Facelift Surgery: The Ultimate Guide

Medically reviewed by William Portuese, MDBoard Certified Facial Plastic SurgeonReviewed on May 15, 2023
Written byJolene EdgarUpdated on May 9, 2023
RealSelf ensures that an experienced doctor who is trained and certified to safely perform this procedure has reviewed this information for medical accuracy.You can trust RealSelf content to be unbiased and medically accurate. Learn more about our content standards.
Medically reviewed by William Portuese, MDBoard Certified Facial Plastic SurgeonReviewed on May 15, 2023
Written byJolene EdgarUpdated on May 9, 2023
RealSelf ensures that an experienced doctor who is trained and certified to safely perform this procedure has reviewed this information for medical accuracy.You can trust RealSelf content to be unbiased and medically accurate. Learn more about our content standards.

Fast facts


Facelift surgery (aka a rhytidectomy) is a facial rejuvenation procedure that can create transformative results. It’s the most effective way to address signs of facial aging, including significant sagging and deep wrinkles and nasolabial folds, with results that last a decade or more.

“A facelift is the singular cornerstone for facial rejuvenation,” says Dr. Stephen Prendiville, a facial plastic surgeon in Fort Myers, Florida. 

All facelift procedures involve lifting soft tissue, repositioning and tightening the underlying muscles, removing excess skin, removing fat deposits in the neck, and re-draping the remaining skin, to give your face and neck a more youthful appearance. 

Despite a hefty price tag and up to two weeks or more of downtime, it’s one of the more popular plastic surgery procedures. 

There’s great debate among plastic surgeons about which facelift technique delivers the most long-lasting, natural-looking result. What’s most important is that a surgeon customizes their approach for each patient's specific anatomy and aesthetic goals.

See New York City-based facial plastic surgeon Dr. Dilip Madnani answer top questions from a RealSelf member who's considering getting a facelift.

Interested in a facelift?

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Pros

  • Facelifts have high patient satisfaction. The procedure has a 92% Worth It Rating on RealSelf, meaning that a majority of reviewers say their results lived up to their expectations. 
  • Facelift before and after photos show dramatic transformations.
  • Modern surgical methods that lift the underlying facial muscles as well as the skin help make facelift results look very natural.  
  • When the procedure is performed by an experienced surgeon, scars are generally undetectable once fully healed.  
  • Results typically last a decade or more.

Cons

  • Facelift surgery doesn’t include any work to the eyelids or brow. “Brow lifts and upper and lower eyelid surgery [or blepharoplasty] are separate cosmetic surgery procedures one can tack on, for an additional cost,” says Dr. Prendiville.  
  • :The procedure doesn’t address fine lines, crepey skin, volume loss, hyperpigmentation, or other signs of aging related to sun damage or poor elasticity," notes Dr. William Portuese, a board-certified facial plastic surgeon based in Seattle. You’ll need additional skin rejuvenation treatments, like laser resurfacing and dermal fillers or fat grafting, to correct those concerns.  
  • Complications can include bleeding, infection, poor wound healing, scarring, visible surgical scars, hematoma, and facial nerve injury with associated muscle weakness or paralysis, according to Dr. Brock Ridenour, a facial plastic surgeon in St. Louis, Missouri. 
  • Asymmetries, deformities, and underwhelming outcomes are also possible. 
  • Recovery requires at least two weeks of downtime.  
  • Facelifts are expensive, and they’re not covered by insurance.

See real RealSelf members decide whether or not they want to go through with facelift surgery.

  • Average Cost:
  • $12,625
  • Range:
  • $5,000 - $32,000

The cost of a facelift can vary widely, depending on the extent of your 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 NYC surgeons reportedly charge as much as $150,000.

Related: Facelift Costs: What Exactly Are You Paying For?

This is an elective cosmetic procedure that's not covered by insurance, but most surgeons accept third-party financing options like CareCredit.

See our complete guide to facelift costs

Interested in a facelift?

Find a Doctor Near You

As you're choosing your facial plastic surgeon, look for facelift pictures that show carefully hidden, thin scars, natural-looking ears and sideburns, cheeks that look lifted without being pulled, facial symmetry, a crisp jawline, and a smooth transition to the neck. Most importantly, the patient should look significantly younger while still looking like themselves.

The pictures in our facelift photo gallery were shared by the surgeon who performed the procedure, with the patient's consent.

The optimal age range for facelift surgery is usually from your 40s into your 60s, but if you’re healthy and have obvious laxity, it's possible to have the procedure in your 30s or well into your 80s.

“The ideal patient should have visible aging of the face—descent of the cheeks, [prominent] jowls and marionette lines, face and neck laxity, and banding in the neck—and the desire to do something about it,” Dr. Prendiville says. 

Good candidates are also nonsmokers in generally good physical and mental health, with no serious underlying medical conditions. Your surgeon will ask about your medical history during a consultation. Here's how to tell whether you're a good candidate.

There are two primary 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 muscle layer of the face. The platysma muscle of the neck is also resuspended during most facelifts.

While facelifts of old stretched and resized the skin only (often giving a windswept look), all modern procedures, both SMAS and deep plane, address both the skin and the SMAS. 

The type of facelift your surgeon performs will come down to their preference—the technique they’re trained in and feel most confident delivering—as well as your needs, anatomy (your skin thickness and quality, the fullness of your face, the angles of your neck, your bone structure), and your desired results. 

Regardless of which approach your surgeon favors:

  • Facelift surgery typically takes 2 to 4 hours, depending on the skill of your surgeon and the technique they use.
  • This outpatient procedure can be performed under either general anesthesia or local anesthesia with IV sedation. 
  • Once you’re unconscious or sedated, your face will be injected with a mix of lidocaine, epinephrine, and tranexamic acid, to numb the area and minimize bruising. 
  • After surgery, you’ll be discharged with either bandages on your face and head or a drainage tube. You’ll be groggy, so make sure you have a trusted friend, partner, or family member take you home and stick around for the first night, to monitor how you’re feeling. 

The SMAS facelift

All SMAS facelifts involve lifting up the skin and manipulating the SMAS to restore the contours of the face. During the procedure: 

  • Discreet incisions are made either inside the ear (tragal incision) or in front of the ear (pre-tragal incision), following the natural crease by your earlobe. A traditional facelift incision typically starts in the temporal hairline and, after traversing the ear, ends in the lower scalp.
  • The skin is raised off the SMAS and muscle layer, which are elevated and tailored (sometimes folded, other times trimmed). 
  • Typically, the platysma is accessed and lifted via ear incisions. It may also be tightened through a small incision under the chin, in what’s known as a platysmaplasty. “Fat deposits are removed from the neck as well,” says Dr. Portuese.
  • The skin is then redraped and any excess skin is removed.
  • The facelift incisions are closed with tiny stitches.

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). 

Learn more about SMAS facelifts

The deep plane facelift

With a deep plane facelift: 

  • The surgeon creates a flap that includes skin, subcutaneous fat, and SMAS, which is lifted and repositioned as one composite unit. 
  • Often, the surgeon releases certain retaining ligaments in the face, to better mobilize and elevate the cheeks and jowls, which is why the deep plane approach is thought to give a better mid-facelift in addition to smoothing nasolabial folds more effectively.
  • The muscular structure of the neck is also lifted and supported with tension-bearing sutures. 
  • As with a SMAS facelift, the skin is redraped and trimmed before incisions are closed.  

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. 

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. 

Learn more about deep plane facelifts

The mini facelift

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.

RealSelf Tip: “Ponytail facelift” is a marketing term with no standard medical definition, but it typically refers to a limited endoscopic lift. “The most common elements of a ponytail lift are the elevation of the midface, cheek structures, and jowls using small incisions” hidden in the hairline, explains San Francisco plastic surgeon Dr. Carolyn Chang. “Often, an endoscope is employed and suture suspension [is used] to achieve the results” (though some surgeons may skip the camera). Since a ponytail lift doesn’t allow for skin removal, it’s most appropriate for younger patients with early signs of aging.

Most full facelifts 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 skin laxity and 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. 

Through this same incision, any excess fat above the platysma muscle can be removed with liposuction, while the deep fat underneath the platysma muscle must be surgically  removed. This typically includes a platysmaplasty for more dramatic contouring, according to Dr. Portuese.

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 by 2 weeks post-op. 

That said, 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 dramatically compound puffiness and discomfort.

Following facelift surgery, 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), so stock up on smoothies, bland soups, and easy-to-chew foods that are high in protein.

You’ll also want a firm cushion that can elevate your head while you rest, since regular pillows can put pressure on your ears. 

“As you begin to heal, you may experience itchiness, swelling, and some tightness, which is completely normal and subsides within the first few weeks,” says Jupiter, Florida, plastic surgeon Dr. Jason Cooper.

Facelift recovery time depends a lot on how your body heals, but this is a typical day-by-day timeline.

  • Day 2: The day after surgery, you’ll have a follow-up appointment. Your surgeon will remove the surgical dressing and evaluate your facelift incisions as well as any bruising or swelling. They’ll also remove any drains that had been placed to prevent fluid buildup and seroma formation. You’ll be sent home in fresh bandages or no bandages at all, depending on how you’re healing. You can bathe the day after your surgery, but if you still have bandages on, avoid getting your head wet. 
  • Day 3–4: Bruising and swelling are at their max at this point. Take only your prescribed pain medication for the first few days of recovery, not aspirin or other over-the-counter painkillers. 
  • Day 3–5: You’ll have another follow-up appointment within five days to check wound healing progress, and any remaining bandages will be removed. Your doctor may give you a removable elastic strap to wear for support. You’ll care for the facelift incisions by cleaning them with saline and applying a thick ointment, such as Vaseline or Aquaphor. You can wash your hair with warm water, using baby shampoo. Gently let the water run through your hair, to remove any dried blood, surgical soap, and normal residue, and don’t disturb the staples or sutures. Avoid letting shower water hit your face. Pat your face dry and let your hair air-dry (blow-dryers can be too hot). You’ll also want to skip makeup and your regular skin-care regimen until your surgeon gives you the green light.  
  • Day 7: Stitches and sutures are removed around this point. You’ll be allowed to do light housework or other activities, if you feel well enough. Some patients choose to return to work at this time, but many wait for most of the swelling to go down (around the two-week mark). Don’t bend over; lift anything heavy; or bump your head, face, or neck—this can cause bleeding.  
  • Day 14: You should look “restaurant ready.” You’ll also be able to resume sleeping on your side, but don’t sleep on your stomach until your doctor says it’s safe to do so. 
  • Day 30: You should be back to your regular exercise routine. 
  • Month 3–4: During the first three or four months after surgery, stay out of the sun and apply sunscreen with a high SPF. 

You may notice very minor swelling, bruising, tightness, and even numbness for up to a year, but it’s rarely noticed by others.

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).

Learn more about facelift recovery

You'll be under anesthesia during the surgery itself, so you won't feel any discomfort. 

Once the anesthesia wears off, it's recommended that you stay ahead of any pain you may feel for the first two to four days with prescribed pain medication. 

Everyone experiences pain differently, but 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. 

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. 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, leading to inconclusive data on outcomes.” This analysis doesn’t focus on any one specific style of facelift or the outcomes of one particular surgeon; it looks at 11,300 facelifts performed between 2008 and 2013, and the complications that arose in this group of patients.  

  • The most common potential complication noted in this study was hematoma (1.1%), a collection of blood under the skin. “It usually stems from too much activity while healing or elevated blood pressure,” says Dr. Prendiville. If you develop a hematoma, your doctor will need to drain the blood via a syringe. 
  • The second most common complication was infection (0.3%), a risk you can mitigate by keeping your incisions clean.
  • Mild bleeding isn’t unusual after any surgical procedure, especially if you cough, sneeze, or strain yourself in any way. If you’re bleeding badly, contact your surgeon immediately. 

Facial nerve injury is possible, but the chance is extremely low, and 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.

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.”

You 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. 

Consistent skin care—a gentle cleanser and moisturizer, a vitamin C serum, a nightly retinoid—can help extend your results by safeguarding skin health and elasticity. 

Additionally, “wearing sunblock, [practicing] good nutrition, getting enough sleep, and trying to minimize stress are wonderful ways to keep your skin and the results of your facelift looking their best,”  says Raleigh, North Carolina, plastic surgeon Dr. Michael Law.

Thermage (Page Image)Thermage FLX

nonsurgical

FaceTite (Page Image)FaceTite

nonsurgical

Liquid Facelift (Page Image)Liquid Facelift

nonsurgical

Vampire Facelift (Page Image)Vampire Facelift

nonsurgical

Thread Lift (Page Image)Thread Lift

nonsurgical

Worth It Rating90%71%92%100%77%
Average Cost$2250$4975$2325$1375$1925
DowntimeNo downtime3–7 days of downtimeNo downtime1 day of downtimeMinimal downtime
AnesthesiaNo anesthesiaLocal anesthesiaTopical anesthesiaNo anesthesiaLocal anesthesia

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.

  • Other nonsurgical options include radiofrequency (RF) or ultrasound therapy treatments, such as FaceTite or Thermage FLX. They use heat to stimulate collagen production and improve elasticity to firm and thicken the skin, thereby improving signs of aging in certain areas of the face. “These give you a fraction of the results that a facelift will give you,” says Dr. Prendiville. They may also complicate a future surgery.
  • Injectable fillers can temporarily add volume to the skin for a smoother, more lifted appearance. Also known as a liquid facelift, they use hyaluronic acid fillers, such as Restylane or JuvĂ©derm, in combination with neurotoxins, like Botox or Dysport, which relax expression lines. 
  • A Vampire Facelift uses injections of platelet-rich plasma (PRP) taken from your own blood and combines them with hyaluronic acid–based fillers. The effects can last up to a year, depending on the type of filler that’s used. 
  • A thread lift is not surgery, but barbed threads are passed under the surface of your skin to lift tissue. As they’re absorbed by your body over six months, the threads boost collagen production, which can increase firmness for up to a year.   

Before deciding on a facelift procedure, schedule a “facial rejuvenation” consultation with a board-certified facial plastic surgeon. Your doctor can discuss both surgical and nonsurgical options to address your aging skin.

Interested in a facelift?

Find a Doctor Near You

Updated May 9, 2023

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