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How Does Facelift Surgery Work?

I've been considering a facelift to look younger and get rid of some of the hanging skin along my jawline. What's involved in the facelift surgery? What kind of incisions are typical? How long does the procedure take?

Doctor Answers 44

Facelifts - Like faces no two are exactly alike

I prefer the term 'facial rejuvenation' over the more antiquated term 'facelift', as many patients that I see who seek a more youthful and refreshed facial appearance undergo a set of surgical procedures very different from what would have been considered a 'facelift' twenty-five years ago.
The word 'rejuvenation' means, literally, 'to make young again'. In each individual, different facial changes occur with age. One person may be unhappy with 'baggy eyelids', while another has 'droopy eyebrows'. One person may be troubled by 'jowls' in the lower face, while another would like an improvement in their 'floppy neck'.
Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.
Plastic Surgery of the Face in the 21st Century
The specialty of Plastic Surgery has been undergoing a 'paradigm shift' in the approach to surgical treatment of facial aging changes over the last two decades. This shift has consisted of a departure from older 'subtractive' techniques to newer 'restorative' techniques.
Surgery which consists mainly of removing (subtracting) skin and fat and pulling tissues tight will lead, in many instances, to a 'skeletonized' and therefore more aged (or "done") appearance. Facial soft tissues (and even the facial bones) actually lose volume and projection with age, and it is thus inevitable that surgery which focuses only on removing tissue will in some fashion 'age' the face.
The contemporary approach to surgical rejuvenation of the face consists more and more of an attempt to restore facial volume and contour, in an attempt to emulate youthful facial features. My personal approach to facial rejuvenation is to first maximize repositioning and recontouring of facial aesthetic areas, and to remove only as much tissue as is necessary.
I also find that structural fat grafting, using a patient's own fat from the abdomen or hips, is an extremely effective means to help restore the facial volume associated with a youthful appearance. The importance of restoring facial volume is readily apparent when I review with a patient a number of photographs from their twenties and thirties. The meticulous addition of soft tissue volume by means of fat grafting is one of the most powerful means now available for 'turning the clock back.'
The Components of a 'Facelift'
Below is a list of facial aesthetic areas and the corresponding surgical procedures that I perform to enhance each specific area. Most patients that have what is commonly referred to as a 'facelift' are undergoing some combination of the procedures listed below based on their own individual needs and goals. For that reason I prefer the term 'facial rejuvenation' over the term 'facelift'. Each of these topics is discussed in answers on the realself site.
To Restore Facial Volume - Structural Fat Grafting
The Brow - Lateral Browlift
The Upper Eyelids - Upper Eyelid Enhancement (Upper Blepharoplasty)
The Lower Eyelids - Lower Blepharoplasty and Lateral Canthopexy
The Midface (Cheeks) - Midface Lift
Nose Reshaping - Rhinoplasty
The Lower Face ('Jowl' Area) - Lower Face / Jawline Lift
The Neck - Neck Lift
Be sure to view many many before and after photos and speak to patients before selecting a plastic surgeon for a facelift 

Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 48 reviews

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Facelift incisions, procedures, and surgeons

The facelift is a technique to tighten the skin of the face. Beyond that, every facelift is different. Facelifts can take from one to six hours in our practice, depending on the involvement of the surgery.

The skill and training of the surgeon performing the facelift is very important. In my opinion, patients should seek a surgeon certified by the American Board of Plastic Surgery or a Facial Plastic Surgeon to perform this procedure, and no other specialty. No other specialties are trained in the anatomy of all the deep layers of the face to the extent of these two specialties. Deep facelifts require a knowledge of the nerves of the face, in order to avoid damaging them. Well trained plastic surgeons are trained in microsurgery to actually operate on these nerves when they are cut, damaged or missing and are therefore very familiar with where the nerves are. I recommend these two specialties as a starting point, then choose after interviewing several doctors.

If you don't actually check with the American Board of Plastic Surgery above, you will not know for sure whether your surgeon is board certified in plastic surgery or facial plastic surgery.

I have seen many poorly done facelifts. In some cases, the patients were sad to discover that their doctors actually were not board certified in plastic surgery at all. The patients were invariably told their doctors were board certified, but they didn't investigate any farther than that. And the doctors might have been board certified... but in what specialty?

"Cosmetic surgery" is a basket term for anybody who wants to consider themself a "plastic surgeon", without the annoying step of a 6-10 year plastic surgery residency training after medical school. Remember this is your face.

One important features of modern facelifts are the ability to hide scars effectively. The incisions are very rarely, if ever, performed in front of the ear. Rather, they are performed inside the ear. Typically, the scars are invisible even the day after surgery. This results from advancements in anchoring techniques.

The ears should appear unaltered and not pulled down or changed in shape or their cant relative to the face. This is actually the easiest way to tell unskilled work: look at the ears. The ears should tell no tales.

Deep layers should be restructured and elevated, not just tightened, in my opinion. This gives the face a fresher, more youthful look rather than just a tighter look.

The many extra procedures that go along with the facelift (brow elevation, eyelid surgery, cheeklifts, laser resurfacing, grafting to hollow areas and lips, lip lifts, chin implants, neck tightening, witch's chin repair, earlobe reduction, etc. etc. etc. are different for every patient. They are as important as the facelift itself. They enable the surgeon to rejuvenate the entire face harmoniously rather than just the "face brow and eyes" of the past.

Because the facelift is such an important decision, many surgeons will offer you to meet former patients face to face in addition to showing before-after pictures.

So the term "facelift" can refer to a subtle minilift all the way up to a facelift, necklift and many ancillary procedures. Never before have patients had so many options and choices.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 103 reviews

Facelift surgery advice

Dr. Moelleken's advice is exceptional. Please read it a few times.

A facelift can be a phenomenal benefit to you if done properly by the right surgeon. It is an art form and no 2 surgeons are alike in their training, talent and artistry. You should obtain a clean, smooth jawline with no jowls, a neck without fat and muscle laxity with a youthful angularity, restored cheek volume and a complete absence of an operated on look. These are the achievable goals for the right patient with the right doctor.

Facelift surgery - Answers to all your questions!

Thank you for your enquiry. My assessment would be more complete if I could assess you in person.  Facelift surgery is a very individualised procedure tailored to each patient depending on their age, skin quality, medical conditions they may have and their desires and expectations.

Injectables such as wrinkle relaxers (Botox) and dermal fillers can help erase some of the signs of facial aging  we perform these procedures in our Perth practice frequently. Although they can not achieve the skin changes which modern facelifts can. The effects of these fillers and relaxers may last anywhere from 4 months to two years, but a facelift's rejuvenating effects can extend up to 10 years. Injectables treat wrinkles and facial volume loss in the face, while a facelift has a lifting effect on the mid/lower face and  neck.  A facelift can remove excess skin, reposition muscles and some of the underlying tissues of the face; all of these functions are way outside the realm of injectables. Other facial rejuvenation procedures such as microdermabrasion, dermabrsion, laser resurfacing, the Pelleve (radiofrequency technology) and light based technologies such as IPL and AFT can achieve some textural changes in the skin and tightening.

In my experience all modalities are used judiciously in achieving the desired changes in the facial rejuvenation procedure.  Often a facelift will require anyone of the above mentioned procedures to address the specific needs of the patient.

Your problem of hanging skin along your jawline and excess skin, makes you an ideal candidate for a facelift. Age is not a barrier. Most people undergo facelifts between the ages of 50 to 65, but this is only the average age range. Many people as young as 40 and some older than 80 also have facelifts.

A consultation with a specialist facial plastic surgeon is an absolute necessity in assessing you prior to surgery.  Consideration will be given to your skin quality, degree of sun damage and skin type, medical history, medication intake, herbal medicine intake, alcohol use, smoking history and family history prior to your surgery.

As your facial plastic surgeon I will develop a plan for your facelift based on your skin's elasticity, facial volume loss and your bone structure. Sometimes other procedures are performed with your facelift, such as brow lift or eyelid surgery, fat transfer, facial implants, and laser resurfacing.

Prior to surgery I start my patients on a course of microdermabrasion and facial serums and infusions (IMANI Skin Care Range), this is designed to nourish the skin and increase the blood flow 6 weeks prior to facelift.

During your consultation we will discuss what type of anesthesia will be used for your facelift. Facelifts are performed under general anesthesia or local anesthesia with intravenous or light sleep sedation. Your anesthesia will only be administered by an anesthetist.

I will go over your preoperative and postoperative instructions. You may be given prescriptions for antibiotics, ointments and pain relievers to fill in advance of your surgery.

You will be given a preoperative information packet that describes everything you should do and know before your facelift. The packet would include a list of all the medications to avoid before your surgery. Generally, this includes anything containing aspirin or ibuprofen, both of which increase bleeding risk. All herbal medications and fish oils are prohibited 2 weeks prior to surgery.

All necessary blood test should be completed at least a week in advance of your facelift. You may be required to consult with my anaesthetist.

If you smoke, quit as soon as possible. Smoking interferes with circulation and healing. It also causes wrinkles and premature aging, both counterproductive to your facelift.

What kind of incisions are typical? How long does the procedure take?

I perform a modern minimally invasive facelift procedure.  The incisions are made in front of the ear and run behind the ear, they are placed in the natural skin folds which result in minimal visible scarring. The skin is elevated and the fat and muscles of the face are repositioned and suspended (using absorbable sutures) to strong bony points in your skull and facial bones.  The direction of suspension is vertical hence giving a natural look rather than a wind swept or pulled look.  Any excess skin is trimmed and repositioned using absorbable hair thin sutures.  Your face is bandaged and you are monitored in recovery before returning to your hospital ward room.  A soft silicone drain tube may be placed in your wound and it is removed the next day.  Your bandages are removed the next day and replaced with a customised facial garment.  You will be seen by my self and office staff on the 7th day after surgery. A complementary lymphatic massage is provided to all patients for 6 weeks after surgery.  You can expect some swelling and bruising after the procedure which should subside in 2 weeks.

A facelift is usually performed as an outpatient procedure, but overnight stays are a possibility depending on your specific circumstances. Your surgery will be performed in an accredited hospital facility.

I hope this helps answer some of your queries.  In summary, make sure you trust your face to a specialist facial plastic surgeon with FRACS (Fellow of the Royal Australasian College of Surgeons) qualifications.

By Dr Pedram Imani

Pedram Imani, MBBS, FRACS
Perth Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Facelift: Its in the Details

I think that the post by Dr. Moelleken was very insightful: when choosing a surgeon to do your Facelift, start with credentials. If your surgeon is not Board Certified by the American Board of Facial Plastic Surgery or the American Board of Plastic Surgery, you need to continue your search.

Secondly, natural results from a Facelift are very feasible, and rely on attention to detail. Facelift, in the modern sense, relies on tension on deeper structures, and not tension on the skin. A memorable quote I remember from a very well respected Facelift surgeon (Dr. Bruce Connell): "If the skin was a great structural support, pregnancy wouldn't be possible". Procedures that do not utilize adequate mobilization of deeper structures (SMAS) will produce short lived results or make a patient look stigmatic. Common Facelift mistakes include poor incision planning, over-pulling the skin and/or under-mobilization of the SMAS. A full and understandable description of Facelift incisions is probably best obtained by a consultation with a board certified Facial Plastic Surgeon or Plastic Surgeon.

Thirdly, a Facelift isn't a quickie job: you cannot do a good job in an hour unless you omit components from the procedure. When components are omitted, either the result or the longevity of the procedure, or both will suffer.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 45 reviews

Facelift Surgery Informative Video- please watch

A facelift is a surgical procedure that can correct sagging around the mid-face, excess fatty deposits and loose skin underneath the chin, some wrinkles and fine lines. 

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.5 out of 5 stars 41 reviews

Facelift for tightening the jawline, jowls, neck

The term 'facelift' is confusing, as the technique is really designed to rejuvenate the lower 1/2 of the face and the neck.

If you read this forum, you will see that many different types of lifts exist--various deep-plane lifts, SMAS lifts, MACS lifts, mini-lifts, etc. The bottom line is that the experience of your surgeon is paramount and together you can decide which type is best for you. The issues to consider are the 'downtime' you are willing to go through and the quality and longevity of the result you desire. Typically, the quicker the lift, the less time the results will last.

The incisions may vary, but are typically place around the ear. There may be a small incision under the chin. What is done deep to the skin will vary with the type of lift.

Hope this helps.

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

A facelift can mean so many different things to patients..and physicians.

As a starter please read Dr. Moelleken's response. It is excellent and is exactly how I feel as well.

There are many out there who consider themselves cosmetic surgeons without the requisite training in the area. I too believe that a facelift surgeon should have the anatomic training as well as surgical experience to operate on a complex region such as the face. It is in my opinion,as well, that the only people qualified to perform such operations are board certified by the American Board of Plastic Surgery or American Board of Facial Plastic Surgery. Ask your surgeon how many reconstructive and cosmetic suregeries they performed on the face during their training. The answer should be in the hundreds.

That being said a facelift to me means a surgical procedure to elevate and or reposition sagging skin and muscle to an elevated and more youthful position. Adjunctive procedures like those already mentioned can add volume and balance and often lead to the best overall results.

In my practice the practice a facelift can mean different techniques as well which also might mean different operative times. In general from two to six hours is the norm. The incisions used are placed so as to use the hair and exisiting creases to camouflage the scars. The ars and the hairline often can tell the tale of a good result versus and pulled and unatural result. Hope this helps!

Giancarlo Zuliani, MD
Rochester Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

There are many ways to rejuvenate a face.

A facelift usually refers to rejuvenating the appearance of the lower face and neck.  However, when evaluating a patient for facial rejuvenation, it is important to evaluate all the features of the face which includes the position of the brow, the appearance of the eyes, the appearance of the midface, lower face, and neck.  Additionally, it is very important to evaluate the volume or lack of volume in the face as it may be useful to address fat transfers at the same time.  

A well performed  facial rejuvenation procedure is performed with incisions that are placed in very inconspicuous locations so that no one can visualize these and so that there is no awkward distortion of the ears.

In addition to offering surgical options for facial rejuvenation, we offer many non surgical options such as Ultherapy, Exilis Elite, ematrix, fractionated CO2 laser resurfacing, IPL, Botox/Dysport, Juvederm, Voluma, Restylane, Perlane and Sculptra.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 124 reviews

Facelift Basics

Thank you for your question. A facelift should address your concern by "getting rid of the hanging skin along the jawline". In addition the underlying SMAS muscle should be tightened in general. This being said there are additional things that are necessary for each patient depending on the level of correction needed. Make sure you go to a Board Certified Plastic Surgeon who performs a lot of facelifts. In addition, make sure you see enough pre/post photos of facelifts from that surgeon. Good luck to you!

Milind K. Ambe, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 15 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.