A facelift (rhytidectomy) is a surgical procedure that can create transformative facial rejuvenation results. “A facelift is the singular cornerstone for facial rejuvenation,” according to Dr. Stephen Prendiville, a board-certified facial plastic surgeon in Fort Myers, Florida.Â
There is no more effective way to address signs of aging, including sagging or loose skin, deep wrinkles, and facial folds, and results can last a decade or more.
Modern facelift procedures involve lifting soft tissue, repositioning and tightening the underlying muscle layer, removing fat deposits in the neck, and tailoring and re-draping the remaining skin, to give the face and neck a more youthful appearance.Â
Despite a hefty price tag, up to two weeks or more of downtime, and a growing roster of nonsurgical treatments claiming to offer similar benefits, facelift surgery remains one of the most popular plastic surgery procedures.
See Dr. Dilip Madnani, a board-certified facial plastic surgeon in New York City, answer the top questions from a RealSelf member who's considering getting a facelift.
Pros
Cons
The cost of a facelift can vary widely, depending on the extent of the procedure as well as your surgeon’s level of training, experience, practice location, and the specifics of your surgery.
While RealSelf members have reported facelift costs as high as $30,000, some Instagram-famous surgeons in NYC and LA reportedly charge in the six figures for their facelifts.
Related: Facelift Costs: What Exactly Are You Paying For?
This elective cosmetic procedure is not covered by insurance, but most surgeons accept third-party financing options like CareCredit.
As you're choosing a facial plastic surgeon, look for facelift pictures that show carefully hidden, thin scars, natural-looking ears and sideburns, cheeks that appear lifted without being pulled, facial symmetry, a crisp jawline, and a smooth transition to the neck.
The photos themselves should be standardized—showcasing consistent lighting, backgrounds, angles, and facial expressions—with the afters taken weeks to months post-op, once swelling has gone down.
Most importantly, the patient should appear younger while still looking like themselves.
Every face evolves at a different rate. While the optimal age range for facelift surgery is 40s to 60s, if you’re healthy and have obvious laxity, it's possible to have the procedure in your 30s or into your 80s.
“The ideal patient should have visible signs of aging—descent of the cheeks, jowls and marionette lines, face and neck laxity, and banding in the neck—and the desire to do something about it,” Dr. Prendiville says.Â
Facelift candidates are nonsmokers in good physical and mental health, with reasonable expectations and no serious underlying medical conditions. Your surgeon will ask about your medical history during a consultation.
There are two main techniques for full facelift surgery: a SMAS lift and a deep plane facelift.
Both methods reposition the deep tissues of the face, primarily the SMAS (superficial musculoaponeurotic system), which is a sheet of firm facial tissue (fascia) covering the muscles of expression in the lower face. The platysma muscle of the neck is an extension of the SMAS; it too is resuspended during most facelifts.
While facelifts of old stretched and resized the skin only (often giving a windswept look), modern procedures, both SMAS and deep plane, address both the skin and the SMAS.Â
While plastic surgeons have long argued about which facelift technique delivers the most long-lasting and natural-looking result, no one style has been proven superior in a peer-reviewed study. What’s most important is finding a qualified, experienced surgeon with the skill to customize their approach for each patient's specific anatomy and aesthetic goals.
The type of facelift your surgeon performs will come down to the technique they’re trained in and feel most confident performing as well as your needs, anatomy (your skin thickness, the fullness of your face, the angles of your neck, your bone structure), and your desired results.Â
Regardless of which approach your surgeon favors:
All SMAS facelifts involve lifting up the skin and manipulating the SMAS to restore the contours of the face. During the procedure:Â
Under the SMAS umbrella, there are various kinds of facelift techniques, two of the more popular being the SMAS imbrication and the SMASectomy. Surgeons commonly put their own spin on these textbook procedures, extending the degree of dissection, mobilizing the SMAS to a lesser or greater extent, or adjusting the direction of lift (aka the vector).Â
Learn more about SMAS facelifts
With a deep plane facelift:Â
Proponents of the deep plane technique say the results are more natural-looking and longer-lasting, but certain studies have found no major differences between the two techniques in patients under 70 years old, even when comparing the results over a 10-year period.Â
When someone has thick facial skin and a very full face, a deep plane lift may provide better support. In the spirit of customizing the procedure to the patient, “many surgeons will vary their facelift technique depending on anatomic considerations, such as the width and shape of the face, the patient’s skin thickness, and the distribution of subcutaneous fat,” says Dr. Ridenour.Â
Learn more about deep plane facelifts
True endoscopic facelifts rely on tiny incisions hidden in the hair of the temples, through which surgeons insert a lighted camera that helps guide their dissection. This eliminates the need for long incisions around the ears, which are standard with open-style facelifts.
In the past, endoscopic facelifts were "subperiosteal," meaning surgeons worked directly above bone, treating the upper two-thirds of the face (essentially taking an endoscopic brow lift one step further to include the midface).
The most modern iteration of the so-called "scarless facelift" is a deep plane endoscopic facelift. It generally addresses the mid- and lower face through incisions in the hair and also, in some instances, behind the ears.
These procedures frequently include neck work, as well, via an incision under the chin.
“The most common elements [of an endoscopic facelift] are the elevation of the midface, cheek structures, and jowls using small incisions,” says San Francisco plastic surgeon Dr. Carolyn Chang.
Since classic endoscopic incisions allow for little to no skin removal, they’re most appropriate for young patients with early signs of aging or older patients with exceptional skin elasticity.
The popular “ponytail facelift” is a trademarked term for a specific type of endoscopic deep plane facelift developed by Dr. Chai Chi Kao, a plastic surgeon in Santa Monica, California. Despite the branding, providers commonly adopt the moniker for other kinds of limited or endoscopic lifts, but a true ponytail procedure follows a specific protocol and addresses the full face and neck, mainly through keyhole incisions.
A short-scar or mini facelift involves making a limited incision, primarily in front of the ear and into temporal hair tuft, explains Dr. Ridenour. “The short-scar facelift is typically done in younger patients who have modest sagging of skin,” he says.
One type of mini lift is a lower facelift, which focuses primarily on the jawline and neck, explains Dr. Ridenour. “A lower facelift may tighten only the platysma, or neck muscles, rather than the entire SMAS layer, and can be good for younger patients with early aging of the lower face.”
While mini lifts vary in scope and intent, outcomes tend to be less dramatic and less durable than those of traditional facelifts.
Related: What Kind of Facelift is Right For You? Doctors Explain the Differences
Most full facelifts do include a neck lift. The surgeon elevates the skin off the neck’s platysma muscle (an extension of the facial SMAS layer) and tightens that muscle.
The platysma can usually be accessed through the same facelift incision sites around the ears, but sometimes an incision under the chin is necessary—especially in the case of severe platysmal banding (when the muscle is seen as two vertical bands that run the length of the neck, from jawline to collarbone).
Platysmal banding can be corrected by cutting and suturing the muscle through a small incision under the chin.Â
Through this same incision, any excess fat above the platysma muscle can be removed with liposuction. The deep fat underneath the platysma must be surgically removed. Some surgeons reduce nearby salivary glands and digastric muscles while they’re in the subplatysmal space to more dramatically improve the neckline.
Related: Lower Facelift vs. Neck Lift: What’s the Difference?
You’ll be through the worst of facelift recovery after 7–10 days and looking pretty presentable 2 to 4 weeks post-op. It typically takes longer to recover from a deep plane facelift than a SMAS procedure, since the tissue dissection is more extensive with the deep plane technique.
The first week can be rough: you’ll be swollen, stiff, and sore, especially if you’ve tacked on additional procedures like laser resurfacing, rhinoplasty, facial fat grafting, and/or eyelid surgery, all of which can compound puffiness and discomfort.
You’ll be on a soft-food diet for the first few days, drinking only from glasses or cups (the sucking motion of straws can be painful). Stock up on smoothies, bland soups, and easy-to-chew foods that are high in protein.
You may want a firm cushion that can elevate your head while you rest, since regular pillows tend to put pressure on the ears. However, some surgeons recommend lying completely flat following a facelift to minimize swelling, so talk to your surgeon before investing in pillows.
Facelift recovery time depends a lot on how your body heals, but this is a typical day-by-day timeline.
Day 2:
Day 3–4:
Day 3–5:
Day 7:
Day 14:
Day 30:
Month 3–4:
RealSelf Tip: Dr. Prendiville tells his patients to eat well so they can heal well. That means a diet high in protein and also avoiding fish oil, alcohol, ginkgo biloba, vitamin E, and other blood thinners (which can prolong bruising).
You'll be under anesthesia during the surgery itself, so you won't feel any discomfort.Â
Once it wears off, stay ahead of pain for the first two to four days with prescribed medication.Â
You can expect to feel swollen, bruised, and tender for the first two weeks of recovery, with the worst swelling between 48 and 72 hours after surgery, says Dr. Prendiville.Â
Avoid bending over or doing any heavy lifting for two weeks, to help prevent excessive swelling.
You can use cold compresses (crushed ice in a bag, a soft ice pack, or even a frozen washcloth) to help reduce swelling and bruising, and ease the discomfort. Gently apply the compress to your face, 20 minutes on, 20 minutes off, during the first 48 hours.
Facelift surgery has a complication rate of 1.8%, according to a 2015 study (the most comprehensive and widely cited data). There is a lack of data on general facelift complications, because as the authors note, “A plethora of accepted techniques exist for facelift surgery, as well as significant individual surgeon variation.”
Facial nerve injury is possible, but the chance is extremely low. When it does occur, it’s typically not permanent. “Facial nerve palsy and facial muscle weakness following a facelift are almost always temporary, with full recovery by three to six months [afterward],” says Tampa, Florida, plastic surgeon Dr. Jaime Perez. (Every facelift surgeon has their own personal rate of temporary and permanent nerve injury. Ask your surgeon about their rate during your consultation.)
A 2019 analysis of complication rates between different types of facelifts found “that all rhytidectomy approaches have a comparable and safe complication profile.” The authors conclude that “the choice of rhytidectomy technique should primarily be made on the basis of the quality of the result rather than the presumed complication rate.”
Rhytidectomy patients should have a more lifted, youthful appearance for 10 years or more.
While you're effectively turning back the clock, the natural aging process will still continue and signs of aging will continue to accrue.Â
Consistent skin care—a gentle cleanser and moisturizer, a vitamin C serum, a nightly retinoid, and daily sunscreen—can help extend your results by safeguarding skin health and elasticity.Â
These less invasive alternatives to a facelift can’t deliver results on par with a surgical lift, but they may be good options for those who aren’t ready for surgery.
At a facial rejuvenation consultation with a facial plastic surgeon, your provider can discuss both surgical and nonsurgical options.
Updated March 31, 2024