It’s important not to rush into the decision to have this type of surgery. Talk to your GP about your options. He or she may be able to refer you to a reputable surgeon or advise you about how to choose a hospital.
Before deciding on a facelift, talk to your surgeon about what you're hoping to gain from the operation and the results you can realistically expect.
There are five main things to think about and do:
- think about what you want to change - find out all you can about the treatment/s you want
- research potential surgeons, check they have the right qualifications and that they regularly do the type of procedure you want
- have a thorough consultation - ask questions and make sure you understand the risks of surgery
- take time to reflect before you make a final decision
- think about your care after your operation, for example how you will be looked after, especially if there are any problems after your surgery
Your surgeon will examine your face and may take photographs, so that the results of your surgery can be compared with how you looked before.
Your surgeon will explain how to prepare for your operation. If you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection. It also reduces the skin circulation so healing may be slower.
You will usually need to stay overnight in hospital after your operation. Most facelift surgery is done under general anaesthesia. This means you will be asleep during the operation. However, you can have the operation done using local anaesthesia and sedation to relax you. This means you will be awake during the procedure.
If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s or surgeon’s advice.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you may have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed so you can give your consent for the procedure to go ahead. You may be asked to do by signing a consent form.
Two weeks before your surgery, your surgeon may ask you to stop taking tablets containing aspirin or non-steroidal anti-inflammatory drugs such as Voltarol. This is because they may make bleeding more likely. Your surgeon will tell you when to stop taking these medicines.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
You can have other treatments as an alternative to, or in combination with, a facelift. The main ones are listed below.
- Resurfacing techniques can help to reduce fine wrinkles and can smooth your skin by removing damaged outer layers. Options include chemical peels and facial laser resurfacing.
- Dermal fillers plump out deep wrinkles with injections of hyaluronic acid, collagen or other types of filler. This type of treatment may last for three to 18 months.
- Botulinum toxin (eg Botox) injections can flatten out wrinkles in your skin caused by muscle movement, for example frown lines, forehead lines and crows' feet. However, it won't help with sagging or wrinkles caused by ageing. You will need to have Botox injections every three to six months to keep the effects.
The operation can take three to four hours, depending on what you're having done. Your surgeon will explain the options suitable for you and each procedure. You may have other procedures such as a brow-lift or eyelid surgery done at the same time.
Your surgeon will make a cut in your hairline, down past the front of your ears and up into your hairline again behind your ears. Your surgeon may also make cuts under your chin if you’re having your jawline lifted.
Your skin is carefully separated from the underlying tissues. Your surgeon will then remove or reposition the excess fat and tighten the muscles or surrounding tissues. The skin will then be pulled back and any leftover skin trimmed.
With some techniques, your surgeon may leave permanent stitches under your skin that hold the deep tissues in the lifted position. These may reduce the tension on the skin when it’s closed. Your skin is stitched back to the line where the cut was first made.
You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
Your face will be wrapped in bandages to help reduce bruising and swelling. Depending on the exact procedure, these may run under your chin, around your ears and/or over your head. These usually stay in place for about 24–48 hours, follow your surgeon’s advice.
You may have thin tubes coming out of the wound and into a bag. These help any blood or fluid to drain away. They are usually removed before you go home.
You may also be wearing compression stockings on your legs to help maintain circulation. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs.
You will need to arrange for someone to take you home. Try to have a friend or relative stay with you for the first 24 hours after your operation.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for at least 24 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 length of time dissolvable stitches will take to disappear depends on what type you have. Your surgeon will tell you how long they take to dissolve. Non-dissolvable stitches are usually removed about a week after facelift surgery. Your surgeon will advise you what type of stitches have been used in your procedure.
It usually takes about two weeks to make a full recovery from facelift surgery. But this varies between individuals and also depends on the techniques used, so it’s important to follow your surgeon’s advice. You should be able to take part in your usual activities and go back to work at this time.
Your face may be swollen after the operation. You can help to ease the swelling by keeping your head propped up when you’re lying down.
You should not do strenuous activity, for at least two weeks after your operation. Your surgeon or nurse will be able to give you more information.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
As with every procedure, there are some risks associated with facelift surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted, but mostly temporary effects, you may get after having the procedure.
Side-effects of facelift surgery include:
- pain, swelling and bruising on and around your face
- a change in skin sensation, for instance numbness of your cheeks and ears – this usually disappears in a few weeks or months
- scarring– the scars will fade, 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 slightly differently
Complications are when problems occur during or after the procedure.
The possible complications of any operation include:
- an unexpected reaction to the anaesthetic
- excessive bleeding
- developing a blood clot, usually in a vein in the leg (deep vein thrombosis)
Complications of facelift surgery can include:
- damage to the nerves in your face – this can cause numbness and muscle weakness in your face
- hair loss around your scars
- thick and obvious scars, called hypertrophic scars – these can be quite noticeable and are most likely to develop behind your ears
- an uneven or asymmetrical appearance.
It’s possible that you may not be completely happy with your appearance after facelift surgery.
It’s important to know that it can take six to nine months to see the full effects of facelift surgery.
I am considering having a facelift and I also want to lose some weight. Should I try to lose weight before or after the facelift?
Losing weight before your operation will improve the results of your facelift.
If you want to lose weight, you should do it before you have a facelift. Losing weight before all cosmetic surgery means that your surgeon will be able to remove more skin and you should end up with better results.
I am worried about how long it will take for my face to heal after a facelift. What should I expect?
Every person is different. It’s normal for your face to take several weeks or even months to heal completely.
You should expect to have some bruising and swelling after your operation, which may take several weeks to go down. The bruising and discomfort may start in your face and move down to your neck over time.
Keeping your head propped up when lying down can help reduce swelling. You can also use ice packs or ice wrapped in a towel to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.
Be prepared for your skin to feel stiff and tight and to look puffy at first. Your skin may also feel rough and dry.
You may also have some numbness after the surgery, particularly in your cheeks and ears. This is usually temporary, but for a very small number of people it can be permanent.
Most of the symptoms of bruising and swelling will go in the two weeks after your operation. However, it can take up to nine months for everything to heal completely.
Smoking can affect skin healing, so it’s best to stop smoking at least two weeks before surgery. Some surgeons may not do facelifts on smokers because of the increased risks.
Once home after my facelift, are there specific ways I should look after my skin?
Yes. Your surgeon or nurse should give you information about taking care of your skin and wounds when you go home. Follow this advice to make sure you heal well.
- You will be given specific advice when you leave hospital but there are things you can do to aid your recovery and stop your skin from becoming irritated. The main ones are listed below.
- Don’t wash your face or hair until your stitches have been taken out, unless your surgeon has advised you to.
- Don’t use any styling products, perm or colour your hair until your skin has healed. This is because the chemicals used in these products can irritate your scars. If you want to perm or colour your hair, plan ahead and have this done before your operation.
- Don’t wear make-up until your stitches have been taken out. Camouflage make-up can help hide any bruising.
- Don’t do any vigorous activity for at least two weeks.
- The sun can affect your skin and new scars. Take care of your skin by using a high factor sun block. Your surgeon can tell you when you can go back to your usual skin care and sun protection.
If you have any concerns about caring for your skin, speak to your surgeon.
What qualifications should my surgeon have?
There is no single qualification for cosmetic surgery, so you will need to do your homework. Your GP is a good starting point.
It’s best to discuss any sort of surgery with your GP first. He or she may know of surgeons in your area and will also be able to pass on any important health information from your medical records to the surgeon. If you don’t want to involve your GP, you can find a surgeon yourself, but it’s important to get as much information as possible about your surgeon’s qualifications and experience. Don’t be guided by price, and be wary of advertising claims.
The surgeons that carry out facelift surgery are usually plastic surgeons. Some plastic surgeons carry out aesthetic surgery (to improve appearance), whereas others specialise in areas such as reconstruction or burns.
Plastic surgery is one of the nine main specialties recognised by The Royal College of Surgeons. Consultant plastic surgeons are listed as being fully trained on the GMC Specialist Register. This means that they have completed specialist training in plastic surgery (usually for six years).
All surgeons who set up as cosmetic surgeons for the first time from April 2002 must also be on the GMC's Specialist Register. You can check the specialist register by looking at the General Medical Council’s website (see Resources).
Before deciding to go ahead with cosmetic surgery, you should meet with your surgeon. Don’t be afraid to ask him or her about their qualifications and experience. Ask whether he or she belongs to a professional association, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons or the British Association of Aesthetic Plastic Surgeons. Both of these organisations can help you to find a surgeon.
- Facelifts. British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 4 September 2013
- Venous thromboembolism: reducing the risk. National Institute for Health and Care Excellence (NICE), January 2010. www.nice.org.uk
- Complications of facelift surgery. Medscape. emedicine.medscape.com, published July 2012
- Questions about cosmetic surgery. Royal College of Surgeons. www.rcseng.ac.uk, accessed 4 September 2013
- SMAS Facelift Rhytidectomy. Medscape. emedicine.medscape.com, published September 2013
- Wrinkles. BMJ Best practice. bestpractice.bmj.com, published April 2013
- Au K, Hazard S, Dyer A et al., Correlation of Complications of Body Contouring Surgery With Increasing Body Mass Index . Aesthetic Surgery Journal 2008: 28 (4); 425-29
- Surgical site infection. National Institute of Health and Care Excellence (NICE) 2008. www.nice.org.uk
- Allman K, Wilson I. Oxford Handbook of Anaesthesia. 2nd ed. Oxford: Oxford University Press 2006:506
- Facial Surgery and Skin Care Surgical Procedures Guide. American Society of Plastic Surgeons. www.plasticsurgery.org, accessed 20 November 2013
- Subperiosteal Rhytidectomy, Medscape. emedicine.medscape.com, published February 2013
- Deep Plane Rhytidectomy. Medscape. emedicine.medscape.com, published October 2013
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