Facelift

A facelift is an operation to tighten and lift the sagging soft tissues of your face and neck, reducing the visible signs of ageing.

Your surgeon will assess you carefully and advise whether a facelift is suitable for you — but the final decision to go ahead is always yours. This guide explains the benefits and risks so you can make an informed choice. If anything here doesn't answer your question, please ask your surgeon or the clinical team before you sign your consent form. You can change your mind at any point, even after signing consent.

As we age, gravity, sun exposure, and loss of skin elasticity cause the soft tissues of the face to sag. A facelift is most likely to benefit you if you have:

• Deepening folds running from the nose to the mouth (nasolabial folds)
• Sagging cheeks
• A double chin or loose folds of skin in the neck

If you also have droopy eyelids, hollow temples, or a low brow, your surgeon may suggest treating these separately or at the same time, as they are often the most effective way to look less tired.

Your surgeon will take a full medical history and clinical photographs (with your consent) to help plan your surgery and measure your results. They will also ask about your weight — it's best to reach a stable, healthy weight before surgery rather than after.

A well-performed facelift should leave your face looking less tired and more youthful, and most patients feel more confident in their appearance. However, results cannot be guaranteed, and you should have realistic expectations.

A facelift is very effective for sagging skin but does not treat fine wrinkling around the mouth, eyes, or forehead caused by muscle movement — these are better treated with resurfacing, botulinum toxin, or fillers. Droopy eyelids and brows are treated with separate procedures (blepharoplasty or browlift), which can be combined with a facelift. Fat grafting can restore volume and can be done alongside, instead of, or after a facelift.

Facelifts are usually performed under general anaesthesia and take 3–5 hours. The most common technique is the SMAS facelift, which lifts and tightens both the skin and the deeper fibrous layer (the SMAS) of the cheek, jawline and neck for a longer-lasting result.

• Incisions are made on both sides of the face, hidden in the hairline above the ear, along the natural crease in front of the ear, around the earlobe, and into the hairline behind the ear.
• The skin is separated from the SMAS layer, which is then tightened separately with sutures or by incising underneath it.
• Excess skin is removed and the remainder re-draped and closed.
• A small cut under the chin may be used to remove fat and tighten neck muscles.
• Drains, dressings, or a compression garment may be used afterwards to limit swelling and bruising.

Other techniques include the MACS lift (tightens the SMAS with suspension stitches, shorter scar, less durable), mid-facelift/composite facelift (deeper tissue lifting, good for cheek sagging), and thread lifts (less invasive, results often last under a year).

• Tell your surgical team about all medications, including blood thinners, herbal remedies, supplements, and over-the-counter drugs.
• Stop smoking and nicotine products at least 6 weeks before and after surgery — this significantly reduces your complication risk. Many surgeons will not operate on active smokers.
• Try to reach and maintain a healthy weight beforehand.
• Follow hand hygiene and infection control guidance when you attend hospital.

All surgery carries risk. The figures below come from published clinical studies; your own risk may be higher if you are older, smoke, are overweight, or have conditions such as diabetes, heart, or lung disease. Ask your surgeon if anything is unclear.

General risks of any operation:

• Minor wound infection – uncommon and usually easily treated with antibiotics
• Bleeding – bruising and swelling of the cheeks/neck is common and settles over about 3 weeks; occasionally a small blood collection needs draining
• Allergic reaction to equipment, materials, or medication
• Blood clots (DVT/pulmonary embolism) – the team will encourage early mobilisation and may use compression stockings or medication
• Chest infection – risk is lower if you don't smoke and have no recent cough or cold

Specific risks of facelift surgery:

• Nerve injury: A large 2025 meta-analysis of over 15,400 patients found the overall pooled rate of facial (motor) nerve injury was 0.66%, and sensory nerve injury 0.39% — the large majority temporary. Permanent motor nerve damage occurred in only 0.047% and permanent sensory damage in 0.045% of cases .
• Haematoma (blood collection under the skin): occurs in around 1.5% of cases overall, and is the most common complication after facelift surgery . Older data suggests men are at higher risk (up to 7–9%) than women (under 3%) due to a richer blood supply to facial skin, and it may require a return to theatre to drain.
• Overall complication rate: approximately 2% of facelift cases experience a significant complication .
• Infection: affects fewer than 0.5% of patients .
• Skin loss near the scars: risk is higher in smokers, older patients, and people with diabetes; scars are usually hidden in the hairline and heal within 4–5 weeks.
• Hair loss along the scar: risk is under 2%, more noticeable in people with light-coloured hair.
• Skin colour changes: temporary redness, then possible pale or dark patches over the areas where skin was lifted; usually settles within a few months, occasionally needs camouflage make-up.
• Cosmetic irregularities: minor asymmetry, ear lobe position changes, or unevenness can occur and sometimes need a small corrective procedure under local anaesthetic.
• Numbness: temporary facial numbness is common due to disruption of tiny sensory nerves and usually improves with time; permanent loss of sensation in the lower ear is possible but rare.

How risk varies by technique: A deep plane facelift carries a lower risk of skin loss than a traditional SMAS lift because the skin and SMAS are lifted together as one unit retaining its own blood supply — but dissection is closer to the facial nerve, so temporary nerve weakness is somewhat more common, though still uncommon overall . Shorter-scar techniques (e.g. MACS/mini facelift) involve less tissue undermining, so complication risk is generally lower, but results may be less dramatic and less durable.

You will usually go home the same day or the day after, though your surgeon may recommend a longer stay. Your face will look bruised and feel swollen for a few weeks; a compression garment or dressing may be worn for a few days.

Returning to normal activities:

• Arrange for someone to drive you home and stay with you for at least 24 hours
• No driving, operating machinery, or potentially dangerous activities (including cooking) for at least 24 hours
• No alcohol or signing legal documents for at least 24 hours
• Avoid heavy lifting or strenuous exercise (e.g. vacuuming, ironing) for 3 weeks
• Light activities possible after about 2 weeks
• No sex or bending down for at least 2 weeks
• Sleep with your head raised on extra pillows; be gentle with your face for at least 2 months
• Avoid alcohol for a few weeks and keep your face out of the sun
• Return to work after 3–4 weeks depending on your job
• Check with your airline/national aviation authority before booking flights

The final result usually settles over a few weeks. Results can last many years but cannot be guaranteed — your face will continue to age naturally, though it should always look younger than if you hadn't had surgery.

How long does a facelift last? Results vary, but a well-performed SMAS or deep plane facelift often lasts 8–12 years or more, though ageing continues.

Will I have visible scars? Most incisions are hidden within the hairline and natural skin creases, becoming very faint over time.

Is a facelift painful? Most patients describe tightness and discomfort rather than severe pain, usually well controlled with simple painkillers such as paracetamol.

Can I combine a facelift with other procedures? Yes — blepharoplasty, browlift, neck lift, and fat transfer are commonly performed at the same time.

What is the most common complication? Haematoma (bleeding under the skin) is the most frequent complication, occurring in roughly 1.5% of cases ; nerve injury is much less common at under 1% and is usually temporary .

When can I see the final result? Initial swelling settles over several weeks, but the final, natural-looking result can take a few months to fully appear.

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.

A deep plane facelift is a facelift technique that lifts the skin and the underlying SMAS (the fibrous layer beneath the skin) together, as a single unit, rather than separating them. This is often considered the "gold standard" facelift technique for more significant or longer-lasting correction of facial sagging, particularly in the mid-face.

Your surgeon will assess you and advise whether this technique is suitable, but the decision to proceed is always yours.

You may benefit from this technique if you have:

• More significant sagging of the mid-face, jowls, and nasolabial folds
• Previously had a facelift and are now considering a more thorough approach
• A preference for a longer-lasting, more natural-looking result than techniques that only lift the skin

Because the skin and SMAS layer are lifted together as one unit, a deep plane facelift can achieve a more natural repositioning of sagging tissue and is associated with a lower risk of skin loss (necrosis) than a traditional SMAS facelift, since the skin retains its own blood supply throughout . Results are generally considered more durable than more limited techniques.

A SMAS facelift lifts the skin and SMAS as separate layers; this is a more established, slightly less technically demanding technique with a lower nerve-injury risk but a somewhat higher risk of skin loss, particularly in smokers. A short scar/MACS lift offers a quicker recovery with more limited correction. Non-surgical treatments cannot achieve the same degree of tissue repositioning.

A deep plane facelift is performed under general anaesthesia and typically takes 3–5 hours, similar to or slightly longer than a traditional facelift.

• Incisions are made in the hairline above and in front of the ear, around the earlobe, and into the hairline behind the ear (as with a standard facelift)
• Rather than separating the skin from the SMAS, the surgeon dissects beneath the SMAS layer, lifting skin and SMAS together as a single composite flap
• The zygomatic and masseteric ligaments (which anchor the tissue to the cheekbone and jaw) are released to allow the tissue to move more freely and be repositioned
• The composite flap is lifted, secured, and excess skin trimmed
• A neck lift and/or platysmaplasty is frequently performed at the same time

All surgery carries risk. As dissection is deeper and closer to the facial nerve branches than more superficial techniques, the risk profile differs slightly from a standard SMAS facelift.

General risks of any operation: minor infection, bleeding, allergic reaction, and (rarely) blood clots.

Specific risks of deep plane facelift technique:

• Nerve injury: because dissection occurs closer to the branches of the facial nerve, temporary nerve weakness is somewhat more common with deep plane techniques than with more superficial (SMAS) techniques, though it remains uncommon overall and the large majority of cases are temporary . Pooled data across all facelift techniques (including deep plane) shows an overall motor nerve injury rate of 0.66% and sensory nerve injury of 0.39%, with permanent injury in only 0.047% (motor) and 0.045% (sensory) of cases
• Skin necrosis (loss of skin due to poor blood supply): deep plane technique carries a lower risk of this complication than a traditional SMAS lift, because the skin is lifted together with its blood supply intact rather than being thinned and separated . Smoking remains by far the biggest risk factor for this complication regardless of technique
• Haematoma: occurs in approximately 1.5% of facelift cases generally and remains the most common complication after any facelift technique, including deep plane
• Overall complication rate: approximately 2% across facelift techniques generally
• Infection: affects fewer than 0.5% of patients
• Scarring, numbness, and cosmetic irregularities: as with any facelift (see general facelift risks); most sensory nerve disturbance is temporary

• Tell your surgical team about all medications, blood thinners, herbal remedies, and supplements
• Stop smoking and nicotine products at least 6 weeks before and after surgery — smoking is the single biggest modifiable risk factor for skin necrosis, and many surgeons will not operate on active smokers
• Ensure good blood pressure control, as this significantly reduces bleeding/haematoma risk
• Reach and maintain a healthy, stable weight beforehand

• You will usually go home the same day or the day after
• Swelling and bruising can be more pronounced initially than with more superficial techniques, given the deeper dissection, though skin viability is generally better preserved
• Compression dressings or a garment may be used for the first few days
• Numbness is common and usually improves over weeks to months
• Avoid strenuous activity for 3 weeks and follow your surgeon's specific advice on head positioning, sun exposure, and activity restrictions
• Final results typically take a few months to fully settle, and can last many years

How is this different from a standard SMAS facelift? In a deep plane facelift, the skin and SMAS are lifted together as one unit, preserving the skin's blood supply. In a SMAS facelift, the skin is separated from the SMAS layer and lifted independently. This trade-off means deep plane has a lower necrosis risk but a slightly higher (though still low) risk of temporary nerve symptoms .

Is a deep plane facelift riskier than a standard facelift? Not straightforwardly — the risks trade off rather than one technique being simply "riskier." Deep plane carries lower skin necrosis risk but slightly higher temporary nerve weakness risk .

How long do results last? Generally longer than more limited techniques — often 10 years or more — because the deeper supporting tissue is repositioned rather than just the skin.

Is nerve damage from a deep plane facelift usually permanent? No — the overwhelming majority of nerve weakness after any facelift technique, including deep plane, is temporary, caused by stretching or bruising rather than cutting of the nerve, and resolves within weeks to months. Permanent injury occurs in well under 0.1% of cases .

Can a deep plane facelift be combined with other procedures? Yes — it's frequently combined with a neck lift, blepharoplasty, browlift, or fat transfer for comprehensive facial rejuvenation.

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.

A short scar facelift — sometimes called a "MACS lift" (minimal access cranial suspension lift), "S-lift," or "mini facelift" — is a less invasive facelift technique using a shorter incision than a traditional facelift. It lifts the deeper tissue layer (SMAS) using permanent or slowly-dissolving stitches, without the longer scar or extensive skin undermining of a full facelift.

Your surgeon will assess you and advise whether this technique is suitable, but the final decision is always yours.

You may benefit from this technique if you have:

• Mild-to-moderate sagging of the jowls, cheeks, and neck, rather than advanced or extensive laxity
• A preference for a quicker recovery and smaller scar than a traditional facelift
• Good skin quality and elasticity, allowing the skin to re-drape smoothly without needing extensive removal

You may be better suited to a traditional or deep plane facelift if you have significant loose skin in the neck or advanced facial ageing, as a short scar lift involves less correction of the neck.

The short scar technique typically offers less bruising and swelling, a quicker recovery (often 1–2 weeks), and a shorter, better-hidden scar than a traditional facelift, while still providing a natural-looking lift for the lower two-thirds of the face.

A traditional SMAS or deep plane facelift provides more powerful, longer-lasting correction, particularly for the neck, but with a longer scar and recovery. Thread lifts are even less invasive but generally give more modest and shorter-lived results. Non-surgical treatments (fillers, radiofrequency skin tightening, Botox) can help with early signs of ageing but do not reposition significantly sagging tissue.

This procedure is often performed under local anaesthetic (sometimes with sedation), as an outpatient, and typically takes 2–3 hours .

• A short incision is made starting at the lower earlobe, running up in the crease in front of the ear, and into the temple hairline (avoiding a scar behind the ear in the simple version)
• Liposuction of the neck fat is often performed first
• The surgeon places one or two vertically-oriented "purse-string" stitches through the SMAS layer, anchored to the firm tissue above the ear, to lift the jowls, marionette lines, and neck
• An extended version adds a third stitch to lift the cheek fat pad, which can also improve the nasolabial fold and lower eyelid area
• Excess skin at the temple is trimmed; because the lift is vertical, there is usually no "dog ear" of loose skin at the earlobe, avoiding the need for a scar behind the ear

All surgery carries risk. As a shorter, less extensive technique, complication rates are generally lower than for a traditional or deep plane facelift, though the same broad categories of risk apply.

General risks of any operation: minor infection, bleeding, allergic reaction, and (rarely) blood clots.

Specific risks of short scar/MACS-type facelift techniques:

• Under-correction: because less tissue is undermined and the neck is often not directly addressed, the most frequently reported issue with short scar techniques is that the degree of correction may be too limited for the amount of sagging present, rather than a surgical complication as such
• Haematoma and bruising: generally lower than with a full facelift due to the more limited dissection, though exact rates vary by technique and surgeon
• Nerve injury: with less extensive undermining, the risk of facial nerve injury is generally lower than more invasive techniques, though not zero — pooled data across all facelift types shows overall motor nerve injury under 1%, with permanent injury under 0.1%
• Scar quality: scars are shorter and, because there is no post-auricular extension needed with the simple technique, better concealed than with a traditional facelift; however, less experienced surgeons or poor skin quality may still occasionally lead to a visible "dog ear" or the need to extend the incision behind the ear
• Asymmetry: possible if the suture tension differs between the two sides; a skilled surgeon minimises this with careful technique
• Recurrence of sagging: results may not last as long as a full SMAS or deep plane facelift, particularly in the neck, since less tissue is directly tightened
• Suture-related irregularities: occasionally the purse-string sutures can be felt or seen as small bumps under the skin, particularly in thin-skinned patients; usually settles with time

• Tell your surgical team about all medications, blood thinners, herbal remedies, and supplements
• Smoking is generally considered only a relative (rather than absolute) contraindication for this technique due to its more limited, single-plane dissection, but stopping smoking is still strongly advised to optimise healing
• Discuss your goals carefully — this technique suits subtle, natural-looking correction rather than dramatic change

• Swelling and bruising are usually milder than with a full facelift and settle within 1–2 weeks
• Sutures are typically removed within about a week
• Most patients return to light activities within a few days to a week, and to work within 1–2 weeks
• Avoid strenuous exercise and facial strain for about 3 weeks

How does this differ from a traditional facelift? A short scar lift uses a shorter incision, less tissue undermining, and relies on internal "purse-string" sutures to lift the deeper tissue layer vertically, rather than removing large amounts of skin. It generally suits earlier, milder signs of ageing.

How long do results last? Generally 6–8 years on average, somewhat shorter than a full SMAS or deep plane facelift, though this varies with skin quality, lifestyle, and genetics .

Will I have a scar behind my ear? Usually not with the simple (short scar) version, as the vertical lift avoids the "dog ear" of skin that would otherwise need trimming behind the ear. Poor skin quality occasionally requires a small posterior extension.

Is this suitable for treating my neck? The basic short scar technique has a limited effect on the neck; if neck laxity is significant, your surgeon may recommend adding liposuction, a formal neck lift, or a different technique.

Can fat grafting be added? Yes — many surgeons combine a short scar lift with fat grafting (microfat grafting) to restore volume to the cheeks, temples, or nasolabial folds during the same procedure .

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.

An endoscopic facelift is a minimally invasive technique that lifts sagging tissues of the mid-face and brow using a small camera (endoscope) and instruments passed through short, hidden incisions — rather than the longer incisions used in a traditional facelift.

Your surgeon will assess you and advise whether this technique is suitable, but the decision to proceed is always yours.

You may benefit from this technique if you have:

• Early-to-moderate sagging of the cheeks or brow, without significant loose neck skin
• A preference for shorter scars and a quicker recovery than a traditional facelift
• Good skin quality and elasticity — the endoscopic approach relies on the skin retracting well over the newly lifted tissue

This technique is less suitable if you have significant loose neck skin or advanced jowling, which usually requires more extensive tissue removal than an endoscopic approach allows.

Compared to open techniques, an endoscopic facelift typically offers smaller scars, less swelling and bruising, and a shorter recovery period, while still providing meaningful improvement in early-to-moderate facial sagging.

A traditional SMAS or deep plane facelift provides more powerful and longer-lasting correction for more advanced sagging, but with longer incisions and recovery. Thread lifts are less invasive still but generally provide more modest, shorter-lived results (often under a year). Non-surgical options such as fillers and Botox can soften early signs of ageing but cannot reposition sagging tissue.

The operation is usually performed under general anaesthetic or local anaesthetic with sedation and takes roughly 1.5–3 hours, depending on the areas treated.

• Several small (1–2cm) incisions are made within the hairline
• An endoscope (a thin camera) is inserted to allow the surgeon to see and work on the tissues beneath the skin without a large open incision
• The soft tissues of the brow and/or mid-face are lifted and secured in their new position, usually with sutures or small fixation devices
• Incisions are closed with sutures or staples, hidden within the hairline

All surgery carries risk. The figures below relate to endoscopic facial rejuvenation techniques from published clinical reviews.

General risks of any operation: minor infection, bleeding, allergic reaction, and (rarely) blood clots.

Specific risks of endoscopic facial lifting, based on a review of 34 studies involving 7,273 patients undergoing endoscopic brow/mid-face lifting :

• Hair thinning/loss (alopecia) near the incisions: 2.8% — the most common complication with this technique, generally mild
• Numbness: 2% — usually temporary, related to small sensory nerve disruption near the incisions
• Need for revision surgery: 1.2%
• Asymmetry: 0.7%
• Itching (pruritus): 0.5%
• Palpability of fixation devices under the skin: 0.3%
• Swelling, eye-related complications, haematoma, infection, nerve injury, pain, and recurrence of sagging: each occur in around 0.1% of cases

Overall, endoscopic techniques generally show a lower complication rate than open (traditional incision) facelift techniques, particularly for hair loss and sensory disturbance, though the trade-off is a more limited correction for significant skin excess or advanced jowling .

Facial nerve injury (as with any facelift technique) is rare: pooled data across facelift techniques generally shows overall motor nerve injury rates under 1% and permanent injury under 0.1% .

• Tell your surgical team about all medications, blood thinners, herbal remedies, and supplements
• Stop smoking at least 6 weeks before and after surgery
• Discuss your hairline and hair density with your surgeon, as this affects incision placement

• Swelling and bruising are typically less pronounced than with a traditional facelift and settle within 1–2 weeks
• Sutures or staples are usually removed within 1–2 weeks
• Most patients return to light activities within a week and strenuous exercise after about 3 weeks
• Numbness or tightness around the incisions is common and usually resolves over several weeks to months

How does recovery compare to a traditional facelift? Recovery is generally faster, with less bruising and swelling, due to the smaller incisions and less extensive tissue undermining.

Will the results last as long as a traditional facelift? Generally, endoscopic techniques provide a more modest and somewhat shorter-lasting correction than open techniques such as a SMAS or deep plane facelift, as they don't remove excess skin.

What is the most common complication? Mild hair thinning near the incision sites, affecting around 2.8% of patients, most of which improves with time .

Am I a good candidate if I have loose neck skin? Probably not for an endoscopic approach alone — this technique is best suited to brow and mid-face sagging rather than neck laxity, which usually needs a neck lift or traditional facelift.

Can this be combined with other procedures? Yes — endoscopic techniques are commonly combined with blepharoplasty, fat transfer, or a neck lift for more comprehensive rejuvenation.

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.