Facelift surgery

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.

A facelift 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 will get the best results if you maintain a stable body weight, don’t smoke, have skin with good levels of elasticity and good bone structure.

Getting advice about facelift surgery

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're 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 an alternative, or in combination with, a facelift.

  • Resurfacing techniques reduce surface wrinkles and can smooth your skin by removing damaged outer layers. Options include chemical peels, pulsed light and laser resurfacing.
  • Dermal fillers plump out deep wrinkles with injections of hyaluronic acid, collagen or other types of filler. Depending on the type of filler used you may need to have repeat treatments every six to nine months.
  • Botulinum toxin (eg Botox) injections can flatten out wrinkles in your skin caused by muscle action, for example when you smile or frown. This treatment is particularly suitable for forehead lines and wrinkles around your eyes. However, it  won't help with wrinkles caused by sagging of your facial tissue as a result of ageing. You will need repeat treatments every three to four months.
  • Creams, gels and beauty treatments may help tighten your skin. However, there is no scientific proof that these work.

Preparing for facelift surgery

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

A facelift typically requires an overnight stay in hospital and is usually done under general anaesthesia. This means you will be asleep during the operation.

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, and 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, which you may be asked to do by signing a consent form.

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

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

What happens during facelift surgery?

The operation can take up to six hours, but it will depend on exactly what you're having done. The procedure may involve using several different facelift techniques. Your surgeon will explain the options available to you and the type of procedure advised.

Standard facelift

A standard facelift helps to tighten the skin on your face and neck from your eyes and ears downwards. 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 your ears. Your surgeon may also make cuts under your chin if you want your jawline lifted.

Your skin is carefully separated from the underlying tissues. Your surgeon will then remove or reposition the excess fat, tighten the muscles or surrounding tissues in your face and then pull back the skin, trimming off any excess. 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 is closed. Your skin is stitched back to the line where the cut was initially made.

Forehead lift

A forehead lift helps to reduce frown lines on your forehead and the frown lines between the inner ends of your eyebrows. The procedure is usually done using a keyhole technique and involves making short surgical cuts behind your hairline. Excess fat and skin is removed and the cuts closed with stitches.

Deep facelift

A deep facelift helps to tighten the skin in the upper half of your face and around your eyes. The procedure involves making short surgical cuts in your temple and in front of your ears. Excess fat and tissue are removed and the cuts closed with stitches.

What to expect afterwards

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. You will usually need to stay in hospital overnight.

Your face will be wrapped in bandages. Depending on the exact procedure, these may run under your chin, around your ears and/or over your head. The bandages are sometimes taken off before you go home.

You may have fine tubes running out from the wound, usually behind your ears. These drain fluid into a bag and 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 drive 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. However, for this procedure they should usually disappear in about six weeks. 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.

Recovering from facelift surgery

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 may have some facial swelling. Keeping your head propped up when lying down can help to reduce this.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Your surgeon will usually advise you not to take any aspirin-containing compounds. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

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

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 – this can last up to a month
  • altered skin sensation, for instance numbness of your cheeks and ears – this usually disappears in a few weeks or months, but can last for up to a year
  • 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

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 or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications of facelift surgery can include:

  • infection – you may need to take antibiotics to help prevent infection
  • damage to facial nerves – this can cause numbness and muscle weakness in your face
  • hair loss around your scars

It’s possible that you may not be completely happy with your appearance after facelift surgery. It can take six to nine months to see the full effects of facelift surgery.

Once home after my facelift, are there specific ways I should look after my skin?

Answer

Yes. Following your surgeon’s advice will stop your skin from becoming irritated.

Explanation

You will be given specific advice when you leave hospital but there are certain steps you can take to help your recovery and stop your skin from becoming irritated. These may include the following.

  • Don’t wash your face or hair for the first few days after your operation. Some surgeons may advise you not to wash your hair until your skin heals and the stitches have been removed.
  • Don’t use any styling products, or perm or colour your hair until your skin has healed as the chemicals used in these products can irritate your surgical scars. If you want to perm or colour your hair, plan ahead and have this done before your operation.
  • Don’t use any make-up for the first few days after your operation. Your surgeon will usually advise you when you can start wearing make-up. Camouflage make-up can help hide any bruising and you may wish to use this if you're returning to work before your skin has fully healed.
  • Don’t do any vigorous activity, have a sauna or a massage for at least two weeks.
  • Don’t expose your face to the sun for at least six weeks. After that you should use a high-factor sun block.

If you have any concerns about caring for your skin, speak to your surgeon.

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?

Answer

Losing weight before the operation will improve the results of your facelift.

Explanation

If you want to lose weight, you should try to do so before having 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?

Answer

Every person is different. It’s normal for your face to take several weeks or even months to settle completely.

Explanation

Your face will be bandaged after the surgery. Bandages may be removed before you go home. Expect to have bruising and swelling, which may take several weeks to subside. Keeping your head propped up when lying down can help reduce swelling. Be prepared for your skin to feel stiff, tight and look puffy at first. Your skin may also feel rough and dry.

It’s usual to 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.

Smoking can affect skin healing, so it’s best to stop smoking at least four weeks before surgery. Many surgeons refuse to do facelifts on smokers because of the increased risks. You must take your surgeon’s advice.

What qualifications should my surgeon have?

Answer

There is no single qualification for cosmetic surgery, so you will need to do your homework. Your GP is a good starting point.

Explanation

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.

There is no central registry of surgeons trained in cosmetic surgery. Doctors performing cosmetic surgery can be trained in any of the nine surgical specialties that are recognised by the Royal College of Surgeons. Most surgeons who do cosmetic surgery have been trained in plastic surgery. Doctors with only basic medical qualifications should not do cosmetic surgery (basic qualifications are shown by the letters MBBS or MBChB). A surgeon who has passed specialist exams in plastic surgery and is trained to carry out all types of cosmetic surgery may have the letters 'FRCS (Plast)' after his or her name. These surgeons are trained to carry out all kinds of cosmetic surgery.

Check that your surgeon is on the General Medical Council’s specialist register – you can do this by looking at the General Medical Council’s website (see Resources).

Before deciding to go ahead with cosmetic surgery, you should have an initial consultation with your surgeon. Don’t be afraid to ask the surgeon questions about his or her 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.