How much do facelifts 'relax' after surgery?

Question

I understand that after a facelift everything 'relaxes' a little but five months after my facelift, my face is still 'relaxing' and I am upset that although my face was more of an oval shape post-surgery it is now returning to more fullness at the bottom. Is this normal? I am concerned that it will keep on losing its nice post-surgery shape and that there will be little longevity in my facelift.

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately, some relaxation of the face after a facelift always happens. The skin, when tightened, will stretch, just as the abdominal skin stretches during pregnancy. And the degree of stretch is related to age and genetics, as well as the surgical technique used. At 5 months, most of the relaxation will have occurred. After that, the normal aging process results in gradual relaxation over many years. 
The longevity of facelifts depends in part on the technique used. Techniques that involve less manipulation and release of the deeper layer (SMAS), and rely mainly on tightening by suturing without release, will have less longevity. The skin stretches more than the SMAS, and therefore, I believe it is better to tighten the SMAS as much as possible and not rely on pulling the overlying skin, but rather bring the skin up with the SMAS. You should discuss your results with your surgeon in terms of what to expect in the future.

Kenneth D. Steinsapir, MD · Answer

Generally, 5 months is just turning the corner on the early healing phase after a facelift.  It is always like this: If you need the face to relax after a facelift, it almost never happens.  When you need the face to stay up after a facelift, it tends to relax.  That is Murphy's law for facelift.  Some facelifts are simply overdone and never relax to something that looks natural and being told that you look marvelous by the Surgeon's office never really rings true.  Generally this is a difficult situation because time does not always provided needed softening.  Consider posting photographs so we have a better idea of your concerns.

Michael I. Echavez, MD · Answer

Many factors can influence how long a facelift may last.  The technique and type of facelift performed, the individual characteristics of the patient's face, and any potential complications involved can all influence the results.  I would say that most facelifts should last more than 5 months, but without examining you or at least seeing before and after pictures of you, it is difficult to give you further advice.

Richard A. Zoumalan, MD · Answer

Healing for any surgical procedure varies from patient to patient. Although most of your recovery may be complete at this point, your face will continue to undergo changes after any procedure. It is always recommended that you consult with your surgeon in regards to all your post-operative concerns.

Kouros Azar, MD · Answer

In all honestly, it is really going to depend on the quality of your skin more than the type of facelift that you had. For now, be patient. It can take up to anywhere from 6 month to a year for your final results. Things might settle out fine in the long run.

Robert D. Wilcox, MD · Answer

Dear JJohnson,
  
Everybody is different and their skin elasticity is different.  This also depends on the particular technique used and whether you smoke or have a lot of sun damage.  I am afraid there is no ready answer.  I hope this has been helpful.

David Q. Santos, MD · Answer

Relaxation will happen after a facelift.  Those individuals with the greatest of heaviness to the neck, or with the most lax and "floppy" necks and surrounding tissues, will have the greater propensity for relaxation after the surgery, and need for revision surgery.  Typically, less than 5% of my patients will ultimately require a revision surgery  Relaxation will generally occur approximately 6 weeks or longer after the initial surgery.  It is normal to have a little relaxation If it is a real bother, then revision surgery can be performed.

Summit Kundaria, MD · Answer

JJohnson,
Thanks for the question.  There are periods of scar buildup after a facelift, and then scar remodeling before you get to your final result.  I would argue that you are still remodeling your scars (the deep ones between your skin and your facial muscles), and you should still see an evolution in your results for another few months.  I agree that it is disappointing to have your face "relax" after a facelift, though this is normal to a variable degree because your face is very full (of fluid) after a facelift and it takes a while for this to come down.  I don't think that your face will continue to keep relaxing to its pre-operative state, and that you should see the effects of the surgery.  Good luck!

Emily Clarke-Pearson, MD · Answer

Thank you for your question. It sounds like you are getting towards the end of the healing period after surgery. At first after a facelift, there is a lot of swelling in your cheeks and jaw that can give a rounded look. Then as the swelling improves the skin and soft tissues heal down, some of that fullness can go away and look slightly less tight/youthful. I tell my patients that at 6 months, they should see the end result, and that result should last 5-10 years, depending on how aggressive the facelift procedure was. 
Remember that a facelift redrapes the skin and soft tissue, but it doesn't bring new volume to your face. If you are a thin woman, sometimes a little supplementary facial filler or fat grafting to the cheeks or around the mouth can help restore volume to your face which can give a more feminine appearance. 
See how things progress over the next 6 months - my guess is that your facial shape will stabilize. You should communicate your concerns with your plastic surgeon too so that everyone is on the same page.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type SMAS facelifts.  Honestly, there are so many different ways to perform a facelift that it makes it impossible to provide a simple answer to your question.  In my experience, no facelift technique alone can properly shape all of the "key" aesthetic facial features.  For this reason, I always aesthetically shape the face when performing facelifts in order to make the face more naturally attractive.  
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Conversely, men look chiseled and handsome when they have angularity in the cheeks, chin and mandibular angles.   The facelift is designed to lift the sagging SMAS muscle layer (and jowls) as well as remove excess skin from the face and neck.  Other procedures must be applied to properly shape the cheeks, chin, lips, chin and jaw line as needed.  The good news is that if following your facelift, the jowls have been reduced, you might just need proper shaping of your cheeks to create a softer more feminine face.
 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed
excess skin removed
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.

How much do facelifts 'relax' after surgery?

Answers (11)

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