A facelift, also called rhytidectomy, is elective surgery that addresses age-related descent in the midface, lower face, jowls and, when indicated, the neck. It is not one continuous tightening manoeuvre. The operation usually follows a defined sequence: anaesthesia, marking, incision placement, skin elevation, dissection in a selected tissue plane, repositioning of deeper structures, skin redraping, closure and dressing in a carefully planned operation.
Each stage addresses a specific layer and is adapted to the patient’s anatomy and the extent of the planned operation. The broad order remains consistent, but dissection depth and direction differ between SMAS, deep-plane and limited techniques. Incision length, tissue handling and closure also depend on skin quality, facial fat distribution, hairline and medical history.
This guide names what is dissected, released or repositioned at each stage so the procedure is easier to follow. It is educational and cannot establish whether an individual is suitable for surgery. A specialist consultation is required before consent, medication advice, anaesthesia selection or an individual operative plan can be given. Outcomes and risks depend on both surgical technique and patient factors. The sequence cannot predict scar quality, recovery speed or how the face will change over time in a particular patient.
Before the Procedure: Consultation, Planning, and Anaesthesia
Before surgery, the surgeon reviews medical history, medicines, allergies, smoking status and previous anaesthetic experience. The face and neck are examined for skin laxity, fat distribution, bony structure, asymmetry and the tissues that can be repositioned safely. Photographs and measurements may assist planning. The surgeon then marks the proposed incision and lift vectors with the patient seated upright because gravity and facial asymmetry can look different when lying down.
Preoperative instructions are individualised. They may address smoking cessation, transport, fasting, wound care and the timing of routine medicines. Do not stop aspirin, anticoagulants, diabetes medicines or other prescribed drugs without instructions from the prescriber and surgical team.
Anaesthesia
Facelift surgery is most often performed under general anaesthetic in an accredited theatre. A limited procedure may sometimes use local anaesthetic with sedation. The anaesthetist chooses the technique after considering the planned extent of surgery, medical history, allergies and previous anaesthetic problems. Marking is usually completed before sedation or anaesthesia.
Step 1: Incision Placement
The planned incision commonly begins in the temporal hairline, travels in front of the ear, passes around the earlobe and then rises behind the ear into the hairline. Its exact course depends on the technique, skin quality, ear shape and hairline. A limited or short-scar facelift may stop near the earlobe and omit a temporal extension. Placing the incision within selected natural lines can help disguise it, but scar visibility cannot be guaranteed.
Step 2: Skin Elevation
Through the incision, the skin is elevated in a plane just deep to the dermis. This exposes the underlying fat and the superficial musculo-aponeurotic system, or SMAS. The dissection must preserve adequate blood supply and allow the skin to be returned without forceful traction. Closing the skin under avoidable tension can contribute to widened scarring, so the skin is not used as the main structural support.
Step 3: Dissection in the Tissue Plane
After skin elevation, the surgeon enters the tissue plane selected for the operation. The depth of dissection determines which retaining ligaments and deeper structures can be moved.
Tissue-Plane Options
| Approach | Plane and tissue action | Planning focus |
|---|---|---|
| SMAS facelift | The skin is raised to expose the SMAS. This layer is then plicated, imbricated or elevated. | A defined lift in the superficial fascial plane. |
| Deep-plane facelift | Dissection continues beneath the SMAS and selected retaining ligaments are released to permit mobilisation. | Deeper tissue release where the patient’s anatomy is suitable. |
| Subperiosteal facelift | Dissection proceeds deep to the periosteum in selected forehead or midface procedures. | Selected work close to underlying bone, used less often for the lower face. |
No technique label automatically makes one approach preferable. Tissue quality, ligament anatomy, degree of descent, scarring risk and the surgeon’s training all influence the choice.
Step 4: Repositioning and Structural Lift
The selected deeper layer is moved superiorly, laterally or posteriorly, depending on the area being treated. Suspension sutures may hold the SMAS, deep tissue or fat compartments in their planned position. Fat can sometimes be repositioned or grafted to restore volume. The deeper tissue carries the lift, while the skin is left available for a tension-free closure.
Step 5: Redraping the Skin
The elevated skin is laid back over the underlying contour. The surgeon trims only the redundancy required for a smooth, untensioned closure. Excessive skin removal or strong traction can distort adjacent tissue and compromise the scar. The final skin position accounts for movement of the forehead, cheek and neck during healing.
Step 6: Closure
Deep tissues are repaired first, usually with sutures that dissolve over time. The skin is then closed in layers with fine sutures, clips or staples, depending on the surgeon and operative site. Sutures or clips may be removed at a planned review. Drains are sometimes placed to remove fluid that could collect beneath the skin, but they are not routine for every facelift. A light dressing is applied after bleeding and wound closure have been checked.
Step 7: Dressing and Recovery Room
In recovery, staff monitor airway, vital signs, pain, nausea, bleeding and the condition of the dressing. The first 24 to 48 hours focus on protection, swelling control and wound checks. Many facelift procedures allow same-day discharge, while more extensive surgery may require an overnight stay. A prompt review is often arranged for dressing or drain care, depending on the operative protocol.
Most patients return to normal activities within 2-3 weeks, while full results appear gradually as swelling subsides.
How Long the Procedure Takes
A standard facelift commonly takes about three to five hours. The exact duration depends on the technique, facial anatomy, extent of undermining and whether additional work is performed. Blepharoplasty, a brow lift, neck surgery or fat grafting can extend the operation. The team confirms the planned sequence and likely duration before consent. A longer combined operation may also increase physiological stress, which is considered during anaesthetic and postoperative planning.
Common Mistakes to Avoid
- Treating a facelift as skin tightening. The skin is redraped after the deeper supporting tissue has been addressed. Pulling only the skin does not correct structural descent.
- Choosing a technique by name alone. SMAS, deep-plane and short-scar approaches address different anatomical patterns. The plan should follow examination and medical history rather than a preferred marketing term.
- Assuming that a deeper technique is always preferable. Deep dissection may be suitable for selected anatomy but is not automatically safer, scar-free or appropriate for every patient.
- Ignoring volume and adjacent regions. A lift may not address lost fat or tissue changes in the forehead, eyes or neck. Adjunctive procedures are considered only when clinically indicated.
- Omitting safety questions. The patient should understand who will perform the operation, who will administer the anaesthetic, where surgery will take place and how complications will be managed.
Risks and Complications
All surgery carries risks. The following complications can occur after a facelift, although their frequency and severity vary with the technique, patient health, smoking status and operative care.
- Haematoma: This is a collection of blood beneath the skin and is the most common early complication. Published series generally report rates in the low single digits, with higher rates in men and people taking blood-thinning medicines.
- Nerve injury: Temporary numbness, altered sensation or facial weakness can occur. Injury to branches of the facial nerve, including the marginal mandibular or temporal branch, is uncommon but recognised.
- Skin injury or poor wound healing: Reduced skin viability is uncommon. Smoking and impaired circulation increase the risk, and affected tissue behind the ear or near the temporal hairline may heal slowly.
- Infection: Infection is uncommon but may cause redness, swelling, discharge, pain or fever. Prophylactic antibiotics may be used according to the surgeon’s protocol and local prescribing guidance.
- Scarring: A hypertrophic or widened scar may develop. Genetics, skin type, smoking, wound tension and healing influence its appearance.
- Asymmetry or residual changes: Symmetry can differ before surgery, and incomplete correction, contour irregularity or remaining laxity may require further assessment or revision.
- Anaesthesia-related complications: Adverse effects can include nausea, sore throat, allergic reactions, heart or lung problems, and rare serious events. These risks are assessed before surgery.
- Hair loss: Temporary or permanent hair loss near an incision is possible and varies between patients.
Seek urgent assessment for rapidly increasing or one-sided swelling, breathing difficulty, uncontrolled bleeding, a spreading red or hot wound with fever, new facial weakness, or severe pain that is worsening. These symptoms require prompt professional review.
Discussing Suitability and Next Steps
Discuss your individual operative plan.
A procedure walk-through cannot establish whether surgery is suitable or which technique is appropriate. For an in-person assessment, contact the Fourways practice on 011 875 1694, or visit Suite B22, Life Fourways Hospital, Corner Cedar Road and Cedar Avenue West, Fourways.
Bring a list of medical conditions, current medicines, allergies and previous anaesthetic problems. Do not stop a prescribed medicine before receiving individual instructions.
Frequently Asked Questions
What is the difference between a SMAS facelift and a deep-plane facelift?
A SMAS facelift elevates and tightens the superficial musculo-aponeurotic system. A deep-plane facelift dissects beneath this layer and releases selected retaining ligaments to allow deeper mobilisation. The appropriate choice depends on the patient’s anatomy and the degree of tissue descent.
At what age is a facelift considered?
There is no strict age requirement, but patients in their 40s to 60s often see the most significant benefits.
How long do facelift results last?
Results typically last 7-10 years, depending on genetics, lifestyle, and skin quality.
Can a facelift be combined with other procedures?
Yes, Dr. Deon often combines face lifting with eyelid surgery, neck lifts, or fat transfer for comprehensive facial rejuvenation.
How long does a facelift operation take?
A standard facelift commonly takes three to five hours. The time depends on the technique and whether additional procedures are performed.
Will I be awake during facelift surgery?
Facelifts are most commonly performed under general anaesthetic. Some limited procedures may use local anaesthetic with sedation. The anaesthetist selects the method after reviewing the planned surgery and the patient’s medical history.
Where are facelift scars?
Incisions commonly follow the temporal hairline, the crease in front of the ear, around the earlobe and behind the ear into the hairline. Visibility varies with incision placement, skin type, tension and healing.
What is the most common facelift complication?
Haematoma, meaning a collection of blood beneath the skin, is the most common early complication. Published series generally report rates in the low single digits, with higher rates in men and people taking blood-thinning medicines.
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This article describes a facelift in general terms for education. It is not medical advice and cannot establish suitability, expected benefit or risk for an individual. The appropriate technique, extent of surgery, anaesthesia and recovery plan require assessment by a qualified practitioner. Check that your surgeon is an HPCSA-registered specialist and discuss your circumstances before deciding on surgery.
