Facelifts Offer Unparalleled Results—But Are Serious Procedures

Facelifts are the medical equivalent of turning back the clock—sort of.

As we age, our skin's production of collagen and elastin naturally slows down, resulting in sagging skin, deep folds or crease lines, falling or lacking facial fat, drooping cheek and jaw skin (known as jowls), and extra fat and loose skin in the neck area that can create the appearance of a double chin or "turkey neck." Facelifts work to restore all those signs of aging and more, resulting in a more youthful appearance with far better results than any you can get out of a bottle.

But facelifts aren't exactly easy, low-key procedures. From prep work to the surgery itself to post-operation healing, there's a lot going on and a lot you need to know. To help break it all down, we spoke with three expert plastic surgeons—Raj Mohan, MD, Hardik Doshi, MD, and Samuel Lin, MD—in the field. Read on for everything you need to know about facelifts.

What Is a Facelift?

A facelift (or a rhytidectomy, as the pros say) is a surgical procedure that helps improve signs of aging in a person's face and/or neck by repositioning or removing skin, fat, and/or muscles. As the several and/ors suggest, there are many different kinds of facelift surgeries depending on the specific areas of the face and neck that are targeted. Types of facelifts include:

• Traditional facelift: Your classic, textbook facelift involves the surgeon creating incisions around the ears, hairline, and below the chin area to remove excess fat as needed, tighten muscles and other supporting structures, remove excess skin, and reposition the skin back onto the face in a natural way.
• SMAS facelift: Shorthand for superficial musculoaponeurotic system (which is long-hand for the muscular layer of your face), a SMAS facelift targets the lower two-thirds of the face. In this procedure, the surgeon tightens muscles in the area and trims excess skin and fat in the cheeks and lower face as needed.
• Deep plane facelift: In this procedure, the surgeon lifts the SMAS, fat, and skin as a single unit or layer (rather than separately), which provides better blood circulation for the overlying skin. The deeper pull underneath the muscle allows the surgeon to address most areas of the face simultaneously, but it can't be tailored to any personal preferences or idiosyncrasies since everything is adjusted in unison. It also poses a greater risk of injury to the facial nerve branches. As a result, many traditionally trained plastic surgeons have abandoned the method.
• Mid-facelift: As the name suggests, a mid-facelift surgery treats the mid-cheek area of the face by repositioning fat in the cheeks and tightening skin in the area.
• Mini-facelift: Mini-facelifts focus on lifting the lower half of the face and neck area, and are generally less invasive than other facelift surgeries.
• Cutaneous facelift: Cutaneous facelifts focus exclusively on the skin layer and tend to target the neck and lower face only.

Facelift type aside, they're all considered cosmetic restorative surgeries, meaning they cannot stop the aging process, change your fundamental appearance, or address the look or quality of the skin itself. Results tend to last around seven to 10 years, and you'll continue to age post-surgery.

Benefits of Facelifts

• Creates a more youthful, rejuvenated facial appearance by reducing visual signs of aging
• Tightens loose, sagging skin
• Tightens and defines the jaw and neckline
• Softens deep creases, fine lines, and wrinkles
• Can boost self-confidence
• Can look incredibly natural (with the right surgeon; more on that later)

The primary benefit of a facelift is reducing visual signs of aging in the face and neck area. As Lin explains, aging often particularly targets the face and neck, creating unwanted features such as sagging skin, wrinkles, fat accumulation, and creasing. And while aging is totally natural (and there's absolutely nothing wrong with visible signs of aging), facelift surgery does provide a solution, albeit not necessarily a permanent solution, for those who are unhappy with their maturing face. And for those people, the procedure can positively impact their confidence and overall quality of life—which all three doctors agree is really the greatest benefit of all.

As for those visual signs of aging on the face and neck, there are actually quite a few of them. They include relaxed and sagging skin, wrinkles, deep folds, or crease lines (especially between the nose and corners of the mouth), fallen or lacking facial fat and muscles, drooping skin and jowls, and loose neck skin and extra fat that creates the appearance of a double chin or "turkey neck"—among others, according to Doshi.

And while facelifts are primarily about reversing signs of aging, there's no set age for when one should get one, says Doshi. He notes that it's actually becoming more common for individuals to get facelifts when they first notice signs of aging but still have some skin elasticity. While this generally occurs between the ages of 40 and 60, people who fall outside of that range (both above or below it) can potentially be good candidates for surgery. As Mohan puts it, if there is sagging or laxity of skin and soft tissues in the neck, jawline, and/or lower face, a facelift might be appropriate.

"A facelift is a delicate and nuanced surgery where surgical skill meets artistry," Doshi explains. "Every stroke of the blade and every suture thrown should be carefully considered to preserve and enhance the intrinsic beauty of the individual. Just as every face is different, every facelift surgery is unique and tailored for that individual."

On that note, Lin emphasizes the importance of having sensible, clear, and realistic expectations for results (as is the case with any other cosmetic procedure). And patients should clearly communicate those expectations to their plastic surgeon before proceeding. Together, the surgeon and patient can discuss goals, expectations, and realistic outcomes.

How to Prepare for a Facelift

The most important step in preparing for a facelift is finding an experienced, trustworthy board-certified plastic surgeon. As Doshi explains, an ideal surgeon not only has expertise in the facelift field but will also act as a partner who will guide you through the preparation work, the procedure itself, and the recovery process. After all, we only have one face, and not all cosmetic surgeons are facelift experts.

When consulting with potential surgeons, be sure to ask about their specific training and experience, and how many facelifts they've performed. Be sure to do your research and look at plenty of before and after photos to help get a feel for the surgeon's aesthetic style.

As is the case with any major procedure, patients usually undergo a medical evaluation to get pre-operative clearance. Lin says this might involve blood work, lab testing, adjusting certain medications, and using or avoiding certain facial products. All three experts agree that you should definitely stop smoking and cease all use of nicotine products before and after the surgery, as well as limit alcohol and illicit drug use. They all also mention that leading up to and following the procedure, patients may need to avoid certain medications and herbal supplements that could increase the risk of bleeding and bruising.

As surgery approaches, Lin suggests arranging a ride home from the facility with a family member or friend who can stay with you for at least one night post-operation.

What to Expect During a Facelift

Patients should expect the operation to take place at either a hospital or, more commonly, an outpatient surgical center. Depending on the technique used, the patient's medical history and preferences, and the surgeon's own comfort level, surgery will be performed while the patient is under general anesthesia or IV sedation, says Doshi.

Once the patient is successfully put under, it's time for the initial incisions. While incision locations are determined by the techniques used and patient preferences, traditional facelift incisions begin in the hairline at the temples and continue into the crevices found at the front of each ear, Doshi shares. Those incisions then wrap around the ears and travel down the front of the occipital hairline. An additional incision may be made in the crevice of the chin crease for further access to the neck. Incision sizes also vary depending on technique but should be discussed with your surgeon beforehand.

The skin is then separated from the underlying connective tissues and muscles. (Side note: Did that make the hair on the back of your neck stand up, or just mine?) The surgeon is then able to reposition and redistribute the deeper facial tissues, get rid of excess fat, and create a firmer, tighter foundation for the skin. Any leftover skin is removed and the remaining skin is gently laid over those newly rejuvenated facial tissues. The result should be a smoother, more youthful facial contour without any overtightened skin.

Facelifts are often done in conjunction with other procedures to maximize results. Lin says popular additions include eyelid lifts, facial implants, brow lifts, nose jobs, and neck and jawline rejuvenation procedures. As a result, the procedure can take anywhere from two to six hours to complete depending on the complexity and technique. Depending on whether other cosmetic procedures are performed concurrently (and if so, which ones), Doshi warns it may take longer.

Aftercare

Lin says your surgeon should provide you with detailed instructions on how to care for your incisions, manage pain, and when to return for follow-up appointments. Follow your surgeon's wound care instructions exactly, even if they contradict any of the below advice.

That being said, after the operation you'll likely experience mild to moderate discomfort, facial swelling and bruising, numbness, and drainage from the wounds. Doshi says bandages may be used to cover incisions and support the general area. They also apply gentle pressure that can reduce swelling and bruising. To drain excess blood and fluid, small tubes called drains may be placed under the skin behind one or both ears. If so, they'll be removed once the output dwindles down to a specific, lower range.

According to Rohan, patients will likely do dressing changes for about one week, after which time the sutures will be removed. Patients may require medication for pain management during that first week. By the end of the second week, most patients see a significant decrease in swelling and bruising, though Lin warns it will likely take several months before the face feels completely back to normal.

During those first three weeks, Doshi says a handful of specific precautions and self-care practices can aid in recovery and reduce the risk of complications. These include:

• Avoiding clothing that needs to be pulled up over the head. Instead, wear clothes that zip or button up the front.
• Refraining from any excessive pressure on or motion of and around the incisions.
• Making sure not to pick at crusting scabs around or on the wounds.
• Applying scar gel on the incisions as directed by your doctor.
• Avoiding makeup, direct sun exposure, and any intensive hair treatments.
• Staying away from any strenuous activities, aerobic exercises, and sports.

Unfortunately, scarring is inevitable with any surgery. That being said, facelift scars tend to be well hidden around the ears, in the hairline, and under the chin. Doshi does note that incisions can occasionally result in raised scars, which may require additional treatment for correction.

Potential Side Effects/Risks

As with any surgery, especially with elective surgeries, there are always risks and potential side effects. While rare, risks for facelifts include:

• Infection
• Facial nerve injury
• Temporary or permanent hair loss at the incision sites
• Anesthesia-related issues
• Prolonged swelling
• Scarring

The Cost

According to the American Society of Plastic Surgeons, the average facelift costs around $8,005. Mohan agrees though he says they can cost anywhere from $5,000 to $50,000 depending on the surgeon and the number of procedures involved. There are also additional costs to consider, such as facility and anesthesia fees. Given the range, we recommend consulting your plastic surgeon to determine your own total fee.

Alternative, Minimally Invasive Options to Facelifts

There are several less invasive alternatives to facelifts, but these procedures are not as permanent, dramatic, or effective as facelifts. That being said, these alternatives do tend to be cheaper, safer, and require less downtime. Minimally invasive options include:

• Thread Lifts: According to Doshi, thread lifts tighten and lift the skin using dissolvable sutures. The procedure takes around 45 minutes and results can last up to a year. One important caveat: Thread lifts can cause significant scarring if done improperly, so much so that it can make a traditional facelift more challenging to perform in the future.
• FaceTite: Done under local anesthesia, FaceTite uses a bipolar handpiece to deliver energy between the ends of the tongs to tighten the skin and help create elastin and collagen within the skin, says Doshi. The procedure usually takes around 45 minutes and ranges in price (though a full-face treatment averages around $5,000).
• Fillers: Fillers provide visible, immediate lifting and volumetric support of the face to create a more youthful complexion. Results can last up to around a year depending on the type of filler and where it's injected and can cost anywhere from $850 to $1,500 per syringe.

The Final Takeaway

Though they're incredibly common and tend to have high satisfaction rates, facelifts are seriously invasive procedures—it's important to have an honest conversation with your plastic surgeon about all the risks and potential side effects, as well as what realistic goals look like. And, as with any elective plastic surgery, consider why you want a facelift; make sure you have healthy expectations when it comes to results. Lastly, be thorough and detailed when choosing a plastic surgeon. Ask any and all questions—nothing is taboo or off-limits.

If you can successfully check off all those boxes, find a binge-worthy series and a whole lot of ice packs and prepare to set the clock back 10 years.