What is a facelift? A facelift is a procedure designed to rejuvenate the central and lower face, and in some cases, the neck in both women and men. A facelift can smoothen the nasolabial folds (the deep creases between the cheeks and the upper lip) and reduce the jowls (the loose skin that develops between the cheek and the chin along the jaw line), define the lower jaw line and correct droopy or wrinkled neck skin.
The multiple versions of a facelift can be defined by the tissue layers of the face that are lifted, the length of the incision used to perform the facelift, and subtle nuances in technique that differentiate the various forms of a facelift. In general, facelifts that involve longer incisions or more extensive manipulation of the facial tissues can offer more dramatic results, but may be involved with longer periods of swelling and recovery. The main facelift categories include:
Standard facelift. An incision is made in the hair above the ear and extended in the natural crease immediately in front of the ear and then travels behind the ear and into the upper neck hair. The skin is then elevated towards the central face and redraped in a more youthful position. In addition, the supportive connective tissue of the face or superficial myoaponeurotic system (SMAS) is either pulled, partially removed and tightened, or also elevated and pulled in an upward direction before being secured in a more youthful position. Most facelifts are derived from some combination of these techniques. It is the degree to which the skin and SMAS are manipulated that usually differentiates these facelift techniques. In addition, some facelifts will transition between the skin, SMAS and even facial muscle planes to achieve the desired goals of facial rejuvenation. A standard facelift is best for people who are 45 or older and are seeking a more dramatic rejuvenation of the face or when their primary goal is to reduce and tighten redundant neck skin.
Short-scar facelift. A relatively short scar differentiates the short-scar facelift from the traditional facelift. In a short-scar facelift, the scar usually starts in the hair just above the ear and is then extended in the natural crease immediately in front of the ear but then stops at the base of the ear rather than extending behind the ear. As in a standard facelift, the skin and SMAS layers are still elevated and manipulated. To address fat pads underneath the jaw, neck liposuction frequently accompanies a short-scar facelift. A short-scar facelift is best for people primarily looking to refine features of the central and lower thirds of the face around the cheeks and jawline, but who do not have large amounts of loose neck skin.
Necklift. This procedure involves an incision that travels behind the ear and may, on occasion, curve immediately in front of the ear. The goal of this surgery is to tighten the neck skin through a combination of skin-tightening, stitch, muscle-pulling and fat-removing techniques. A necklift is best for people who are satisfied with the appearance of the face but wish to have only the neck addressed.
Mini-facelift. This procedure is performed with the patient under local anesthesia in the office through a short scar immediately in front of the ear. The skin is elevated and redraped to a more youthful position. The SMAS layer is also repositioned to provide a more long-lasting result. A mini-facelift is best for people who seek an office-based facial rejuvenation that will provide moderate improvements to the central and lower thirds of the face. Combined with fractionated laser resurfacing and other office-based procedures like upper-lid blepharoplasty and neck liposuction, a comprehensive facial rejuvenation can be performed in a comfortable office setting.
Click here to view a video on facelifts.
Although a facelift is the most powerful technique that a plastic surgeon has to rejuvenate the lower two thirds of the face and neck, it has a few limitations that can be addressed by other techniques. When performed together, these techniques provide a comprehensive approach to facial rejuvenation. They include:
Fractionated laser resurfacing. Fractionated laser resurfacing provides an effective, low-downtime solution for treating fine wrinkles and blotchy skin throughout the face, as well as the deeper wrinkles around the mouth and eyes.
Upper-lid blepharoplasty (upper-eyelid lift). A facelift does not affect the upper eyelids. An upper-lid blepharoplasty provides a more crisp contour to the upper eyelid by removing redundant upper-eyelid skin.
Lower-eyelid blepharoplasty (lower-eyelid lift). Depending on the style performed and your specific concerns, a facelift has only moderate effects on the lower eyelids. Tightening extra skin, removing fat bulges, and smoothening the contour between the lower eyelid and the cheek with a lower-lid blepharoplasty, also known as a lower-eyelid lift, can rejuvenate the lower eyelids.
Brow lift (forehead lift). Whereas a facelift rejuvenates the lower two thirds of the face, a brow lift can be performed to help rejuvenate the entire face. This procedure will reduce forehead and frownline wrinkles and reposition the eyebrows in a more youthful position by using well-concealed incisions.
Fat grafting. While a facelift may be required to reposition the soft tissues of the face, fat grafting can restore lost facial volume. Your own fat may be used to replace lost volume in the lower cheekbone area, the folds between the cheeks and the upper lips, and between the jowl and the chin.
Dermabrasion. This technique removes a superficial layer of skin over the upper lips. This skin then heals over the next few days with fewer wrinkles.
Anesthesia: Standard and short-scar facelifts are usually performed with the patient under general anesthesia while mini-facelifts are usually performed in the office with the patient receiving local anesthesia.
Length of procedure: 1 to 4 hours, depending on technique chosen.
Estimated recovery time: You can return to work after 5 to 14 days, depending on the technique chosen, but should avoid vigorous activities for 2-3 weeks. Visible bruising or swelling should clear up within 1 to 2 weeks. To learn how to prepare for a facelift and what to expect afterwards, click here to download our patient instructions for facelift.
Side effects: Common side effects include bruising, swelling, a well-hidden scar and some cheek numbness. Muscles that raise your eyebrows or raise up the bottom corners of your lips may be weak for a few days to weeks after surgery. Click here to download a detailed consent form from the American Society of Plastic Surgeons that lists the risks and benefits of facelift surgery.
Before-and-after photos: Click here to view photos of facelifts.