Facelift surgery

Expert reviewer, Foiz Ahmed, Consultant Plastic, Reconstructive and Aesthetic Surgeon
Next review due, April 2022

A facelift is an operation to correct age-related changes, such as sagging and loose skin, in the lower half of your face. It involves lifting up and repositioning the skin and underlying soft-tissues that support your face, to help make it tighter and smoother.

An older lady in the pool

About facelift surgery

As you get older, the skin on your face loses its elasticity and tone – causing it to droop. The lines on your face gradually become deeper and your skin may sag as the structures supporting it lose their volume and strength. Losing a lot of weight can also make the skin on your face sag, whatever your age. Some people accept this as a natural part of ageing, but others feel frustrated or self-conscious with the changes happening to their face.

A facelift operation can make you look younger by reducing sagging skin and wrinkles on the lower half of your face. You can also have a browlift which can deal with loose skin around your eyebrows and forehead wrinkles, and a necklift to lift and tighten the skin of your neck. You can have these procedures on their own or together.

A facelift tends to work best while your skin still has some elasticity and your bone structure is good and well-defined. For this reason, most people who have this operation tend to be in their 40s to 60s. You can still have the procedure when you’re older too, but the results might not be quite so good.

Deciding on facelift surgery

It’s important not to rush into the decision to have any cosmetic surgery. You need to have a good think about what you’re hoping to gain, the limitations of the procedure and the risks involved. Make sure you’ve explored all the alternatives too – see our section below for more information. It’s also important to do your research into finding a suitable surgeon. Your GP may be able to refer you to a reputable surgeon, or give you some advice on how to choose one. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) and the British Association of Aesthetic Plastic Surgeons (BAAPS) are a good starting point. For more information, read our FAQ ‘What qualifications should my surgeon have?’

Before you decide whether to have a facelift, you should book a consultation with the surgeon you’re considering using. They’ll be able to advise you whether it’s safe for you to have a facelift. They will also talk to you about what will happen before, during and after your procedure, and the results you can realistically expect. This is your opportunity to ask your surgeon any questions you have. The organisations listed in the ‘Other helpful websites’ below give examples of good questions to ask.

Take your time to make a decision. Most surgeons will recommend having two consultations before having a procedure, to allow you enough time to think everything through and ask any questions. You should never feel rushed into making a decision. If you decide to go ahead, you’ll be asked to sign a consent form – so it’s important to make sure you feel properly informed. You can change your mind at any time before your procedure.

Alternatives to facelift surgery

If you have sagging skin and deep wrinkles that you want to correct, the main alternative to facelift is another procedure called fat grafting, or lipofilling. This involves taking fat from another part of your body by liposuction, and injecting it into your face to make your face look younger. This can also be done as part of a facelift procedure.

Another alternative, less invasive procedure to a facelift is a threadlift. This involves inserting long stitches with ‘hooks’ or ’barbs’ on them into your face, to help lift the skin up. It is less invasive than facelift surgery, much quicker to do, and can be done under local, rather than general anaesthetic. However it tends to work best when the sagging is quite minor, and the effects are only temporary.

There are other non-surgical alternatives to facelift that you might want to consider if your wrinkles aren’t too deep. You can have these treatments instead of, or as well as, a facelift to improve the appearance of your skin. The main ones are listed below.

  • Chemical peels – these involve applying certain chemicals to your face, which remove the outer layer of your skin.
  • Dermal fillers – these are injections of hyaluronic acid, collagen or other types of filler, which can correct wrinkles and improve the shape of your face. They may last for around six months. Some clinics offer synthetic, permanent fillers. It’s important to be aware that these are often associated with complications, which can be very difficult to treat. They aren’t recommended for treating facial wrinkles.
  • Dermabrasion – this uses a small, hand-held device to ‘sand down’ the surface of your skin. It’s mostly used for lines around your mouth.
  • Microdermabrasion – this involves blowing crystals or other abrasive substances onto the surface of your face, to smooth your skin.
  • Laser resurfacing – this can help with wrinkles by removing outer layers of skin on your face and encouraging new skin to grow underneath.

For more information about these options see our information on wrinkle treatments.

If you’re concerned about the skin on your forehead and around your eyebrows, your surgeon may suggest a browlift instead of a facelift. Botulinum toxin (eg Botox) injections are another option for wrinkles and lines on your forehead and around your eyes, and can work well to temporarily reduce these.

As with any cosmetic procedure, if you’re considering any of these treatments, it’s important to do your research first. Make sure you go to a reputable health clinic and a suitably qualified health professional. Your doctor should discuss the benefits and risks of the procedure and answer any queries you have before you decide whether to go ahead.

Preparing for facelift surgery

Changes to make before your operation

Your surgeon will explain how to prepare for your operation. If you’re intending to lose weight, you should do this before your operation. Your surgeon will be able to get a better result as they’ll be able to remove more skin. If you smoke, you’ll be advised to stop at least six weeks before your operation. This will help to reduce your risk of complications from the anaesthetic, and help your skin to heal. You may find your surgeon won’t perform the facelift if you haven’t been able to stop smoking.

Your surgeon may ask you to stop taking any tablets that contain aspirin or non-steroidal anti-inflammatory drugs at least two weeks before your surgery. This is because they increase the chance of you bleeding during your operation.

On the day

Make sure you know what to expect after your operation, so you can make any necessary preparations. You’ll usually need to stay overnight in hospital after a facelift, but sometimes you can go home on the same day. If you do go home on the day, you’ll need to have a responsible adult who can stay with you for the night.

If you’re having a general anaesthetic, you should be given clear instructions about when to stop eating and drinking before your operation. It’s important to follow your anaesthetist or doctor's advice.

On the day of your procedure, your surgeon will meet with you to check you are well and still happy to go ahead. The staff at the hospital will do any final checks and get you ready for surgery. This may include asking you to wear compression stockings, or having an injection of an anticlotting medicine to help prevent deep vein thrombosis (DVT).

Facelift surgery – the procedure

There are a number of different techniques for facelift surgery. Your surgeon will explain exactly what your surgery involves beforehand. The operation can take around two to five hours, depending on what you're having done. You’ll usually have your facelift done under general anaesthesia, which means you’ll be asleep during the operation. Or, you may have local anaesthesia plus sedation. This means you’ll be awake but a little sleepy.

Once the anaesthetic has taken effect, your surgeon will begin the operation. Your surgeon will make cuts along your hairline, along the skin creases in front of your ears, and possibly up into your hairline again behind your ears. They may also make some cuts under your chin if you’re having your jawline lifted.

Your surgeon will carefully separate your skin from the underlying tissues. They will remove or reposition the excess fat and tighten the supporting layers of your face or surrounding tissues. Then they’ll gently pull back your skin, before laying it back down and trimming to remove any excess. Your skin will be stitched into position.

Your surgeon will use dressings and bandages – sometimes special cooling dresses – to help reduce bruising and swelling.

What to expect after facelift surgery

You might have some discomfort as the anaesthetic wears off after your operation, but you'll be offered pain relief as you need it. You’ll usually need to keep your bandages on for a few days after your surgery, but follow your surgeon’s advice.

You may have thin tubes coming from your face and neck, to drain away any blood or fluid. These will usually be removed before you go home. You’ll be encouraged to get out of bed and move around to help prevent blood clots forming in the veins of your legs. Before you go home, you should be given a letter with a date for a follow-up appointment along with any advice about caring for your healing wounds. You can also read our advice about caring for surgical wounds. Your stitches will usually be removed about a week or two after facelift surgery.

Make sure someone can take you home and, if possible, can stay with you for a day or so while the anaesthetic wears off. Having a general anaesthetic can really take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, cook, operate machinery or sign anything important.

Recovering from facelift surgery

It’s normal to have some swelling and bruising after a facelift operation. The skin around your cheeks and ears may also feel numb at first, and it may feel tight when you open your mouth. It usually takes a couple of weeks for the swelling to go down.

There are several things that can help while you recover.

  • Help to ease any swelling and discomfort by keeping your head propped up when you’re lying down.
  • Try applying ice packs to your cheeks, or ice wrapped in a towel to reduce the swelling. Don’t put ice directly onto your skin as this can damage it.
  • Use camouflage make-up to help cover any bruising.
  • If you need pain relief, take over-the-counter painkillers such as paracetamol or ibuprofen.
  • Take care to protect your wounds while they are healing.

You’ll have some scars from your surgery, but these should mainly be hidden in your hairline. The scars will be red at first, but should gradually fade over 12 to 18 months.

You’ll need to take it easy at first after a facelift. Depending on what you do for a living, you should be able to do light activities and go back to work after two weeks. Don’t do any strenuous activity or heavy lifting for a few weeks. Your surgeon or nurse will give you more specific information on how to make a good recovery.

You might feel a bit low in the first week or so after your facelift. It can take a while to get used to having had the procedure, and the swelling might affect how your face looks after the surgery. Within a few weeks though, you should be feeling more like yourself.

Complications of facelift surgery

Complications are unwanted problems that can happen during or after the procedure. The possible complications of any operation can include things like an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot (deep vein thrombosis).

Your surgeon will explain what the complications associated with a facelift are, and how these relate to you, before you have the surgery. Complications of facelift surgery can include.

  • A build-up of blood under your skin (called a haematoma). This causes discolouration, swelling and pain in your skin. You may need to return to theatre to have this dealt with.
  • Infection of your wounds – they may be red, swollen and painful, and you may have a high temperature. You may need antibiotics or more surgery to resolve this.
  • Damage to the nerves in your face. This can cause numbness and muscle weakness around your eyebrow and lip. This usually improves over several weeks, but it can be permanent.
  • Thick or red scars, called hypertrophic scars. Although most scars fade, sometimes they become more noticeable or painful. You may need surgery to correct them.

It’s possible that the result of your procedure might not be exactly how you imagined it, and you might not be completely content with your appearance after facelift surgery. It can take six to nine months to see the full effects, so give yourself time to heal and then see what you think. If you have any questions, ask your surgeon.

Frequently asked questions

  • Your surgeon or nurse will give you information about how to take care of your skin and wounds when you go home. Here are some points to follow.

    • You can usually gently wash your hair at home, taking particular care around your wounds and stitches. Don’t soak your hair in the bath though, and be sure to follow your surgeon’s advice.
    • Don’t use any styling products, or perm or colour your hair until your skin has healed. This is because the chemicals can irritate your scars. Plan ahead and have anything like this done before your operation.
    • Take care of your skin by using a high-factor sunblock – sunburn can make your scars darker and more obvious. This is particularly important for the first 18 months, while your scars fade. You may want to carry on using high-factor sunblock after this time, to reduce skin ageing and your risk of skin cancer.
    • Avoid smoking. It’s best to give up smoking before the operation. But it’s also important not to smoke after your operation. It can make it harder for your wounds to heal properly. Also, smoking is known to age your skin and cause wrinkles – so stopping can help with the appearance of your skin too.
    • Aim to maintain a healthy weight and level of exercise. A change in your weight will affect the results of the facelift.
  • It’s important to make sure your surgeon is properly trained and holds the right qualifications. You may find it helpful to discuss surgery with your GP first, or ask them to recommend where you can find more information. They 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’d rather not involve your GP, make sure you do your research and get as much information as possible about the qualifications and experience of any surgeon you choose. Don’t be guided by price, and be wary of ’free’ consultations, non-refundable deposits and booking fees.

    The surgeons who do facelift surgery are usually plastic surgeons. Consultant plastic surgeons are listed as being on the General Medical Council (GMC) Specialist Register of Plastic Surgeons. They should have the qualification, FCRS (Plast) after their name. You may see some international websites talk about ‘Board Certified’ surgeons – being on the Specialist Register is the UK equivalent of this term. You can check this on the General Medical Council’s website.

    Don’t be afraid to ask your surgeon about their qualifications and experience. Also ask if they belong to a professional association, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) or the British Association of Aesthetic Plastic Surgeons (BAAPS). Both of these organisations can help you to find a surgeon and will provide trustworthy and reliable information.

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Related information

    • Wrinkles. BMJ Best Practice., last reviewed March 2018
    • Face and brow lift. British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)., accessed 11 December 2018
    • Facelift and necklift. British Association of Aesthetic Plastic Surgeons (BAAPS)., produced August 2016
    • Considering cosmetic surgery? British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)., accessed 12 December 2018
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    • Good surgical practice. The Royal College of Surgeons, September 2014.
    • Barbed suture lift. International Society of Aesthetic Plastic Surgery., accessed 23 April 2019
    • Personal communication, Foiz Ahmed, Consultant Plastic, Reconstructive and Aesthetic Surgeon, 8 April 2019
    • Cosmetic facial injections. British Association of Aesthetic Plastic Surgeons., accessed 23 April 2019
    • Botulinum toxin and fillers. British Association of Plastic Reconstructive and Aesthetic Surgeons., accessed 23 April 2019
    • Joint briefing: smoking and surgery. Action on Smoking and Health, the Royal College of Anaesthetists, the Royal College of Surgeons of Edinburgh and the Faculty of Public Health, April 2016.
    • Anaesthesia explained. Royal College of Anaesthetists, 2015.
    • Deep vein thrombosis (DVT) prevention. MSD Manual., March 2018
    • Postoperative care. MSD Manual., April 2018
    • Caring for someone who has had a general anaesthetic or sedation. Royal College of Anaesthetists, February 2018.
    • Complications of facelift surgery. Medscape., updated 6 August 2018
  • Reviewed by Pippa Coulter, Freelance Health Editor, April 2019
    Expert reviewer Foiz Ahmed, Consultant Plastic, Reconstructive and Aesthetic Surgeon
    Next review due April 2022