of returning to a younger version of yourself, free of wrinkles and loose, sagging skin, then facelift surgery - also known as rhytidectomy - may be an option worth considering. Facelifts offer a means of manipulating deeper facial tissues in the effort to restore youthful contours, leaving you with a refreshed appearance. This guide will provide you with a comprehensive outline of everything you need to know before you set foot in your surgeon’s office.

Before surgery

What is a facelift and what does it achieve?

Across cultures, the face constitutes one of the most symbolic and significant elements of the human body. Physical appearance is important to human beings and more than any other part of the body, the attractiveness of one’s face affects a range of critical social outcomes. One’s facial characteristics bear an influence on relationships, jobs, general confidence and self-esteem.

Rhytidectomy, or facelift surgery, visibly diminishes the inevitable aging of the face that occurs over time and restores aesthetic harmony. As we age, our facial muscles simultaneously loosen and tighten, which in turn creates sagging skin and wrinkles. Rhytidectomy reverses the effects of aging by tightening loose skin around the lower face and neck, then repositioning facial tissues to give tauter, more youthful facial contours. Facelifts can also be used to correct facial anomalies.

The loss of a youthful appearance can be caused by a range of factors that may occur on their own or in conjunction with other influences, including

  • Heredity (genetics)
  • Environmental factors such as skin damage due to prolonged sun exposure
  • Stress
  • Personal habits (i.e. smoking, yo-yo dieting)
  • The downward pull of gravity

These factors often render marked effects on the aging face, and may result in:

  • Crow’s feet (lines at the corners of the eyes)
  • Wrinkles or deep creases on the forehead
  • Slackening of the jawline, resulting in jowls
  • Softening of the chin, or excess fatty deposits under the chin creating the appearance of a double chin
  • Deep creases beneath the eyes
  • General loss of skin tone and elasticity in the connective tissue (elastosis)
  • Creases extending from the nose to the corner of the mouth (deep nasolabial folds)

While facelifts won’t stop a face from aging, they do offer patients a way to drastically turn back the clock and slow down the process. Facelifts may be had in conjunction with other cosmetic surgical procedures like eyelid surgery (blepharoplasty), neck and/or brow lifts (the latter also known as a forehead lift or browplasty) for more complete facial rejuvenation.

With humans living longer than ever before, and most of us compelled to keep the visible signs of aging at bay, it’s no surprise that the facelift has been ranked by the  American Academy of Facial Plastic and Reconstructive Surgery as the third most desired plastic surgery procedure in the United States.

The facelifts rise in popularity

Facelifts have risen in popularity in recent years as the result of constantly evolving technologies, increasing affordability, less invasive procedures and shorter recovery times. In 2015, more than 125,000 American women underwent rhytidectomy.

Dr Scott Miller, a plastic surgeon based in San Diego, CA, explains that as innovations in the technology produce ever finer results, facelifts have become more desirable than ever. Patients can now enjoy the restoration of a youthful and refreshed appearance that is far more natural-looking than in recent years gone by.

Facelifts offer a proven means of facial rejuvenation for those seeking a robust method to alter the signs of aging. Whilst non-surgical facial treatments such as Botox or dermal fillers are effective to a certain degree, facelift surgery consistently offers more dramatic results with increased longevity. Dr Miller notes that following a facelift, patients appear years younger, well-rested and healthy.

Benefits of facelift surgery

Facelifts offer a range of benefits, including:

  • Tightened and smoother skin around the face, neck and jawline
  • The removal of excess fat from the face, particularly the chin area
  • The smoothing/softening of wrinkles or deep creases
  • The elimination of loose skin
  • The tightening of facial muscles
  • A youthful and well-rested appearance

However, the most meaningful benefits of facelift surgery are often more intangible by nature. Dr. Eric Swanson, a plastic surgeon based in Kansas City, argues that the strongest indicators of a successful facelift surgery are determined by the levels of patient satisfaction and an improved quality of life. Most patients who’ve had facelift surgery claim the most significant benefits they gained from the procedure were increased self-esteem and confidence.

A 2015 study in the journal of Plastic and Reconstructive Surgery asserted that patients demonstrated very high levels of satisfaction with their appearance and quality of life following surgery. Ninety percent of patients reported benefits such as greater confidence in social settings, while another 93 percent reported improved psychological well-being. The most marked improvements following surgery were seen in the softening of nasolabial folds, cheeks, the lower face and jawline.

Another recent study, a follow-up on 93 patients who underwent facelift operations in 2011, reported that over 96 percent of respondents agreed that they perceived themselves as having a more youthful appearance following surgery, with an average of 11.9 years subjective reduction in apparent age. Slightly more than 94 percent of post-surgical facial patients agreed that their facelift was a worthwhile endeavor, with many commenting that following surgery everyday aspects of life, such as looking in the mirror or having their photo taken, no longer filled them with dread.

Many patients who have undertaken facelift surgery attest to the power of the procedure to reinvigorate their life and strengthen their sense of self-worth, proving that the benefits of facelift surgery run far more than skin deep.

Are you a good candidate for a facelift?

Most surgeons agree that the best facelift candidates have realistic expectations about what the surgery will do for them, and understand the importance of why they need to closely follow their surgeon’s pre and post-operative instructions. For the very best results, however, it’s essential to arrange a one-on-one consultation with  a plastic surgeon so you can receive professional, personalized advice about which procedure will be most appropriate for you.

To determine if you’re a suitable candidate for a facelift there are several important factors to contemplate that will ultimately impact the efficacy of the procedure.

Age

According to Dr Brooke Seckel, a plastic surgeon based in Boston and internationally recognized authority on facial aging, waiting until the facial signs of aging are severe reduces the likelihood of achieving the best results. Dr Seckel says that for most people, noticeable changes to their bodies caused by aging start to become apparent as they’re approaching their late thirties.

Taking action early and booking a facelift while still in your forties or fifties is alleged to prevent physical changes caused by aging before they become permanent. Furthermore, people in their forties and fifties are healthier, with fewer medical issues than those in their sixties, meaning there is a greater probability of experiencing a more rapid recovery.

Dr John Hilinski, a double-board certified facial plastic surgeon from San Diego adds, “There is a benefit to undergoing facelift surgery earlier rather than later. If you prove to be a good candidate for the procedure in your 40s, you can enjoy your results for longer and also benefit from the refreshed appearance during a time that is often important for one’s career. In addition, by addressing facial aging before it has become severe, you can achieve enhanced results and the ability to age more gracefully over time.”

Gender

While facelifts have traditionally been sought by women, rhytidectomy is equally effective for men seeking facial revitalization. The 2015 Plastic Surgery Statistics Report released by The American Society of Plastic Surgeons (ASPS) notes that facelifts are the fifth-most popular surgical procedure among American men.

With that in mind, there are specific considerations men need to take into account before undergoing rhytidectomy. For example, it’s vital that surgeons take care to avoid rendering their male patients with a feminized appearance through alterations to their hairline. The surgical procedure itself may also be more challenging as men have broader faces, heavier necks, stronger ligament support structures, and thicker skin. The most effective procedures create a more youthful appearance through contouring of the neck and jawline.

RELATED: Dermal Fillers For Men: How To Avoid The Dreaded Chipmunk Face

Skin elasticity

A good candidate for a facelift will have skin that has retained its natural suppleness. Supple skin is important because during the procedure the surgeon will tighten the skin to smooth out wrinkles, and successful healing depends on the skin’s capacity to adjust to its new contours. Skin elasticity may be affected by factors such as one’s genetic background, a history of “yo-yo” dieting, acne scarring and exposure to sun. Dr Richard Rand, a plastic surgeon located in Bellevue, Washington notes, “Seriously sun-damaged skin will never achieve the same result from a facelift as skin that hasn’t been damaged by sun”.

Bone structure

Well-defined bone structure can significantly enhance the effects of rhytidectomy, with some surgeons asserting that strong facial bone structure forms the cornerstone of a successful facelift. Defined cheekbones and chins help facelifts to last longer, which is, of course, not to say patients lacking strong underlying bone structures cannot undergo satisfactory facelifts. Patients with less distinctive features can most certainly benefit from acquiring facial implants or fat transfers to support facelift surgery.

Health

Facelift surgery represents one of the more invasive aesthetic surgical procedures, therefore being in a state of good health prior to surgery is advantageous, and can help ensure you receive the best surgical outcome possible.

Dr Robert Tornambe, a plastic surgeon in New York City, asserts that adopting a healthy diet during the pre-operative period can enhance facelift results. “For many plastic surgical procedures, reaching an ideal weight greatly enhances the final result. Operations such as breast reduction and augmentation, abdominoplasty (tummy tuck), liposuction and even a facelift are positively impacted by weight loss prior to surgery and maintenance afterward. I often counsel patients that liposuction is not a weight loss tool, and if weight loss is planned and or desired, it is best to try to reach that goal prior to surgery. When this is accomplished, the surgical result is improved.”

All plastic surgeons also emphasize the importance of giving up smoking before having a facelift. In addition to accelerating the aging of the face, smoking also carries serious risks for facelift patients. Dr Robert Singer, a plastic surgeon in La Jolla, California explains: “Exposure to smoke, either directly or indirectly, or the use of any nicotine-releasing products, has been shown to increase the incidence of serious complications after facelift surgery and in most other cosmetic or reconstructive procedures. Most plastic surgeons refuse to perform facelifts on patients who are active smokers or are using nicotine in any form.”

He recommends that patients preparing to undergo a facelift cease smoking or using nicotine releasing products at least 10- 14 days before a facelift, and for at least 10-14 days after the surgical procedure. Specifically, tobacco use can decrease blood flow to the skin. Dr Singer adds, “All wound healing depends on blood supply. The blood flow to the skin and underlying tissue is diminished by smoking, which constricts the small blood vessels. Smokers have a significantly higher rate of delayed healing, infection, opening of the incisions, necrosis or loss of the facial skin that is elevated and the underlying tissue, poor scarring, and anesthesia problems.”

Types of facelifts

Facelift procedures and techniques are constantly evolving and diversifying. Furthermore, different facelifts target specific regions of the face, differ in the type and quantity of incisions required, and vary in the length of time needed to recover from the surgical procedure. With such a wide range of factors to contemplate, it can lead to confusion about what’s available and most appropriate for your needs and budget. These are the five most popular and common variations of the surgical facelift:

  • Deep plane lift
  • SMAS facelift
  • Mid-face lift
  • Short scar lift
  • Endoscopic facelift

Each of these facelifts is outlined in more detail below, with emphasis placed on what takes place during surgery, the advantages and disadvantages of each procedure, the candidates who benefit most from this type of surgery, and the approximate costs.

Deep plane lift

What is a deep plane lift?

Medical studies have shown that the deep plane offers the longest-lasting results of all facelift surgeries, with effects visible for ten to fifteen years afterwards. It is also credited with providing a more natural appearance, avoiding the “pulled” look of some facelifts by going deeper under the skin, beneath the SMAS layer. The SMAS, or superficial musculoaponeurotic system, is located beneath the skin which envelops the muscles that are used for facial expressions, like smiling or frowning. The deep plane lift is, however, a more technical surgical procedure than most other facelifts, requiring a deeper level of dissection and demanding a greater level of expertise from the surgeon.

What happens during surgery?

  • Tiny incisions are made along the hairline
  • The SMAS is lifted and separated from the skin
  • After the separation of the SMAS layer from the skin, the “deep plane” is entered when the surgeon goes beneath the SMAS to release attachments
  • The surgeon redrapes the SMAS layer and the layer of skin above it in a more youthful position that is free of the tensions that cause wrinkles and creases
  • Following the repositioning of the SMAS, loose and excess skin is removed, and in some cases, the skin and muscle tissues reshaped
  • The skin and SMAS is then pinned into place with sutures (stitches) or staples.

Deep plane lifts may be combined with an eyelid lift (blepharoplasty), forehead lifts (brow lifts) and sometimes neck lifts, to enhance the overall final result.

Advantages

The deep plane lift allows improved access to the mid-face (which encompasses the area below the eyes, the sides of the nose, and above the mouth). The loss of volume and descent of fat pads in this region represents a significant component of facial aging that may not be sufficiently treated by more traditional facelift techniques, such as the SMAS lift.

The cheek ligaments are released and cheek fat pads and muscles (also known as the malar fat mound) are elevated. Access to this area allows the surgeon to reduce deep nasolabial folds, rejuvenating the midface region.

Less downtime is yet another advantage of the deep plane facial. There’s less swelling and less chance of scarring, meaning it is possible to return to work and your social life after two weeks.

Disadvantages

One of the risks posed by the deep plane lift procedure is the possibility of provoking facial nerve damage by dissecting below the SMAS layer. A deep plane lift requires a surgeon with years of training and extensive knowledge of facial nerve and muscle systems to even consider performing a deep plane facelift. There are a limited number of surgeons who are sufficiently qualified to safely and effectively carry out the most demanding of all facelift procedures.

“When performed by an expert, complication rates are are no different to other facelift procedures, but the results are highly eloquent and many times more natural," says Dr Ben Cilento, a surgeon in Houston, Texas that specializes in the deep plane facelift.

In addition, because the deep plane lift is a more extensive surgical procedure which accesses deeper facial tissue, the healing process for these lower layers is more prolonged. The healing will not be obvious to the casual observer, however, as there is no telltale swelling.

The most suitable candidates for deep plane lift facelifts include:

  • Older patients
  • Individuals with severe facial sagging and laxity
  • Those who want to look refreshed and well-rested while avoiding any telltale or overtly obvious signs of having had work done
  • Individuals who do not want to undergo multiple facial surgical procedures may elect to undergo deep plane lift facelifts because of the longer lasting results.

Estimated cost

A deep plane facelift typically costs between $12,000 and $15,000. The price is influenced by a range of factors: the surgeon’s fee, the cost of the facility, the cost of medication, and the cost of anesthesia.

RELATED: How Long Does A Facelift Last? 5 Tips For Maintaining Surgery Results

SMAS facelift

What is a SMAS facelift?

Some surgeons refer to the SMAS as the ‘traditional’ facelift. Similar to the deep plane lift, the SMAS lift repositions the SMAS layer, a relatively thin layer of supporting fascial tissue, but does not venture beneath it. A SMAS facelift reduces and in some cases, visibly reverses, the effects of aging by manipulating the skin, fat, and musculature of the face, providing patients with a revitalized visage.

There are different types of SMAS lift, such as the LiteLift or the LifeStyle Lift that vary in the degree to which the SMAS layer is lifted or manipulated. According to Dr Larry Nichter, a plastic surgeon in Orange County, California who serves on the committee of the American Society of Plastic Surgery, “In many cases there are more similarities than differences between these procedures as they share the use of smaller incisions, quicker recoveries, and are often done under local anesthesia with oral sedation. Differences are more often related to the surgeon’s experience and preference of surgical technique.”

What happens during surgery?

  • An incision is made at the temple, above the hairline
  • Cuts are made along creases already present in the skin, usually in front of the ear, below the earlobe and behind the ear.
  • The surgeon surgically elevates the SMAS layer, which in turn elevates the soft tissue and facial structure
  • The SMAS layer may be folded and re-attached to itself, known as SMAS plication, or
  • The SMAS layer may be lifted, tightened and the redundant portion of SMAS excised to be reattached in the uplifted position, known as an SMAS resection, or SMASectomy
  • The skin is reattached or stitched up using sutures or staples.

Advantages

The SMAS lift is effective in smoothing out and refreshing the tissues of the upper layers of the face, which have a tendency to sag with age. The traditional SMAS lift offers greater longevity than its “mini” counterparts. As the surgeon does not venture beneath the SMAS layer, it’s also safer with less risk of nerve damage.

Disadvantages

Healing and recovery from a SMAS lift requires a significant chunk of time with bruising and swelling normally taking around two weeks to reside. There may also be more scarring compared to less invasive facelift surgeries.

The best candidates for SMAS facelifts are:

  • Those aged 45 years of age or older
  • Individuals with neck laxity
  • Individuals with jowling (sagging around the jawline)
  • Individuals with mid-face sagging
  • Those with loose skin
  • Those with deep wrinkles or creases

Estimated cost

Depending on the variation of procedure used and the extent of the work carried out, a SMAS lift can cost anywhere from $6000 to $15,0000.

Mid-face lift

What is a mid-face lift?

According to Los Angeles mid-face lift specialist Dr Robert Goldberg, a mid-face lift can powerfully rejuvenate one’s appearance by addressing the deflation and descent of the malar fat pad or mid-face, which strongly betrays signs of aging. A mid-face lift is achieved through the vertical suspension of the mid-face tissues and possible volume augmentation such as fat injections. Mid-face lifts may be performed on their own, or to complement other facelift procedures such as the SMAS, which in general target the lower one to two thirds of the face.

What happens during surgery:

  • Small cuts are made in the hairline and the inside of the mouth
  • Alternatively, a mid-face lift can be performed endoscopically through the temples, or  through the lower eyelids for reduced recovery time and greater precision
  • The cheek may be re-inflated with a substance such as Sculptra
  • The natural fatty layer that sits over the cheekbones is vertically elevated, repositioned, and pinned into place, giving higher mid-facial curves.

Advantages

Effective mid-face lifts can bestow a more youthful countenance by creating higher mid-facial curves while maintaining the personal features of the patient and lessening the hollowing of the cheeks and lower eyelids. Many surgeons note that a mid-face lift is a relatively subtle, “freshening-up” procedure. There is less risk and recovery time when compared to more invasive procedures.

Disadvantages

One of the advantages of the mid-face lift also constitutes one of its main weaknesses. The subtle effects of the procedure may not offer a sufficiently dramatic difference for those seeking complete rejuvenation, but rather, leave the patient with more modest, natural looking  improvements. Nonetheless, the midface represents a central consideration in any facelift surgery, and effective improvement in this area can render a marked difference to one’s overall appearance.

Another possible disadvantage is lower lid swelling should the surgeon elect to conduct the surgery through the lower eyelids, a notoriously sensitive area. However, many surgeons who carry out mid-face lift surgery are nowadays opting for endoscopic surgery, which has minimal chances of scarring or swelling.

The best candidates for mid-face lifts include:

  • Individuals in their thirties to fifties with heaviness below the cheeks
  • Individuals with deep nasolabial folds or creases
  • Individuals seeking cheek elevation who do not need lifting in the chin or neck

Estimated cost

A mid-face lift is typically priced between $6,000 and $10,000.

Short scar lift

What is a short scar lift?

“Short scar” facelift, or limited incision facelift, refers to the incision or scar pattern that characterizes this type of lift. The short scar lift is a less invasive surgical procedure designed to re-suspend the tissues that support the central and lower face, softening the nasolabial folds, reducing jowls and adding definition to the jawline. There are different variations of the short scar lift, including the MACS technique (Minimal Access Cranial Suspension lift), or the mini facelift, sometimes referred to as the weekend facelift.

What happens during surgery?

  • The surgeon will usually make an s-shaped incision at the temple or in the hair in front of the ear. (Unlike the deep plane lift or SMAS lift, the incision will not extend behind the ear.)
  • The small incision nonetheless allows the surgeon to access the SMAS (superficial muscular aponeurotic system) layer.
  • The SMAS is repositioned through the incision, allowing a moderate amount of loose skin on the face to be tightened.
  • Neck liposuction may accompany a short scar facelift to correct the fat pads that sit underneath the jaw.

Advantages

A short scar lift, such as a mini lift, can be performed in a surgeon’s office with local anesthesia. The recovery is more rapid, with some patients returning to work in as little as two days, plus there is less swelling and bruising. For individuals who like to wear their hair pulled back, there is no scarring behind the ear as there could be with a deep plane or SMAS lift. Combined with other procedures such as an upper-lid or lower-lid blepharoplasty, a more comprehensive facelift result can be achieved.

Disadvantages

The short scar lift has limited efficacy in addressing loose, sagging skin around the neck. Dr Joe Niamtu III, a plastic surgeon based in Midlothian, Virginia and fellow of the American Academy of Cosmetic Surgery, believes that that a short scar lift may cheat a patient should a more extensive facelift be more appropriate. He asserts, “ If a patient is going to put the time, effort and money into a facelift, they might as well select one that will do the most and last the longest. To forego a traditional lift to save several inches of incision or shorten recovery by five days is not a deal in my mind when compared to the more comprehensive result they could have.”

Dr Timothy Miller, a board-certified plastic surgeon based in Aliso Viejo, California who specializes in specialist in face and neck lift surgery adds, “When deciding which facelift is best for you, don't get too hung up on scar length. Shorter doesn't always mean better and longer doesn't mean worse. Often, too short an incision can commonly leave puckering or an un-natural orientation of skin. A meticulous facial plastic surgeon can hide scars so they are nearly invisible regardless of their length. In other words, the more important issue or question is where the incision is placed and how it is closed. Keep this in mind during your consultation."

The best candidates for short scar lifts include:

  • Individuals primarily looking to refine the features of the central and lower thirds of the face around the cheeks and jawline
  • Individuals who do not have large amounts of loose neck skin
  • Those who want to minimize surgical scarring
  • Those in their late thirties to late forties who have relatively good skin elasticity and are seeking facial rejuvenation

Estimated cost

Short scar facelift procedures are typically priced between $6,000 and $10,000, depending on the extent of the surgery.

Endoscopic lift

What is an endoscopic facelift?

The endoscopic facelift, also known as an endoscopic mid-face lift, is a  procedure which uses an endoscope to target the mid-face. An endoscope is a small pencil shaped probe with a tiny camera and light attached to it which in turn helps the surgeon to visualize the treatment area without the need for a large incision

Sometimes cosmetic problems are confined to one area of the face, such as the mid-face region, which is one of the most prominent elements of face to betray age due to the hollowing of the cheeks. Endoscopic facelifts are primarily  used for access to the mid-face region to address cheek sagging, and as a result, offer limited improvement to the neck and jowl region. They are generally performed on an outpatient basis, as they use local or intravenous anesthesia. Brow lifts can also be performed using endoscopy.

What happens during surgery?

  • During an endoscopic facelift, the surgeon will insert an endoscope beneath the skin via three or more incisions all less than one inch long
  • The endoscope transmits video images of the patient’s  internal facial structure to a TV screen
  • The surgeon uses the images to dissect, elevate, and reposition tissues
  • The incisions are sutured.

Advantages

Because endoscopic surgery does not require significant incisions and is less invasive than other facelift techniques, the risk of nerve damage is minimal. Scarring is also minimal and easily concealed in the hairline.

Overall, endoscopic facelift patients experience less bleeding, bruising and swelling than traditional facelift patients. They can usually return to work and other activities in a week or less. Endoscopic facelifts are typically  less expensive than traditional facelifts because there is no need for general anesthesia or overnight hospital stays.

Disadvantages

There is, however, a trade-off for the relative ease and quick recovery accompanying the endoscopic facelift. They are only effective in treating cheek sagging and will register very little effect on the lower third of the face. The results of an endoscopic mid-face lift simply cannot compare with those of a traditional (SMAS) lift. In addition, the neck cannot be lifted through an endoscopic facelift.

Best candidates for an endoscopic facelift include:

  • Individuals with relatively supple skin
  • Individuals in their thirties, forties or fifties with cosmetic problems in the mid-face region such as sagging cheeks, deep lines around the nose, or thin, downturned lips.

Estimated cost

The cost of an endoscopic facelift ranges from $6,000 to $10,000.

Choosing a surgeon

Of all the factors contributing to a successful facelift, carrying out thorough pre-operative research is one of the most critical parts of the process. Selecting the right surgeon for your facelift is essential to ensuring you get results you’re delighted with, that leave you looking refreshed and well-rested, and also have longevity.

Dr Timothy Miller emphasizes the importance of researching the credentials and competence of your doctor. “The skill and experience of the surgeon is far more important than the technique chosen. Factors such as the lift directional vector, how tight to lift it, and the skill to not go too deep where underlying important structures could be harmed, is essential to the best outcome and longevity of the procedure. After more than a quarter of a century performing face lifts and seeing the results of other, less-trained, surgeons, my advice is to always go with the best when it comes to facial rejuvenation.”

RELATED: How To Find A Plastic Surgeon You Can Trust

There are several steps you can take to help guide you in selecting a surgeon:

  1. Ensure that the surgeon has certification from an accredited medical board such as the American Board of Plastic Surgery. Members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery are all board-certified. Board certification requires lengthy and rigorous training, examinations and re-certification in specific procedures like facelift surgery, that help ensure that the surgeon’s practice is safe and effective.
  2. Take a look at the surgeon’s website to verify his or her experience in facelift surgery, particularly in the procedure you are interested in.
  3. Ask to see “before” and “after” photos, especially those that show the results over the long term. This will give you a good idea of how much, and what kind of changes you can expect to see following surgery.
  4. Ask the number of times you can expect to see your actual surgeon following the completion of your operation, as opposed to a medical assistant.
  5. Once you’ve selected a surgeon, book a consultation. Throughout this consultation it’s vital that you feel at ease, comfortable, and free to ask questions or raise any concerns you may have. The surgeon should discuss the most appropriate options for you based on your budget and the improvements you hope to see achieved.

As Dr Timothy Miller says, “The first chance is your best chance to get it right”. By carrying out research you will not only become more aware of what’s feasible and improve your chances of getting the facelift results you desire, but will feel more empowered in your decisions.

Risks and potential complications

As is the case with all medical procedures, facelift surgery carries a certain degree of risk. With the more invasive procedures such as the deep plane or SMAS lift, the risks are somewhat increased. Being aware of any postoperative complications or risks that could occur is essential, and will help you make better decisions.

  • Scarring that results from incisions are sometimes permanent, but can usually be concealed by the hairline and natural contours of the face and ears. Occasionally, incisions may result in noticeable raised red scars. However, corticosteroid injections can be used in the unlikely event such scarring occurs.
  • Swelling and bruising both constitute a normal part of the healing process, particularly from more invasive facelift procedures. In some cases, hematoma may also occur, a condition where blood collects outside the blood vessel. For a traditional facelift, such as an SMAS lift, you can expect swelling and bruising to subside after approximately two weeks. For a mini-lift, swelling and bruising will be less significant, possibly requiring several days to a week of recovery time. Do not be alarmed if swelling distorts or stiffens your facial features and expressions at first.
  • Neurological dysfunction and numbness. A facelift repositions the tissue of your face and neck, and as a result, can affect the nerves. Feelings of numbness in the cheeks, neck or scalp are possible and may last for a few months to a few years, depending on the extent of your facelift.
  • Necrosis, or loss of skin. Occasionally, facelift surgery may result in patches of necrosis on the face where the skin has died. Necrosis happens because the skin is stretched too tightly over the face, or because the blood supply to the skin is interrupted for an extended period of time. Surgeons take excessive precautions to prevent necrosis from occurring, although necrosis is also caused by exposure to smoke, both first and secondhand. For this reason it’s imperative to avoid any exposure to cigarette smoke prior to surgery
  • Hair loss. In some cases, temporary or permanent hair loss is experienced near the incision sites. In most cases, hair should grow back within three months.

Other potential risks include:

  • Infection(pus under the skin, soreness)
  • Pain
  • Anesthesia complications
  • Facial asymmetry
  • Skin contour irregularities
  • Skin discoloration
  • Fat necrosis(death of fatty tissue)
  • Seroma, or the pooling of fluids under the skin
  • Clotting caused by hematoma
  • Depression
  • Heart and lung complications
  • The need for revision surgery

Nevertheless, through careful preoperative preparation, adherence to the doctor’s recommendations for both pre and post-surgical care and assuming a level of personal responsibility, many of these risks can be mitigated.

Finding a surgeon with strong credentials, board certification and extensive experience in the procedure you are undertaking further minimizes the risk, as does having realistic expectations about the results. Most surgeons can’t stress strongly enough the importance of patients being cognizant of what can and cannot feasibly be achieved through cosmetic surgery.

Preparing for your facelift

In order to minimize risks and facilitate a successful, safe surgery with a swift recovery, there are steps you can take to ensure you enter the operating room as well-prepared as possible.

In the weeks leading up to your surgery, it’s likely your doctor will advise you to do the following:

  • Avoid taking aspirin, anti-inflammatory medication or herbal supplements as they may increase your chance of bleeding. If you are taking any medications, be sure to inform your surgeon so he or she can advise you if you need to adjust your dosage.
  • Follow a healthy and a sustainable diet in order to reach an optimal weight before surgery (yo-yo dieting, particularly after facelift surgery, may affect the elasticity of your skin, causing it to loosen again)
  • Give up smoking and refrain from exposing yourself to secondhand smoke. This is crucial to avoid any risk of skin necrosis occurring after surgery.
  • Go for a thorough medical check-up to ensure that you are in a state of sound overall health.

During surgery

What to expect on the day of the surgery

In the days leading up to your facelift, your surgeon will provide you with a list of special instructions that clearly outline what to do both the night before and morning of  your surgery,  details about the anesthesia that will be used, and what to expect with respect to post-operative care and follow-up.

It is entirely natural to feel a little nervous on the day of your surgery. Try as much as possible to engage in relaxing or calming activities the day before your operation and ensure you are well-hydrated before going to bed for the night. In many cases you will be required to avoid eating or drinking anything after midnight the day before your surgery.

On the morning of your facelift, clean your face, hair and body thoroughly with soap, but do not apply any moisturizers, deodorant or makeup. Remove all jewelry, as wearing jewelry during the procedure can lead to the burning or scarring of the skin. It is recommended you wear loose fitting, comfortable clothing.

Depending on the procedure, you may need someone to drive you to your surgery and pick you up afterward. Facelifts may take place in an accredited office-based surgical facility, a licensed surgical center, or hospital.

If you are undertaking one of the more extensive facelift procedures, such as a deep plane lift, you will need someone to stay close by and take care of you for at least the first night after surgery. This person needs to be with you continuously for 24 hours, and ideally should be supportive of your decision to undertake surgery to better facilitate your convalescence.

The surgical procedure

All facelift surgical procedures are characterized by a few common features. They are briefly demystified and explained here:

Anesthesia

All facelifts use local anesthetic to numb the area where the incision will be made. Adrenalin is sometimes added to constrict the blood vessels to reduce bleeding. Mini facelifts and short scar lifts only use local anesthesia. Minor sedatives such as Valium are also commonly given to patients to relax them.

General anesthesia or IV sedation (which induces what is sometimes called a “twilight sleep”) are sometimes more suitable for longer procedures, such as an SMAS lift or a deep plane lift. In making the decision about the most appropriate approach for you, your surgeon will carefully consider your personal comfort, preferences and safety. Many surgeons performing longer procedures prefer prolonged intravenous IV sedation, which ordinarily requires the presence of an anesthesiologist. If you are prone to sleep apnea or heavy snoring, general anesthesia may represent a safer choice.

Incision

Once the local anesthetic has taken effect, the surgeon will make an incision in the temple, just above and in front of the ear. In the case of a deep plane lift or SMAS lift, the incision will continue beneath the earlobe towards the back of the hair, blending into the hairline.

For mid-face lifts, short scar lifts and endoscopic lifts, one incision is made but it will not extend behind the ear. With SMAS lifts, one incision will be made at the temples and extend behind the ear towards the hairline. For deep plane lifts, the incision at the temple is made along with tiny incisions along the hairline. Incisions are always in places where the natural creases of the skin or hairline will disguise them. For men, incisions are made along the lines where the beard grows.

The "lift”

Following the incision(s), the SMAS (superficial muscular aponeurotic system) layer of the skin (a layer of facial musculature) will be gently lifted, tightened, and repositioned with any excess skin trimmed. All facelifts target the SMAS layer in differing degrees and  ways. Deep plane lifts, the most invasive facelift, go beneath the SMAS layer, while mini-lifts manipulate the SMAS to a lesser extent for a more moderate level of tightening.

Closing the surgical site

After trimming the excess skin, the sites where incisions were made are sealed with fine sutures (stitches) and/or metal clips. Some surgeons also use “glues” such as fibrin glue, an adhesive sealant for tissue and very small blood vessels.

Duration

The length of time taken to complete a facelift depends on the type of lift being performed and the surgeon carrying out the procedure. Short scar lifts may only require one to two hours. Mid-face lifts ordinarily take about two hours, while a deep plane lift with additional surgery, such as a fat graft or blepharoplasty (eyelid surgery), may take six hours or more. Your surgeon will explain the expected length of your intended procedure.

After surgery: facelift recovery

Recovery from facelift surgery occurs in stages. The time it takes to return to your normal routine may be as little as two weeks. After approximately three weeks, it will be difficult for anyone to tell if you’ve had work done.

Nevertheless, the recovery time required for your face to completely return to normal and for residual swelling or changes in skin sensation such as numbness to subside, can take up to a year. Therefore, in order to have realistic postoperative expectations it is essential to view recovery as a gradual process.

Week one:

For the first week after your facelift, it is perfectly normal to experience the following:

  • Pain
  • Swelling
  • Bruising
  • Stiffness in the neck or face
  • Itchiness around the stitches or sutures
  • Nausea (usually due to the pain relief medication)
  • Fatigue

Facial dressings and drains will be removed 24 hours after surgery. Both swelling and bruising should have peaked three or four days after the operation. It’s common for swelling and bruising to be more severe on one side of the face than the other, as each side represents separate surgical sites. Try to keep your head elevated for two to three days post-operation to minimize swelling. During this first week of recovery resting is paramount, however, engaging in low-exertion activities is also important in order to get the body moving and encourage circulation, which in turn facilitates a swifter recovery.

Week two:

By the second week of recovery, residual swelling and bruising is still common and some patients also report occasional sensations of tingling, burning, numbness and/or tightness in their faces. Stitches or staples are often removed during the second week of recovery, however, some bunching or puckering is likely to remain as the incision site heals.

Light exercise is recommended during this period. While major gym workouts are too strenuous to safely attempt during this stage of healing, going for brief walks is highly recommended. If you underwent one of the more extensive facelift procedures you may feel more comfortable remaining at home during the second week of recovery anyway, rather than attempting to venture out to social gatherings or work.

Weeks three and four:

Weeks three and four will see you returning to routine, looking and feeling much better. Many patients are ready to return to work during this period. There’s still the possibility of swelling or tightness remaining in some locations on the face, but this will improve with time and differs from patient to patient.

Some pinkness around the incision sites is common, albeit mostly temporary. Any remaining scarring can be alleviated in part by massaging topical Vitamin E oil into the skin. Some scars will heal within a year whereas others may leave a permanent trace. Surgeons recommend applying makeup to camouflage any prominent scars or simply allowing the hair to conceal them.

The type of makeup you use matters: Dr Ross Clevens, an innovator in the field of facial plastic surgery advises to avoid heavy or oil-based products. “Some types of makeup are better than others after plastic surgery. Since the skin is usually still delicate a week or so afterward, it’s usually a good idea to choose makeup that is gentle and can be removed easily, " says the Melbourne, Florida plasic surgeon. "Mineral makeup is often recommended as it’s very gentle yet still effective. If you can’t find a mineral makeup that you like, look for something that’s water-based. Oil-based products usually require a special remover and can be more challenging to take off. Plus, oil-based cosmetics can irritate your still-healing skin.”

By weeks three and four it is possible to return to your regular exercise regime, although especially vigorous workouts or any exercise that poses a risk of injury should be avoided.

RELATED: 6 Non-Surgival Facelift Treatments Recommended By Plastic Surgeons

Recovery diet

Kim Pearson, a nutritionist with specialization in pre and post-operative plastic surgery nutrition, asserts that vigilance with one’s postoperative diet will facilitate healing, reduce the risk of infection, inflammation and swelling, while optimizing overall results. “Scientific studies have established that certain nutritional requirements can increase up to five-fold during the post-surgery healing phase”, says Pearson. “Lack of nutritional support during this crucial period can adversely affect recovery from cosmetic surgery.”

Soups and smoothies high in protein are recommended for the first week after surgery as they are easily digested, same with foods high in monounsaturated fats such as avocados, extra virgin olive oil and blueberries, which all have anti-inflammatory properties. Plenty of organic fruit and vegetables are also recommended as they provide a good source of antioxidants, while foods with trans fats and refined products like white flour or sugar should be avoided since they are known to cause inflammation.

Avoid:

  • Consumption of salty foods. A low-salt diet is critical as it reduces the chances of postoperative swelling. Any opportunity to minimize or avoid swelling is vital, as swelling stretches the skin you’ve just paid to have tightened.
  • Heavy lifting or vigorous exercise that accelerates your heart rate or blood pressure must be avoided for at least two weeks following surgery, as strenuous exercise can lead to delayed bleeding.
  • Products that may exacerbate bleeding, such as aspirin, Vitamin E, ibuprofen and various herbal supplements shown to inhibit or slow down blood clotting must also be avoided. Be sure to tell your surgeon the name of any supplements or prescription medication you’re taking so they can advise you if it possibly presents this danger.
  • Consuming foods which are excessively crunchy, chewy, or difficult to eat.
  • Exposing  yourself to the sun or sunbeds, as this will darken your scars and render them permanent.

How long can you expect your facelift to last?

Aging represents a natural and inevitable part of life that continues even after you’ve had a facelift. The longest-lasting facelift is the deep plane lift, with surgeons estimating the procedure to have longevity of 10-15  years. Other forms of SMAS facelifts will last not quite as long as the deep plane lift. Less invasive facelifts, such as variations of the short scar facelift, last on average two to five years. Sometimes smaller maintenance procedures can be performed to prolong a facelift, such as tightening the skin at the jawline or plumping the cheek tissues. In other cases, secondary facelifts may be undertaken.

Nevertheless, these are only very broad guidelines. Most surgeons take care to emphasize that there is a host of interacting factors that will ultimately determine the longevity of your facelift. Dr Sherrell J. Aston, a plastic surgeon based in New York City, points out that while aging is inescapable, your appearance is nonetheless improved as a result of surgery, and remains so even as you grow older.

“Once you have a face-lift, you will look better than nature intended for the rest of your life. Mind you, 10 years after surgery you're not going to look as good as 4 or 5 years after surgery because aging does continue, but you will look better than if you did not have the procedure.”

Furthermore, most surgeons agree that to a certain extent you are responsible for the success and longevity of your facelift. The following is a list of recommendations from facial plastic surgeons for protecting your face, to ensure you enjoy the results of your surgery for years afterward.

  1. Wear sunscreen everyday, even in overcast weather.
  2. Drink plenty of water to keep your skin hydrated and flush out toxins.
  3. Reduce your alcohol intake, as it can dehydrate and prematurely age skin.
  4. Follow all of the post-operative advice your surgeon gives you.
  5. Maintain a regular skincare regime to protect your skin, with facials, laser treatments, Botox or Dysport to enhance your lift and ensure the results last longer.
  6. Maintain a healthy and stable weight, as dramatic weight loss and weight gain detrimentally impact the skin’s elasticity.
  7. Avoid excessive stress: a range of scientific studies have proven that skin is affected by stress, with high stress levels linked to skin inflammation.

By actively taking responsibility for your health, well-being and protecting the investment you’ve made in yourself, you will be able to enjoy the results of your facelift for a longer stretch of time.

Alternatives to facelifts

For some, a facelift may not represent the most appropriate or desirable course of action to restore a youthful facial appearance. Fortunately, there is an ever-diversifying range of less-invasive, non-surgical alternatives that offer quick and relatively painless ways to refresh your face. Six are briefly outlined here.

Stem cell facelift

The stem cell facelift is a newer procedure that has been enjoying increasing popularity in recent years. During a stem cell facelift, fat is harvested from donor sites of the body through a process similar to liposuction. Stem cells present in the fat are then manipulated or “activated” with chemicals or laser. The fat cells and stem cells are injected into locations on the face to give a fuller, more volumized look. It’s important to note, however, that stem cell facelifts have not yet been approved by the Food and Drug Administration (FDA).

The procedure costs between $5500 and $15,000.

Thread (also known as Feather or Aptos) facelift

Thread lifts are used to lift sagging skin without invasive surgery. A lifting effect is provided by the use of a thread with tiny suture barbs that function as hooks, pulling the skin upwards and holding it in place. The procedure can be performed under local anesthesia and conducted alongside other facial procedures for a rejuvenating effect. That said, it is argued by some surgeons that a thread lift is limited in its efficacy and merely functions as a stand-in until a more invasive facelift procedure is required.

Thread lifts cost between $1500 and $4500.

Silhouette Instalift

The Silhouette Instalift  lifts cheeks and drooping brows, and also addresses jowls. While not a facelift in the traditional sense, it can prevent or postpone the need for a facelift by addressing emerging signs of aging. Placing the patient under local anesthesia, the surgeon inserts a tiny thread with dissolvable PLGA cones under their skin.  These cones stimulate collagen production. The skin tissue is lifted and the cones suspended in place. The procedure takes around 30 minutes. However, Dr Daniel C. Mills, a plastic surgeon in Laguna Beach, California and President of the American Society for Aesthetic Plastic Surgery, points out that one of the downfalls of this non-surgical approach is possible facial asymmetry.

Silhouette Instalift costs on average $2750.

Dermal fillers

Dermal fillers restore facial volume and diminish fine lines. They can effectively plump thinning lips, soften facial creases and enhance shallow facial contours. They are most suitable for those experiencing early signs of aging, or as one element of a more comprehensive facial rejuvenation package.

There are a range of different types of dermal fillers with specialized effects: hyaluronic acid fillers best address wrinkles and lines while calcium hydroxylapatite, the heaviest dermal filler, is effective in targeting moderate to severe creases such as nasolabial folds that run from the nose to the corners of the mouth.

Depending on the type of dermal filler used, the procedure may cost between $500 and $2000.

Fat transfer

Fat transfer, also known as fat grafting, is similar to the stem cell facelift in the respect that fat from the patient’s own body, usually the abdomen or thighs, is harvested and then used to restore the youthful contours of the facial features. It is most effective at restoring volume to areas of the face that appear sunken or creased, and provides a more permanent solution than temporary fillers. The results are natural, long-lasting and safe, but it is a more expensive procedure than dermal fillers.

Fat transfers range from $350 to $5000 to treat the entire face.

Kybella

Up until recently, a double chin could only be treated effectively with surgery. Kybella, which began entering surgeon’s clinics in June 2015, uses deoxycholic acid as its active ingredient to melt away fat cells from beneath the chin (the submental area), which are then naturally absorbed by the body. To disperse the fat in the chin, the area is injected multiple times, with as many as six treatments possibly required. There are risks associated with this new technique, however, such as nerve injury leading to an asymmetrical smile, or trouble swallowing.

Kybella costs on average $1000 per session, with most patients needing at least two to three sessions.

Latest Techniques and Scientific Studies

In the age of the selfie, maintenance of a smooth and youthful visage remains a relevant cosmetic concern for many individuals. Facelifts offer a dramatic way to refresh one’s appearance. However, facelift surgery is shifting to reflect the desires of contemporary consumers who now want a relaxed, natural look with minimal downtime or recovery. In 2017, one of the most significant advances in the area of facelift surgery is a facelift performed in conjunction with facial fat repositioning—this results in smooth, lifted facial skin which also looks voluminous, and replenishes the fat loss that happens as a result of aging.

A newer form of facelift which is starting to make waves in 2017 is the “Presto” facelift, which seeks to rejuvenate the face while retaining one’s facial identity and expressions. Innovators of the “Presto” facelift have determined that what is essential to create a natural result is the preservation of facial ligaments “the guardians of facial identity” which too often are sacrificed or severed in the older style of facelift, resulting in the loss of natural facial expression. The end result is the conservation of the individual facial aesthetics, the restoration of a youthful look, and a rapid and safe procedure.

Another innovative facelift that also emphasizes optimal outcomes and minimal downtime is the Minimal Undermining Suspension Technique mid-face and eyebrow lift. Ascribing to the belief that surgical techniques can be minimally invasive but still deliver excellent outcomes, the surgery uses only one temporal incision to rejuvenate and lift the midface and eyebrows. Initial studies have shown significant improvements to the mid-face and eyebrow regions with a brief recovery time of 7 days, and no significant complications.

Frequently Asked Questions (FAQs)

How much does a facelift cost?

The cost of a facelift depends on the type of procedure your surgeon determines most appropriate for your needs. Less extensive facelifts, commonly referred to as limited incision or short scar facelifts, are commonly priced between $6000 and $10,000. More invasive procedures such as the deep plane lift typically cost between $12,000 and $15,000.

How do I know if I am a good candidate for a facelift?

Those who benefit most from facelift surgery are individuals in their forties or fifties seeking to address sagging or loose skin, particularly around the jowls or cheeks, and are dissatisfied with the loss of their natural contours and the appearance of deep creases or wrinkles.

Plastic surgeons agree that the best candidates for facelift surgery have realistic expectations, a positive outlook and are in good overall health. Individuals with well-defined bone structure and supple skin that hasn’t been damaged by sun or tobacco also tend to enjoy better results.

How do I know which type of facelift is right for me?

The best way to determine the most appropriate facelift for you is to consult with a plastic surgeon who can advise you on the procedure, or procedures, which will best suit your individual needs. As a general rule, however, less invasive facelifts such as the mini lift are often more appropriate for younger patients (in their late thirties or forties) with moderate sagging and wrinkles, while more extensive facelifts are better suited to those who are more obviously exhibiting signs of age and in need of greater tightening and repositioning of the skin.

I am on a limited budget. Can I still afford a facelift?

Many surgeries offer patient financing plans with reputable companies that allow surgery to be paid in installments. It is best to speak to your surgeon to discuss the options available.

How long does it take to recover from a facelift?

Recovery times depend on the type of facelift procedure you have undertaken. Mini facelifts may take up to one week for the swelling and bruising to subside, while a deeper SMAS lift could require several weeks before you can comfortably return to your normal routine. Recovery is also dependent on how closely you adhere to your surgeon’s pre and post-operative instructions.

What are some of the risks associated with facelift surgery?

Facelifts, like all surgeries, carry a certain degree of risk. Some risks include bleeding, scarring, infection, facial asymmetry, loss of sensation due to nerve damage, numbness and hematoma. However, most risks can be mitigated by closely adhering to your surgeon’s advice prior to and following surgery.

How should I go about selecting a surgeon?

Choosing the right surgeon to carry out your facelift represents one of the most critical decisions you will make. It is vital that you choose a surgeon who is board-certified by an approved medical body such as the American Society of Plastic Surgeons or the American Society  of Aesthetic Plastic Surgeons, and that the surgeon you choose has extensive experience with the facelift procedure you will be undertaking. Ask to see before and after photos of patients who have undergone the same procedure you’re planning to have done, and ensure that you feel comfortable and at ease with the surgeon.

How can I ensure my facelift lasts?

Once you leave your surgeon’s office or operating room, the longevity of your facelift is largely in your own hands. It’s vital to make lifestyle choices that will protect your skin and prevent the acceleration of aging process. Avoid smoking, excessive alcohol intake and overexposure to stress. In addition, be sure to follow a healthy diet to maintain a stable weight (which prevents the skin from loosening due to rapid weight loss), use sunscreen every day, drink plenty of water and maintain a regular skincare regime, possibly with the addition of non-surgical procedures such as Botox, to keep your facelift looking fresh.

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