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Facelift surgery

Published by Bupa's health information team, June 2009.

This factsheet is for people who are having a facelift operation, or who would like information about it.

A facelift lifts up the facial skin and tissues and/or the underlying muscle, to make the face tighter and smoother.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About facelift surgery
Getting advice
What are the alternatives to facelift surgery?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from a facelift
What are the risks?
Questions and answers
Further information
Related topics
Sources

About facelift surgery

As you age, your facial muscles loosen and your skin becomes less elastic, creating folds and lines. A facelift operation can give you a more alert and youthful appearance by reducing saggy skin and wrinkles.

Facelifts can lift your whole face (a full facelift) or just your brow area, lower face, or neck. The effects of a facelift usually last for seven to 10 years. Your face will continue to age. You'll get the best results if you maintain a stable body weight, have skin with good levels of elasticity, don't smoke and have good bone structure.

Getting advice

It's important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a reputable surgeon or advise you on how to choose a hospital to be treated in.

Before opting for a facelift, discuss with your surgeon what you are hoping to gain from the operation and the results you can realistically expect. A facelift will not affect the fine lines around your lips, for example.

What are the alternatives to facelift surgery?

Other treatments may be used either as alternatives, or in combination with a facelift.

Resurfacing techniques reduce surface wrinkles and can smooth the skin by removing damaged outer layers. Options include chemical peels and laser resurfacing.
Pulsed light therapy stimulates the middle layer of the skin to produce more collagen, which plumps out fine lines and wrinkles.
Tissue augmentation plumps out deep wrinkles with injections of collagen or other types of filler.
Botulinum toxin injections can flatten out wrinkles that appear in your skin when you smile or frown. This is particularly suitable for forehead lines and wrinkles around your eyes.
Creams, gels and beauty treatments may help tighten your skin. However, there is no scientific proof that these work.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you may be asked to quit, as smoking increases your risk of getting a chest or wound infection, which can slow your recovery. It also reduces circulation in your skin, which slows healing.

A facelift typically requires an overnight stay in hospital. It's usually done under general anaesthesia. This means you will be asleep during the procedure. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine. Your surgeon or other health professional will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your surgeon will examine your face and may take photographs so that the results of surgery can be compared with your original appearance.

About the operation

The operation can take up to six hours. There are several different facelift techniques. Your surgeon will explain the options available to you.

Traditional facelift

In a traditional facelift, your surgeon will make a surgical cut in your hairline, down past the front of your ears and then up into the hairline again behind the ears. Cuts may also be made under your chin if you want to lift a sagging jawline.

Your skin is carefully separated from the underlying tissues. The surgeon will then remove or reposition the excess fat, or tighten the muscles or surrounding tissues in your face. He or she will finally lift your skin, pull it back and trim off any excess.

Your skin is then stitched back to the line where the cut was initially made.

Afterwards, your face is wrapped in bandages. Depending on the exact procedure, these may run under your chin, around your ears and/or over your head. They are usually taken off after a day or two, before you go home.

Fine plastic drainage tubes may be left in the wounds, usually behind your ears, for a day or two afterwards. These allow blood and fluids to drain into a bag.

Minimal-access cranial suspension (MACS)

In this type of procedure, the surgical cuts are shorter than for a traditional facelift. The cuts are just made in your temple and in front of your ears. Excess fat is removed and the muscles are tightened using permanent stitches.

Keyhole surgery

In keyhole surgery, your surgeon makes several tiny cuts into your skin. Special operating instruments and a narrow, flexible, tube-like telescopic camera called an endoscope are passed through the cuts, and the surgeon does the operation by looking at pictures sent from the endoscope to a monitor.

This type of surgery leaves smaller scars and usually means a shorter recovery time. It's most commonly carried out for upper face or brow lifts. Your surgeon will let you know whether this type of surgery is suitable for you.

What to expect afterwards

You will need to rest until the effects of the general anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Your nurse will give you some advice about caring for your healing wounds and a date for a follow-up appointment before you go home.

The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. They usually disappear in around two to three weeks, but can sometimes last as long as a couple of months. Non-dissolvable stitches are removed about a week after surgery.

Recovering from a facelift

You can take over-the-counter painkillers such as paracetamol or ibuprofen if you need them. Don't take aspirin as it can cause increased bleeding. Always read the patient information leaflet that comes with the medicine.

You will have some swelling. Applying a cold compress, such as ice or a bag of frozen peas wrapped in a towel, can help to reduce the swelling and bruising. Don't apply ice directly to your skin as it can damage it.

Most people can return to work after about two weeks.

To help your recovery:

keep your head up for a couple of days to reduce swelling
don't do any vigorous activity for at least two weeks
don't have a sauna or a massage for at least two weeks
don't expose your face to the sun for six weeks

What are the risks?

Facelift surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

These are the unwanted but mostly temporary effects you may get after having this procedure.

Side-effects of facelift surgery include:

pain, swelling and bruising - this can last up to a month
scarring - this usually fades, but won't completely disappear
raised hairline in front of, and behind, your ears - in men, your beard may lie closer to your ear and you might need to shave differently

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding, infection, or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Antibiotics may be needed to help prevent infection.

Complications of a facelift can also include:

bleeding under your skin (haematoma) - this may need another operation to stop the bleeding and drain the area
damage to facial nerves - this can cause numbness and muscle weakness in your face
hair loss around your scars
unusually red or raised scars - these can take a long time to heal

There is a risk your face may be uneven afterwards and you might need another operation to correct this.

It's possible that you may not be completely happy with your appearance after the operation.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.