How is a facelift procedure performed?

Most facelift techniques focus on the lower facial areas, such as the jawline, jowls and cheeks. A facelift can also focus on the midface or the forehead. In some techniques, deeper facial tissues may be repositioned or tightened to restore a more youthful contour. In other techniques, removal or addition of fat or other soft-tissue fillers may be necessary to achieve the best results. Today, many different techniques exist with outcomes that can be consistently reliable, safe, and durable. Your incisions will depend on the area of the face that is targeted and the amount of change you want.

Once the incisions are made, various degrees of ‘undermining’ of your skin is performed, and the deeper layers of your face are lifted. Undermining separates the overlying skin of the face and neck from the muscles and tissues deep to the skin. This frees or loosens facial and neck skin so it can be redraped at the end of the procedure, making sure skin is smooth.

Then, your surgeon will raise the skin from the temples, cheeks, and neck, and lift and reposition the underlying connective tissue, removing excess fat and skin. If this procedure is performed in conjunction with a neck lift, the surgeon will draw the neck muscles together, stitching them together at the midline to form a strong sling of muscles that supports the entire neck and jaw. Your surgeon may also include liposuction of the neck and jowls. Facial implants may be added to increase cheek or chin volume.

Finally, your surgeon redrapes the skin over the new underlying structure and closes the incisions with stitches and/or small metal clips. Where needed, drainage tubes may be inserted. A padded, supportive dressing is usually applied.

The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, and to make your surgical experience as easy and comfortable as possible.

What are my options?

There are several approaches to facelift surgery. Your plastic surgeon will recommend an approach based on your goals and facial characteristics, including the shape of your face. The placement and length of incisions vary, depending on the facelift technique that best suits you. Your surgeon might find you appropriate for a ‘short scar’ facelift procedure in which a short incision is usually limited to the area around the ear.

Brand name procedures for facelift such as the ‘LifeStyle Lift’ or ‘Quick Lift’ are still a form of facelift. One method is not superior over another and the best treatment for you will be determined during your consultation with a board-certified plastic surgeon.

What will my facelift incisions and scars be like?

Regardless of the type of facelift you undergo, you will have incisions that involve the skin around your ear.

Limited-incision facelift: Your surgeon will make short incisions in your hairline, starting at your temples and continuing down and around the front of your ears, hidden in the natural creases. There may also be incisions in the lower eyelids, temporal area, or under the upper lip.

Neck lift: Your surgeon will make incisions starting in front of your earlobes and continuing around behind your ears in your lower scalp. There will also be a small incision underneath your chin.

Facelift scars can be virtually invisible: narrow, flat, and well placed behind the ear so you can wear your hair close-cropped.

Your board-certified surgeon will place the incision in areas that are hidden and in areas where the scars look like natural wrinkles. Incision healing depends on surgical technique, infection prevention, reduction of tension, your nutrition, any known or unknown underlying medical conditions, no smoking, and your genetic tendencies.

There is a risk of ‘hypertrophic scars’ and ‘keloids’ anytime the skin is cut. This risk is greater in darker-skinned people such as African Americans and Hispanics. Injections of a corticosteroid medication or other treatments, might be used to improve scar appearance.

Select a surgeon you can trust

It’s important to choose your surgeon based on:

• Education, training, and certification
• Experience with facelift surgery
• Your comfort level with him or her

Members of the American Society for Aesthetic Plastic Surgery are experienced and qualified to perform your aesthetic procedure. Learn how to select a Surgeon.

After finding a board-certified plastic surgeon in your area who is experienced in performing facelift surgery, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for a facelift and clarify what a facelift can do for you. Alternative and additional treatments may be considered, once the surgeon understands your goals and medical condition.

It is important to be completely honest during the consultation. Also, bring pictures of yourself at an earlier age; they may serve as a good point of reference for discussing your goals. It’s a good idea to be fully prepared to answer these questions:

• Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
• Have you had any previous surgeries?
• What are your current medications and vitamin and herbal supplements?
• What is your current use of alcohol, tobacco, and recreational drugs?
• What is your history with any noninvasive cosmetic procedures?
• What outcome do you expect from the surgery?
• What is your chief motivation in undergoing a facelift?

Your surgeon may also:

• Ask you to look in a mirror and point out exactly what you would like to see improved
• Take photos for your medical record, measure your face, and use computer imaging to show you possible improvements
• Evaluate your health status, including pre-existing health conditions or risk factors
• Evaluate the elasticity of your skin
• Discuss your options and recommend a course of treatment
• Discuss potential outcomes, including risks or potential complications
• Discuss the type of anesthesia that will be used

Your treatment plan for a Facelift

Based on your goals, physical characteristics, and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your surgery, including the type of procedure or combination of procedures
• The outcomes that you can anticipate
• Your financial investment in the procedure
• Associated risks and complications
• Options for anesthesia and surgery location
• What you need to prepare for your surgery
• What you can expect to experience after surgery
• Before-and-after photos of cases similar to yours and answers to any questions you may have, so you can make the most informed and intelligent decision

Questions to ask your aesthetic plastic surgeon about a possible Facelift

We developed these questions to help you:

• Make the most informed and intelligent decision about your procedure
• Confirm that you have the right surgeon for your procedure
• Make your initial consultation as rewarding as possible
• Understand your options, potential outcomes, and risks

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for a facelift?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for this procedure?
• Will my scars be visible?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my facelift?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my facelift does not meet the goals we agreed on?

How do I prepare for a facelift procedure?

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery. You may also be required to obtain medical clearance from your personal family physician or internist.

Preparation for surgery begins after the surgeon examines you and discusses the details of the procedure. If he recommends that you stabilize your weight before surgery or makes other lifestyle suggestions, do your best to follow them to ensure the best results and minimize complications.

In advance of your procedure, your surgeon will ask you to:

• Stop smoking six weeks before your surgery to promote good wound healing and to reduce scarring. Smoking also increases your risk of serious complications.
• Avoid taking aspirin, nonsteroidal anti-inflammatory medications (NSAIDs: Advil, Motrin, Aleve) and vitamins/homeopathic regimens. These can increase bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.

Your facelift may be performed in a hospital or an outpatient surgical facility. If it is outpatient, be sure to arrange for someone to drive you home after surgery and stay with you for the first twenty-four to forty-eight hours, unless you and your surgeon have decided on other postoperative recovery options.

For the easiest recovery period, prepare carefully:

• If you color your hair, you should do it just before surgery or you will need to wait at least a month.
• Stock your refrigerator with lots of fruits and vegetables and lean protein. Lean protein assists in healing. Sodium increases swelling; avoid it! Prepare frozen meals in advance. High protein, low sodium, soft foods are best for the first couple of days.
• Plan where you will recuperate. If you have a recliner chair, it is best for elevating the feet, knees and head. If you do not have a recliner, be sure to have lots of pillows available to prop up your head and knees. If possible, keep your phone and remote control for the T.V. by your bed.
• Decide what you will wear for the first few days; pick items that open in front and do not have to be pulled over your head. The same kind of clothing should be worn on the day of surgery. Wear slip-on shoes.
• Be sure to get plenty of rest and plan on not doing any housework, heavy lifting, or exercise. Avoid hot showers, hot tubs and saunas for two to three weeks.

What can I expect on the day of facelift surgery?
Facelift surgery, which may be performed in a hospital, freestanding ambulatory facility or office-based surgical suite, requires at least several hours to complete, though more extensive procedures may take longer.

• You will receive medications to keep you comfortable during the surgical procedure.
• Local anesthesia combined with sedation is commonly used during facelift surgery, though general anesthesia can be used instead. An anesthesiologist or nurse anesthetist may be present to administer sedatives (or general anesthetic) and assist in monitoring.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• After surgery, you will be taken into a recovery area where you will continue to be closely monitored.
• Your incisions will likely be covered with bulky bandages that provide gentle pressure to minimize swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid.
• Before leaving for home on the day of surgery, you or someone looking after you should feel comfortable emptying and resetting the drains.
• You may choose to go home on the day of surgery or spend the night with an office consultant or nurse, unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. Under no circumstances will you be permitted to go home alone.

What will my recovery and healing from a facelift be like?
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Potential signs of complications

Immediately after your facelift surgery

• You may be placed in a compression garment or wrap immediately after surgery. Wear this exactly as directed. Remove it only as directed for cleansing incisions or showering.
• To minimize swelling, recline rather than lie down. This will be more comfortable for you, and can reduce swelling. Always keep your head elevated. Do not bend forward or over.
• You will have a mild to moderate amount of pain and discomfort. This should be easily controlled with oral medications. If it is not, call your surgeon.
• The discomfort and pain should begin to decrease within forty-eight hours after surgery. If you have a significant increase in pain after this period, call your plastic surgeon. Severe pain is rare; if you experience this, call the doctor immediately.
• Expect bruising and swelling. These symptoms will peak within the first thirty-six to forty-eight hours after surgery and will gradually subside over the next ten to fourteen days. To minimize swelling, sleep with your head elevated for a couple of weeks after the surgery.
• It is not unusual to have some slight drainage for the first forty-eight hours. A bulky cotton compression dressing with drains will cover your scalp and face for one to two days to help prevent blood collections under the skin.

Recovery time frame after a facelift
Follow all postoperative instructions, including information about bandages, drains, taking an antibiotic (if prescribed), and the level of activity that is safe. Your doctor will let you know the signs of problems to watch for, such as signs of infection. Recovery time will vary by patient and in relation to the extent of your surgery.

The first week after your Facelift

• You may not drive for at least a week after surgery.
• A feeling of tightness in your neck is not unusual after surgery. This sensation is most pronounced in the first one to two days after surgery while the bulky dressing is in place.
• During your first postoperative visit, the bulky dressing and usually the drains will be removed. You may be placed in a supportive elastic face garment that is to be worn according to your doctor’s instructions.
• Do not take any aspirin or any anti-inflammatory compounds for two weeks before and two weeks after your surgery unless you first discuss it with your surgeon.
• It is recommended to sleep with your head elevated forty degrees for two weeks; an additional pillow or two under your mattress may help, if necessary.
• Apply cool (not cold) compresses to your eyes. Do not apply ice or anything frozen directly on the skin. Soak soft, white washcloths or gauze squares in ice water and wring out well. Apply directly to the eyes, but not to the cheeks or neck. Do not apply any pressure. Apply cool compresses for no longer than twenty-minute intervals. Do not apply heat.
• Stay up (sitting, standing, walking around) as much as possible after you return home. This helps to decrease facial swelling.
• Avoid bending or lifting heavy things for one week. Besides aggravating swelling, this may raise your blood pressure and encourage bleeding.
• You may wash your hair gently twenty-four hours after your surgery. Do not use the usual heat-type hair dryer; use the cap type or use the cool setting on the blow dryer.
• You may shower or bathe the day after surgery, but do not let the spray directly strike your face. It is permissible to get your suture lines wet, however.
• Report any excessive bleeding that persists after applying pressure for fifteen to twenty minutes.

Two to six weeks following a Facelift

• Don’t go swimming, diving, water skiing, or participate in strenuous athletic activity for at least one month after surgery.
• You can expect to experience some numbness around your ear lobes, face, and neck for several weeks after surgery.
• Refrain from any strenuous exercise and from bending or lifting.
• You may begin sleeping in a modified reclining position, but do not sleep lying flat or on your stomach. If you are a side sleeper, two pillows under your head and a soft pillow under your mid-back and shoulders may offer more comfort.
• Do not wear makeup until you have been told to do so.
• During the first four to six weeks your scars may appear red and be slightly firm and raised then the redness fades and the scar softens. It takes a minimum of one year for the scar to achieve its final appearance.
• Refrain from direct sun exposure. Wear sunglasses and a wide-brimmed hat. If you are outdoors, apply at least an SPF thirty at least thirty minutes before sun exposure. Your face will be highly susceptible to sunburn or the formation of irregular, darkened pigmentation.

Long term
You may ease into your regular fitness routine. However, wear protective eyewear and a hat. Discomfort or tightness and tingling in your face will resolve. Be prepared to wait at least six months for your facelift to completely heal inside and out. It is important to see your doctor as scheduled.

Side by side comparison Facelift Patient

Before and After Facelift Patient

Before and After Facelift Patient

Before and After Facelift Patient

Before and After Facelift Patient

Your genes, skin quality, and maintenance routine are important factors in the longevity of your facelift, but the facelift technique is the number one factor in determining how long the result will last.  Additional photos can be seen at http://www.cosmeticsurgerycare.com/photos

• Minimal facelift techniques with fast recoveries will last the least amount of time
• Mini-facelift, or ‘S-Lift,’ refers to a facelift with a small amount of skin undermining with limited SMAS (muscle/fascia) mobilization. With this technique, recovery is fast and results can last up to five years.
• Full or standard classic facelift: There are many versions of the operation that fall into this class, and can be called SMAS platysma, SMAS-ectomy, SMAS imbrication, deep plane, composite lift, or subperiosteal. These all require extensive rearrangement of the underlying facial tissues in addition to significant skin undermining. They are technically demanding procedures that are undertaken by trained, board-certified aesthetic plastic surgeons. The recovery is longer (two to four weeks), but the results generally can last over ten years.
• The more extensive the procedure, the longer the recovery period will be, and the longer you will enjoy the results.

Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you have any questions about your facelift healing and results.

The cost of a facelift varies from doctor to doctor, from one geographic area to another, and based on the facelift technique that is performed.

Because a facelift is elective surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.  The practice of Michael P. Vincent MD FACS participates with CareCredit.  Click on the logo for more information.

Choose your surgeon based on quality, training, and experience—not cost.

See why ASAPS members are widely recognized for upholding the highest standards in the area of aesthetic plastic surgery by viewing their basic credentials, training, and certifications.

Fortunately, significant complications from facelift surgery are infrequent. This surgery remains the gold standard for facial rejuvenation and is usually performed without any major problems.

Risks and potential complications of surgery should be discussed during your consultation. The risks in most surgeries are similar. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures.

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your facelift surgery.

Photos and illustrations are from multiple sources and serve as examples and are meant to be helpful, informative, and educational.  No implicit guarantees regarding similar results can be given.  Additional information and the above text can be found on Dr. Vincent’s American Society for Aesthetic Plastic Surgery Smart Beauty Guide home page

How is a neck lift procedure performed?

If only minimal contouring is needed, this procedure can be done with liposuction alone.
The procedure for a full neck lift is as follows:

• Incisions are made under the chin and/or behind the ears depending on the procedure that has been chosen
• The platysma muscle is tightened and sewn together (corset platysmaplasty) similar to the way shoelaces are cinched.
• Excess skin and fat are carefully trimmed away
• Tissue and skin are repositioned and secured with sutures
• Incisions are closed and drains may be placed before the wounds are bandaged

What are my options?

As a stand-alone procedure, your neck lift can be done with liposuction alone, if only fat is being removed and your skin quality is good. When there are more significant signs of aging, such as a turkey wattle, jowling, excess fat, sagging skin, and a prominent platysma muscle, a more extensive procedure is required that will address all of those problem areas.

What will my neck lift and/or facelift incisions and scars be like?

There are various incision approaches, depending on the extent of the surgery and the structures being altered. If a corset platysmaplasty is planned (in which the platysma muscles are tightly sewn together to create a smooth neck contour) a small incision is made under your chin (submental incision) along with a limited facelift-type incision behind each ear. For younger patients who request a neck lift with minimal change to the face, the neck correction can sometimes be accomplished with only the submental incision or with only the incision behind each ear.

Select a surgeon you can trust

It’s important to choose your surgeon based on:

• Education, training, and certification
• Experience with neck lift surgery
• Your comfort level with him or her

Members of the American Society for Aesthetic Plastic Surgery are experienced and qualified to perform your aesthetic procedure. Learn how to select a surgeon.

After finding a board-certified plastic surgeon in your area who is experienced in performing neck lift surgery, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment for a Neck Lift and/or Facelift

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a neck-lift candidate and clarify what a neck lift can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered.

You should come to the consultation prepared to discuss your complete medical history. This will include information about:

• Previous surgeries including a prior Facelift
• Past and present medical conditions
• Allergies and current medications

Your treatment plan for a Neck Lift and/or Facelift

Based on your goals, physical characteristics, and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your surgery, including the type of procedure or combination of procedures
• The outcomes that you can anticipate
• Your financial investment for the procedure
• Associated risks and complications
• Options for anesthesia and surgery location
• What you need to prepare for your surgery
• What you can expect to experience after surgery
• Show before-and-after photos of cases similar to yours and answer any questions

Questions to ask your aesthetic plastic surgeon

We developed these questions to help you:

• Make the most informed and intelligent decisions about your procedure
• Confirm that you have the right surgeon for your procedure
• Make your initial consultation as rewarding as possible
• Understand your options, potential outcomes, and risks

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for a neck lift and/or Facelfit?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos of Facelift and/or Neck Lift patients that I can look at for the procedure I am undergoing?
• Will my scars be visible? Where will my scars be located?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my surgery?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

How do I prepare for a neck lift and/or Facelift procedure?

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery.

In advance of your procedure, your surgeon will ask you to:

• Stop smoking at least six weeks before undergoing surgery to promote better healing
• Avoid taking aspirin, certain anti-inflammatory drugs, and some herbal medications that can cause increased bleeding
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.

Neck lift may be performed on an outpatient basis, particularly if only liposuction is performed. However, if more extensive surgery is planned, you will likely have an overnight stay in the hospital so that you can be monitored for possible problems. Be sure to arrange for someone to drive you home when you are released from the surgical facility and to stay with you at least the first night release from the hospital.

What can I expect on the day of neck lift surgery?
Your neck lift surgery may be performed in an accredited hospital, free-standing ambulatory facility, or office-based surgical suite. Neck lift procedures can range from one hour to three hours or longer, depending on the complexity of the procedure and whether the platysma muscle is manipulated.

• Medications are administered for your comfort during the surgical procedure.
• General anesthesia is commonly during your neck lift, although local anesthesia or intravenous sedation may be desirable in some instances.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your surgeon will follow the surgical plan discussed with you before surgery.
• After your procedure is completed, you will be taken into a recovery area where you will continue to be closely monitored. You will have drainage tubes in place.

You may be required to stay overnight for observation unless you and your plastic surgeon have made other plans for your immediate postoperative recovery.

 Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Potential signs of complications

How will I look and feel immediately following neck lift and/or facelift?

Immediately after surgery, your neck will be bruised and it will feel tight and numb. The bruising will resolve over the next four to five days but the feelings of tightness and numbness may remain for several months, if not longer.

Recovery time frame after neck lift and/or facelift

It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about care of your drains and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

 Under normal circumstances, the results of your neck lift surgery will be long-lasting.

Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in your neck lift. Do not hesitate to contact your surgeon when you have any questions or concerns.

 The cost of a neck lift varies from doctor to doctor and from one geographic area to another.  Because a neck lift is elective surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.  The practice of Michael P. Vincent MD FACS and Brent C. Faulkner MD participates with the CareCredit financing Company.

Choose your surgeon based on quality, training, and experience—not cost.

See why ASAPS members are widely recognized for upholding the highest standards in the area of aesthetic plastic surgery by viewing their basic credentials, training, and certifications.

 Fortunately, significant complications from neck lift are infrequent. Your specific risks of neck lift will be discussed during your consultation.

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

Other risks specific to neck lift are outlined below:

• Numbness and tightness in the neck area; this will usually resolve within a few months’ time

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your neck lift and/or Facelift surgery.

Photos and illustrations are examples and are meant to be helpful, informative, and educational.  No implicit guarantees regarding similar results can be given.  The above text, some of the above illustrations/photos, and additional information about breast lift and breast reduction surgery can be found on Dr. Vincent’s American Society for Aesthetic Plastic Surgery Smart Beauty Guide home page.