What is facelift surgery?
Also known as rhytidectomy, facelift surgery is a comprehensive approach to facial rejuvenation that has the potential for significant, transformative outcomes. It is considered the gold standard when it comes to addressing the signs of aging on the face, such as skin sagging, deep-set wrinkles, and pronounced nasolabial folds.
Facelift surgeries always include elevating soft tissues, adjusting and firming up underlying muscles, removing surplus skin, and eliminating fat deposits in the neck area. Additionally, the remaining skin is carefully re-draped to restore a fresher, more youthful look to both the face and neck.
Despite commanding a substantial cost and requiring a recovery period of up to 2 weeks or even longer, facelifts rank as one of the most popular procedures in plastic surgery.
There is an ongoing debate among plastic surgeons regarding the facelift technique that offers the most enduring and natural-looking outcomes. However, a surgeon's expertise and proficiency is the most crucial factor in a successful facelift procedure.
What are the pros & cons of a facelift?
- Facelifts enjoy significant popularity among patients, with 93% considering the procedure worth the money. This high score implies that the procedure has met or surpassed the expectations of the majority of reviewers.
- Before and after images of facelifts demonstrate remarkable transformations.
- Contemporary surgical techniques, which elevate the skin and underlying facial muscles, contribute to very natural-looking facelifts.
- When carried out by a seasoned plastic surgeon, the scars become almost invisible after a full recovery.
- The results of facelifts normally last for 10 years or even longer.
- Facelift surgeries do not incorporate any modifications to the eyelids or eyebrow area. Procedures such as brow lifts and upper and lower eyelid surgery (blepharoplasty) are separate that can be added on for an extra charge.
- The procedure does not fix issues like fine lines, crepey skin, volume loss, hyperpigmentation, aging symptoms caused by sun damage or diminished skin elasticity. To address these issues, supplementary skin rejuvenation treatments like laser resurfacing, dermal fillers or fat grafting would be required.
- Possible complications may include bleeding, infection, slow healing, scarring, hematoma, and facial nerve damage that can lead to muscle atrophy or paralysis.
- There is a possibility of asymmetry, deformities, and underwhelming results.
- Recovery from a facelift necessitates at least 2 weeks of downtime.
- Facelifts are an expensive procedure and are typically not covered by Medicare or private insurance insurance.
How much does a facelift cost?
Average Cost: $18,750
Range:$9,500 - $45,300
The price range of a facelift can fluctuate wildly, subject to the scope of the procedure, the surgeon's expertise, the geographic location of the clinic, and the details of your surgery all play a role. According to reports from patients, the cost of a facelift can reach up to $45,000. However, there are some renowned surgeons, who are Instagram-famous that command prices as high as $150,000 for their services.
Since facelifts are considered elective cosmetic procedures, it is usually not covered by Medicare or private health insurance.
Most surgeons do provide the option of third-party financing arrangements.
Is it safe to get a facelift, what are the risks and side effects?
According to a study in 2015, facelift surgery carries a 1.8% complication rate. The data on general facelift complications is insufficient because, as the authors observe, “A plethora of accepted techniques exist for facelift surgery, as well as significant individual surgeon variation, leading to inconclusive data on outcomes.” The research does not concentrate on a single facelift method or the results of a specific surgeon; instead, it examines 11,300 facelifts conducted between 2008 and 2013 and the complications that occurred in these patients.
- The most common potential complication in the study was hematoma (1.1%), an accumulation of blood beneath the skin. This typically results from excessive activity during recovery or increased blood pressure. If a hematoma occurs, your physician will need to drain the blood using a syringe.
- Infection (0.3%) was the second most common complication, a risk that can be managed by maintaining clean incisions.
- Mild bleeding after any surgery is not uncommon, particularly if you cough, sneeze, or exert yourself. If you experience significant bleeding, reach out to your surgeon immediately.
While possible, the likelihood of facial nerve injury is incredibly low, and it is usually not permanent. Facial nerve palsy and weak face muscles after a facelift are temporary, with a full recovery usually seen between 3 to 6 months post-operation.
A 2019 study comparing complication rates across different facelift techniques found that all facelift methods had similar and safe complication ranges. The authors concluded that the selection of a facelift technique should largely be based on result quality, rather than the assumed complication rate.
What age should you get a facelift?
The best age bracket for a facelift generally lies between your 40s and 60s, although it is not uncommon for healthy individuals with noticeable sagging to undergo the procedure in their 30s or even as late as their 80s.
The best candidate for a facelift is someone who exhibits obvious signs of aging like downward migration of the cheeks, noticeable jowls and marionette lines, laxity in the face and neck, and neck banding.
Ideal candidates are also non-smokers who are generally in good physical and mental health, without any serious underlying medical conditions. As part of the consultation, your surgeon will inquire about your medical history to ensure you're a suitable prospect for the procedure.
What are the different types of facelifts?
There are two major techniques applied in comprehensive facelift surgery: the SMAS lift and the deep plane facelift.
Both techniques aim to adjust the deep tissues of the face, called the SMAS (superficial musculoaponeurotic system). The SMAS is a robust facial fascia that overlays the muscular structure of the face. During most facelift procedures, the platysma muscle in the neck is also repositioned.
Contrary to facelifts of old that only manipulated and resized the skin (often resulting in a windswept appearance), modern techniques, including the SMAS and deep plane method, target both the skin and the SMAS.
The facelift method your surgeon utilizes hinges on their preference, their training and confidence in the technique, your individual needs, anatomy (factors such as skin thickness & quality, facial fullness, neck angles, and bone structure), and desired results.
Regardless of the surgeon's favoured technique:
- The operating time of a facelift surgery is typically between 2 to 4 hours, dependent on your surgeon's skill and the specific technique used.
- Facelift surgery is an outpatient procedure that can be performed under general anesthesia or local anesthesia with IV sedation.
- Once you are either unconscious or sedated, a combination of lidocaine, epinephrine, and tranexamic acid will be injected into your face to numb the area and reduce bruising.
- Post-surgery, you will be sent home with either facial and head bandages or a drainage tube. As you will likely feel groggy after the procedure, organise a reliable friend, partner, or family member to escort you home and stay with you during the first night to monitor your condition.
Every SMAS facelift procedure requires lifting the skin and adjusting the SMAS to reestablish the facial contours.
During a SMAS facelift:
- Incisions are carefully placed either within the ear (tragal incision) or in front of the ear (pre-tragal incision), alongside the natural crease going to the earlobe. A conventional facelift incision generally beings at the temporal hairline and, after passing by the ear, finishes at the lower scalp region.
- The skin is lifted away from the SMAS and muscular layer, which are then raised and reshaped (sometimes folded or cut, depending on the requirement).
- In most cases, the platysma is accessed and elevated through ear incisions. Occasionally, it may be tightened through a minor incision under the chin, in a process known as platysmaplasty. Neck fat deposits are also removed during this step.
- Subsequently, the skin is carefully re-draped and any surplus skin is trimmed.
- Minuscule stitches are used to close the incisions.
SMAS comprises several different types of facelift techniques, two of the more frequently used being the SMAS imbrication and the SMASectomy. It is not uncommon for surgeons to adapt these standard procedures, enhancing the level of dissection, manipulating the SMAS to varying degrees, or modifying the direction of the lift.
Deep plane facelift
During a deep plane facelift:
- The plastic surgeon constructs a flap comprised of skin, subcutaneous fat, and SMAS, all of which are lifted and moved as a single cohesive unit.
- It is common for the surgeon to release certain facial retaining ligaments, to improve mobility and raise the cheeks and jowls. This explains why the deep plane method is often considered superior for mid-facelifts and more effective at smoothing out nasolabial folds.
- The neck's muscular frame is also raised and reinforced using tight stitches.
- Much like a SMAS facelift, the skin is re-draped and cut before closing the incisions.
Supporters of the deep plane method assert that it offers more natural-looking and longer-lasting results. However, studies suggest no significant differences between the two methods for patients 70 and under, even when comparing the results over a decade.
A deep plane lift may provide better support for someone with thick facial skin and a very full face. Many surgeons customize the procedure to the patient, adjusting their facelift technique based on anatomical factors such as the width and shape of the face, the patient's skin thickness, and the distribution of subcutaneous fat.
A short scar or mini facelift means a smaller incision, from the front of the ear extending into the temporal hairline. This type of facelift is usually performed on younger patients who exhibit only moderate skin sagging.
One variant of the mini facelift is the lower facelift, which mainly targets the jawline and neck. A lower facelift might only address the platysma, or neck muscles, rather than the whole SMAS layer, making it suitable for younger patients who are showing the initial signs of aging on the lower face.
While mini facelifts differ in scope and objective, the results generally tend to be less dramatic and not as long-lasting compared to traditional facelifts.
It is important to note that a "Ponytail facelift" is a marketing phrase with no universally recognised medical definition. However, it generally refers to a limited endoscopic lift. Common elements of a ponytail lift include raising the midface, cheek, and jowls using tiny incisions concealed in the hairline. An endoscope is frequently used, along with suture suspension, to accomplish the desired results (some surgeons may forego the camera). As a ponytail lift doesn't permit skin removal, it is best suited for younger patients showing early signs of aging.
Does a facelift include the neck?
The majority of full facelifts incorporate a neck lift. Here, the surgeon lifts the skin away from the neck platysma muscle, a continuation of the facial SMAS layer, to tighten.
The neck platysma is normally accessed via the same facelift incision sites around the ears, but occasionally, an incision under the chin may be required, particularly in the instance of significant skin sagging and platysmal banding (where the muscle shows two vertical bands on the neck, from jaw to collarbone).
Platysmal banding can be rectified by severing and stitching up the muscle from a minor incision under the chin.
Through the same incisions, any surplus fat above the platysma muscle can be extracted via liposuction, though the fat beneath the platysma muscle must be excised surgically. This often incorporates a platysmaplasty for more significant contouring.
How long is facelift surgery recovery?
You can expect the worst of your facelift recovery over the first 7 to 10 days, with most patients looking considerably better by the two-week mark.
Nonetheless, the initial week might prove challenging, with symptoms like swelling, stiffness, and soreness. These can become more severe if you've added procedures such as laser resurfacing, rhinoplasty, facial fat grafting, or eyelid surgery, which all can significantly increase swelling and pain.
In the immediate aftermath of a facelift, you'll adhere to a diet of soft foods for the first few days, only drinking directly from cups and glasses, as sucking on straws can cause discomfort. Make sure to stock up on smoothies, soups, and protein-rich foods that require minimal chewing.
A firm pillow to prop up your head while resting will also be beneficial, as regular pillows can put unnecessary pressure on your ears.
As the healing process advances, it's normal to experience itchiness, swelling, and tightness, which usually subsides after the initial weeks.
The timeline for facelift recovery depends heavily on your body's healing process, but here's a detailed breakdown of what to expect:
- Day 2: post-surgery, you will have a follow-up appointment. The bandages and dressings will be removed, and your incisions, along with any bruising or swelling, will be assessed. Surgical drains inserted to stop fluid buildup and seroma formation will be taken out. Depending on your healing progress, you will either be sent home with fresh bandages or none at all. You're allowed to bathe the day after surgery, but avoid wetting your head if you still have bandages.
- Day 3–4: At this point, bruising and swelling typically peak. For the first few days of recovery, only take the prescribed pain medication, not panadol or other over-the-counter painkillers.
- Day 3–5: Within five days, you’ll have another check-up appointment to assess your healing progress, any remaining bandages will also be removed. You might receive a removable elastic band for support. Incision care involves cleaning with saline and applying a thick ointment like Vaseline. Washing your hair with baby shampoo and warm water is allowed. Let the water gently cleanse your hair, removing dried blood, surgical soap, and normal residue, while being careful not to agitate the staples or stitches. Try to avoid direct water on your face. Lastly, dry your face gently with a towel and allow your hair to air-dry only. Do not apply makeup and your regular skin care until your surgeon gives you the go-ahead.
- Day 7: Around this time, stitches and sutures are typically removed. If you feel up to it, you can do light housework and other activities. While some patients may decide to go back to work at this point, many prefer to postpone until most of the swelling has subsided (around the 2-week mark). Refrain from bending over, lifting heavy objects, or bumping your head, face, or neck as these movements can cause bleeding.
- Day 14: By now, you should be ready to be seen in public, or as some say, "restaurant ready." You can also restart sleeping on your side but abstain from sleeping on your stomach until your doctor gives you the all-clear.
- Day 30: By this point, you should have resumed your regular exercise routine.
- Month 3: For the first three to four months post-surgery, avoid direct sun exposure and apply a high-SPF sunscreen.
Minor symptoms like swelling, bruising, tightness, or even numbness can persist for up to a year.
Melon Hint: Doctors emphasize the importance of a nutritious diet for optimal healing. Advocating for a protein-rich diet while skipping fish oil, alcohol, vitamin E, and other substances known to thin the blood, as these can extend the bruising period.
Is getting a facelift painful?
The surgical procedure is carried out under general anesthesia, so you won’t feel any discomfort.
However, once the effects of the anesthesia subside, it is advisable to preemptively manage any potential pain during the initial 2 to 4 days with prescription pain medication.
The perception of pain varies among individuals, but you can generally anticipate swelling, bruising, and tenderness during the first fortnight of recovery, peaking on the 2nd and 3rd-day post-surgery.
To prevent swelling from worsening, refrain from bending over or engaging in strenuous lifting activities for a period of 2 weeks.
To mitigate swelling and bruising, and to alleviate discomfort, consider using an ice pack. This could be a bag of crushed ice, a soft ice pack, or even a frozen towel. In the first 48 hours post-surgery, carefully apply the ice pack to your face in intervals, with 20 minutes on followed by a 20-minute off.
How long do facelift results last?
The results of a facelift can impart a more youthful and uplifted appearance lasting for a decade or longer. However, while the procedure may temporarily halt the hands of time, the progression of natural aging continues and signs of aging will still accumulate.
To prolong the effects of your facelift, diligent skincare is key - regular use of a mild cleanser, moisturizer, vitamin C serum, and a nightly retinoid can protect the health and elasticity of your skin.
Additionally, protecting your skin with sunscreen, maintaining a balanced diet, ensuring sufficient sleep, and managing stress levels are effective strategies to maintain the health of your skin and sustain the effects of your facelift.
What are alternative procedures to a facelift?
While minimally invasive options can not produce the same results as a surgical facelift, they might be suitable for those not ready to go under the knife.
- Procedures such as radiofrequency (RF) or ultrasound therapy treatments like FaceTite or Thermage FLX are available. These procedures promote collagen production and enhance skin elasticity with heat, improving age-related changes in specific facial regions. However, these treatments only offer minor relief compared to a facelift and may affect future surgeries.
- Dermal fillers are a temporary solution to enhance skin volume, resulting in a smoother and lifted look. A liquid facelift uses dissolvable fillers together with neurotoxins to alleviate wrinkles and fine lines.
- A Vampire Facelift injects your own platelet-rich plasma (PRP) mixed with dissolvable fillers. Depending on the filler used, results may last up to a year.
- Thread lifts, while not surgical, use barbed line inserted beneath the skin surface to elevate tissue. While your body dissolves these threads over a half year, they stimulate collagen production, potentially improving skin firmness
Before settling on facelift surgery, it is beneficial to arrange a facial rejuvenation consultation with a board-certified facial plastic surgeon. This doctor can guide you through both surgical and nonsurgical treatments to counter your aging skin.
Sources & Studies
Alpert, BS, Baker, DN, Hamra, ST, Owsley, JQ & Ramirez, OM 2009, ‘Identical Twin Face Lifts with Differing Techniques: A 10-Year Follow-Up’, Plastic and Reconstructive Surgery, vol. 123, no. 3, pp. 1025–1033, viewed 3 July 2023, <https://pubmed.ncbi.nlm.nih.gov/19319071/>.
Becker, FF & Bassichis, BA 2004, ‘Deep-Plane Face-lift vs Superficial Musculoaponeurotic System Plication Face-lift’, Archives of Facial Plastic Surgery, vol. 6, no. 1, p. 8, viewed 3 July 2023, <https://pubmed.ncbi.nlm.nih.gov/14732637/>.
Gupta, V, Winocour, J, Shi, H, Shack, RB, Grotting, JC & Higdon, KK 2015, ‘Preoperative Risk Factors and Complication Rates in Facelift: Analysis of 11,300 Patients’, Aesthetic Surgery Journal, vol. 36, no. 1, pp. 1–13, viewed 3 July 2023, <https://pubmed.ncbi.nlm.nih.gov/26578747/>.
Jacono, A & Bryant, LM 2018, ‘Extended Deep Plane Facelift’, Clinics in Plastic Surgery, vol. 45, no. 4, pp. 527–554, viewed 3 July 2023, <https://www.plasticsurgery.theclinics.com/article/S0094-1298(18)30053-1/fulltext>.
Jacono, AA, Alemi, AS & Russell, JL 2019, ‘A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques’, Aesthetic Surgery Journal, vol. 39, no. 9, pp. 927–942, viewed 3 July 2023, <https://academic.oup.com/asj/article/39/9/927/5320438>.