How Is a Facelift Performed? Stages, Anaesthesia, Stitches and Recovery
In a facelift, the surgeon works through incisions in front of and behind the ear, most of which are hidden in the hairline; the sagging SMAS layer and the deep tissues are repositioned, and excess skin is removed without creating tension. The operation is performed in hospital, usually under general anaesthesia; local anaesthesia can also be used in suitable patients, and the hospital stay is usually two nights. Most patients return to social life within 2–3 weeks, and the final appearance usually settles within 3–6 months.
Why does the face sag, and what does a facelift correct?
Facelift surgery repositions the deep supporting tissues that have slipped downwards with age and removes excess skin; in other words, it targets the deeper cause of sagging rather than the skin surface. Ageing is a three-dimensional process that affects every layer of the face:
- Reduced bone support: The jaw and cheekbones lose some volume with age.
- Volume loss: The fat pads in the cheeks become thinner and shift downwards.
- Skin laxity: Collagen and elastin production falls, and the skin becomes thinner and loses its elasticity.
- Loosening of the SMAS layer and ligaments: The SMAS (superficial musculoaponeurotic system) is the fibrous supporting layer beneath the skin that links the muscles, fat and skin together. As this layer and the retaining ligaments that anchor it to the bone loosen, the cheeks descend, the lines beside the nose (nasolabial folds) deepen and sagging forms along the jawline (jowls).
A facelift aims to correct this sagging in the cheeks, along the jawline and, depending on its extent, in the neck. Separate procedures may be needed for the forehead and brows, such as a brow lift, or for the area around the eyes, such as eyelid surgery.
How is a facelift performed?
A facelift is performed through incisions in front of and behind the ear, most of which are hidden in the hairline; the deep tissues are repositioned and excess skin is removed. The stages are usually as follows:
- Consultation and planning: The source of the sagging (skin, fat, SMAS, ligaments, bone support) is assessed, and whether additional procedures are needed for the neck, the eyelids or volume loss is discussed. Your general health, the medicines you take and your smoking history are reviewed.
- Anaesthesia: The operation is performed in a hospital setting. General anaesthesia is usually preferred for a facelift; in suitable patients, the operation can also be performed under local anaesthesia. The anaesthesia method is decided together with the anaesthetist, taking into account the extent of the operation and your general health; the hospital stay is usually two nights.
- Incision: The incision usually starts at the temple, in front of the sideburn and along the hairline, passes in front of the ear and around the earlobe, and extends behind the ear and from there along the nape hairline. If the neck is also being treated, a small incision under the chin may be added.
- Repositioning the deep tissues: The surgeon reaches the SMAS layer. In SMAS techniques such as plication (folding with stitches) or SMASectomy, this layer is tightened; in the deep plane technique, the surgeon works beneath the SMAS, releases the retaining ligaments and moves the skin and SMAS together. For the differences, see our article on deep plane facelift vs SMAS lift.
- Removing excess skin: Once the deep tissues have been settled into place, the surplus skin is removed without creating tension.
- Closure: The incisions are closed in layers. Dissolvable stitches are usually used; when stitches that need removing are used, they are usually taken out on day 10. If needed, a thin drain (a small tube that draws off fluid) is placed to reduce fluid build-up, and a light bandage is applied to support the face. We cover scarring separately in our article on whether a facelift leaves scars.
How long the operation takes depends on its extent; for the face alone it usually takes a few hours, and it takes longer when additional procedures such as a neck lift or eyelid surgery are added.
Preparing for surgery
Smoking and nicotine products impair blood flow to the skin and markedly increase wound-healing problems, so you will usually be asked to stop at least 2–4 weeks before surgery and not to use them during recovery either. Blood thinners such as aspirin and some herbal supplements can increase the risk of bleeding, so they are usually stopped 1–2 weeks before surgery, with the approval of the doctor who prescribed the medicine; your individual timings are given at consultation, based on the medicines you take. It is also important that your blood pressure is under control.
How long does recovery take after a facelift?
After a facelift, most patients return to social life within 2–3 weeks; most of the swelling goes down in the first 1–3 months, and the final appearance of the face usually settles within 3–6 months. The timeline below shows the general course seen in most patients; timings vary from person to person.
| Period | What usually happens? | What to look out for |
|---|---|---|
| Days 1–2 | There is a bandage on the face and, if needed, a drain. You will have swelling and a feeling of tightness; pain is mostly controlled with painkillers. The drain is usually removed during this period. | Rest and sleep with your head raised. Avoid exertion that could raise your blood pressure. Report any sudden increase in swelling or pain on one side straight away. |
| Week 1 | Swelling and bruising increase over the first few days and then start to ease. Numbness around the cheeks and ears is common. | Avoid bending your head forwards and lifting heavy objects. Follow the wound care your surgeon recommends and, if needed, use a support band. |
| Week 2 | Most of the bruising fades. If stitches that need removing were used, they are usually taken out on day 10. Most patients can return to desk work and social life in weeks 2–3. | Light walks are fine. Protect your face from the sun. Wait for your surgeon’s approval before treatments such as hair colouring. |
| Month 1 | Mild swelling may continue, especially in the mornings. The incision scars may be pink and slightly noticeable. | Light exercise usually starts after week 3, with the intensity increased gradually. Keep up your scar care. |
| Months 3–6 | The remaining swelling largely subsides, the tissues soften, and the jawline and neck contour become more defined. The final appearance of the face usually settles during this period. Numbness decreases noticeably in most patients. | Attend your follow-up appointments. Keep protecting the incision scars from the sun. |
| Month 12 | The incision scars continue to fade; scar maturation is usually complete at 12 months and may take up to 18 months in some patients. | The result is reviewed together. A stable weight, sun protection and staying away from smoking help to preserve the result. |
If a drain was used, it is usually removed within the first 1–2 days. Because the incisions are mostly closed with dissolvable stitches, stitch removal is not needed for every patient; if stitches that need removing were used, they are usually taken out on day 10.
What affects recovery time?
The extent of the operation (the face alone, together with the neck, or with additional procedures), skin type, age, general health, smoking and how closely you follow the post-operative advice all determine how quickly you recover. Firmness and numbness around the earlobe and under the chin can last for months in some patients; this mostly improves with time. Check-ups are usually carried out the day after surgery, within the first week and at set intervals over the following months. Light exercise can usually begin after week 3. Between week 3 and month 3, exercise intensity can be increased gradually while you keep an eye on how you feel; full performance can be reached at the end of month 3.
If you are travelling to Istanbul, plan your stay around the hospital nights and these early check-ups, including stitch removal on day 10 if stitches that need removing are used.
What are the risks of a facelift?
A facelift is a planned operation; like any surgical procedure, it carries risks, and these should be discussed openly at consultation.
- Haematoma: A collection of blood under the skin is the most common early complication; it mostly appears within the first 24 hours and sometimes requires a further procedure. Keeping blood pressure under control helps to reduce the risk.
- Facial nerve involvement: Weakness in the muscles of facial expression is rare and mostly resolves within weeks to months; permanent damage is even rarer.
- Loss of sensation: Numbness around the cheeks and ears is common and usually decreases over a period of months.
- Scar problems: Scars mostly lie in concealed areas, but in some people they may thicken or widen; the shape of the earlobe may change.
- Other: Infection, skin circulation problems (more common in smokers), asymmetry, and temporary or permanent hair loss along the incision line.
Results vary from person to person; which method and what extent of surgery suit you are decided at consultation.
Facelift or non-surgical methods?
When there is marked sagging, a jawline that has lost its definition and excess skin, the effect that can be expected from non-surgical methods is usually limited; if the concern is mainly skin quality, fine lines or mild volume loss, non-surgical options may be considered. We look separately at what methods such as thread lifts, focused ultrasound, radiofrequency and fillers can and cannot do in our article “Can non-surgical facelift methods replace surgery?”. If the signs in the neck are prominent, our article on who a neck lift is suitable for may also help.
What is assessed at consultation?
At consultation, the source and degree of the sagging, skin quality, volume loss and the condition of the neck are assessed; based on this, the extent of the facelift, the technique to be used and any procedures that could be planned alongside it are discussed. If you decide to go ahead with surgery, it is made clear from the outset that recovery progresses gradually, that the swelling in the first weeks does not reflect the final result, and that attending your check-ups regularly matters.
For the techniques used, candidacy and the consultation process, see the facelift surgery page; for a personal assessment, you can arrange a consultation appointment with Assoc. Prof. Dr. Yalçın Bayram.
Frequently Asked Questions
How long does facelift surgery take?
It depends on the extent of the operation and the technique used. For the face alone it usually takes a few hours; it takes longer when additional procedures such as a neck lift, eyelid surgery or fat injection are added. The exact duration is set according to the plan made at consultation.
Is a facelift performed under general anaesthesia?
General anaesthesia is usually preferred for a facelift; in suitable patients, the operation can also be performed under local anaesthesia. Which method is used is decided together with the anaesthetist, according to the extent of the operation and your general health. The hospital stay is usually two nights.
When are the stitches removed after a facelift?
Dissolvable stitches are usually used in a facelift, so stitch removal is not needed for every patient. If stitches that need removing were used, they are usually taken out on day 10 after surgery. Your surgeon will give you your check-up and stitch plan after the operation.
When can I go back to work after a facelift?
Most patients can return to desk work within 2–3 weeks. Light exercise can usually begin after week 3, and its intensity is increased gradually until month 3. The timing is agreed with your surgeon, based on the extent of the operation and how quickly you heal.
When do swelling and bruising go down after a facelift?
Most of the bruising usually fades around week 2. Most of the swelling subsides in the first 1–3 months; mild swelling and firmness can last a few months, especially under the chin and around the ears. The final appearance usually settles within 3–6 months.
How long do the effects of a facelift last?
A facelift does not stop ageing; it moves the tissues to a younger position, and ageing continues from that new position. How long the effect is noticeable depends on personal factors such as skin quality, genetics, weight changes, smoking and sun exposure.
Medical review: This article has been medically reviewed by Assoc. Prof. Dr. Yalçın Bayram, specialist in plastic, reconstructive and aesthetic surgery (Şişli, Istanbul). For his background and academic publications, see about us. This article is for general information; the right approach for you is decided at consultation.
