A modern facelift repositions deeper facial structures, not just the skin. The operation combines general anaesthesia, structural lifting, and skin redraping, typically taking two to four hours depending on the technique. The article walks through the steps of the procedure, from pre-operative preparation through recovery, so candidates know what to expect.
Facelift surgery (rhytidectomy) is performed under general anaesthesia, takes roughly two to four hours, and addresses the deeper facial layers rather than only tightening the surface. The steps run from pre-operative assessment through incision closure and recovery. What follows is the practical sequence patients experience on the day, including what the surgeon does during each phase, how long each step takes, and what to expect in the hours afterwards.
Before the procedure
The process starts well before the operating theatre. A facelift is an elective procedure, so the pre-operative phase is where the surgical team confirms that the operation is safe for the individual patient and that the planned technique matches the anatomy and goals.
Pre-operative consultation and assessment
The first consultation is a working session, not a sales conversation. Dr Deon Weyers takes a full facial history, examines skin laxity, bone structure, fat distribution, and neck contour, and discusses what a facelift can and cannot change. Photographs are taken for planning, and the patient is walked through the incision pattern, the recovery timeline, and the realistic range of outcomes. Candidacy is assessed in person because the clinical picture (skin thickness, prior surgery, smoking history, medical conditions) drives the technique choice.
Medical evaluation, medications, and lifestyle
Bloodwork, a baseline ECG in patients over a certain age or with relevant history, and a medication review are standard. Blood-thinning agents, certain supplements, and anti-inflammatory drugs are stopped ahead of surgery on a schedule set during the consultation. Smoking is addressed directly: nicotine impairs wound healing and increases the risk of skin-flap complications, so patients are asked to stop a defined number of weeks before and after the operation.
Anaesthesia planning
A modern facelift is performed under general anaesthesia. The anaesthetist reviews the pre-op workup, confirms fasting instructions, and discusses the anaesthetic plan with the patient. The anaesthesia choice and airway plan are documented before the patient is brought into theatre.
On the day of surgery
On the day, the sequence is consistent: arrival and pre-op checks, anaesthesia induction, marking the patient while awake, the surgical procedure itself, recovery room, and discharge or overnight admission. Knowing the order reduces anxiety on the morning of surgery.
Anaesthesia induction
The anaesthetist induces general anaesthesia in the operating theatre. Once the patient is asleep, the airway is secured, monitoring lines are placed, and the face is cleaned and prepared with antiseptic solution. Sterile drapes frame the face so only the surgical field is exposed.
Incision placement
Incisions are placed where they will hide in natural contours: in the hairline at the temples, around the front of the ear, around the earlobe, and back into the hairline behind the ear. The exact pattern depends on the technique (SMAS, deep plane, or mini lift) and on the patient’s hairline and ear shape. The aim is to keep the resulting scar within shadows and creases so it is not visible at conversational distance once healed.
Skin flap elevation
The skin is lifted off the underlying tissues in a carefully controlled plane. The dissection extends forward to the cheek and nasolabial fold, down to the neck, and back toward the ear. The skin flap is kept moist and handled gently to preserve its blood supply.
Deep tissue work (SMAS or deep plane)
With the skin elevated, the deeper layer is addressed. In a SMAS lift, the superficial musculoaponeurotic system is tightened and repositioned. In a deep plane lift, the dissection continues beneath this layer to release the retaining ligaments and allow the cheek and jawline to be repositioned as a unit. The choice between SMAS and deep plane depends on anatomy, age, and the degree of descent to be corrected.
What the surgeon does step by step
This is the technical core of the operation. Each step has a defined purpose and contributes to the final contour.
Ligament release
Retaining ligaments anchor the facial soft tissues to deeper structures. To allow the midface and jawline to be lifted without tension, these ligaments are released in a controlled fashion. Release is what enables a natural, lasting repositioning rather than a pulled look.
Tissue repositioning
The released tissues are lifted and secured in a higher, more youthful position. Sutures are placed in the deeper layer to hold the new contour. The lift is calibrated: the goal is restoration, not exaggeration, and the vector of the lift follows the natural direction of facial ageing in reverse.
Fat handling
Fat is managed, not ignored. In some patients, fat grafting is added to restore volume in the cheek or temple. In others, submental (under-chin) liposuction is performed to refine the neck contour. The decision is made during the operation based on what the tissues look like once lifted.
Skin redraping
With the deeper layer repositioned, the skin is laid back down without tension. A facelift that pulls the skin tight is a facelift that produces an unnatural result and a wide scar. The skin is allowed to drape naturally over the new contour, and the excess is measured for trimming.
Closure and dressings
A small rim of excess skin is trimmed, and the incisions are closed in layers. Fine sutures or skin adhesive are used for the surface closure. Drains may be placed under the skin to collect fluid in the first day or two. A light compression dressing is applied to support the tissues and reduce swelling.
After the procedure
The operation itself is one part of the process. The first 24 hours, the first week, and the follow-up schedule determine how the result settles.
Recovery room and discharge
The patient is taken to the recovery room and monitored while the anaesthesia wears off. Most patients go home the same day, although some stay overnight for observation. Pain is managed with prescribed medication, and the face feels tight and swollen rather than acutely painful.
Dressings and drains
Dressings stay in place for the first day or two. If drains were placed, they are usually removed within 24 to 48 hours. After the dressings come off, the incision lines are visible but usually easy to conceal with hair or a light scarf.
First week of healing
Swelling and bruising peak in the first 48 to 72 hours and then begin to settle. Sleeping with the head elevated and applying cold compresses as directed helps. Most patients feel presentable for light public contact within 10 to 14 days, although residual swelling takes longer to resolve fully.
Follow-up schedule
Sutures are removed at around day one to two weeks, depending on the closure. Follow-up visits are scheduled at one week, two weeks, six weeks, three months, and six months. The final result is not judged at six weeks; the face continues to refine for several months as the deeper tissues settle.
Common mistakes to avoid
A facelift is a procedure where the choices made before surgery shape the outcome more than anything that happens in the operating theatre. Three mistakes come up repeatedly in consultation.
- Choosing by price alone rather than technique-specific experience. A lower quote from a surgeon who performs facelifts infrequently is not a saving; it is a different risk profile. Ask how many of the surgeon’s primary procedures are facelifts and what techniques they use.
- Underestimating recovery time. Most patients need two weeks before they look socially comfortable and six weeks before strenuous exercise is back on the table. Planning around the recovery, not the surgery date, is what makes the process manageable.
- Skipping pre-op medical optimisation. Stopping smoking, controlling blood pressure, and sorting out dental or skin issues ahead of surgery reduce complication rates. The pre-op window is part of the procedure, not optional preparation around it.
Risks and complications
Facelift surgery is a well-established procedure, but it is still surgery, and the consent process exists to make sure the recognised risks are understood before the operation is booked.
The most discussed complication is haematoma, a collection of blood under the skin that can occur in the first 24 hours and may require return to theatre for evacuation. Published series report haematoma rates of roughly 1 to 3 percent, with higher rates in men and in patients on blood thinners. Infection is uncommon but possible, and is treated with antibiotics and, occasionally, drainage. Nerve injury to branches of the facial nerve can cause temporary weakness in specific muscle groups; permanent injury is rare. Scarring is part of any incision-based procedure, and the scars are managed with taping, silicone, and time. Skin-flap compromise, where a portion of the skin does not heal well, is a recognised risk and is more common in smokers.
The consent consultation covers each risk in the context of the individual patient’s history and anatomy. Signing consent is not a formality; it is the documented conversation in which the surgeon explains what can go wrong and the patient confirms understanding.
Frequently asked questions
How long does a facelift take?
A facelift typically takes two to four hours of operating time, depending on the technique and whether adjunct procedures such as fat grafting or eyelid surgery are performed at the same sitting. Anaesthesia and recovery room time extend the day but are not part of the surgical time itself.
Will I be awake during surgery?
No. A facelift is performed under general anaesthesia. The anaesthetist monitors breathing, blood pressure, and heart rate throughout, and the patient is fully asleep for the duration of the procedure.
How many incisions does a facelift involve?
A standard facelift uses a continuous incision that runs from the temple hairline, around the front of the ear, around the earlobe, and back into the hairline behind the ear. The incision is one line on each side, placed within natural contours so it is not visible once healed. A mini facelift uses a shorter version of the same incision.
What type of anaesthesia is used?
General anaesthesia is standard for a full facelift. The airway is secured, and anaesthesia is maintained throughout. Local anaesthetic with sedation is occasionally used for limited procedures, but is not the typical choice for a full rhytidectomy.
How long is the hospital stay?
Most facelift patients are discharged the same day after a short observation period in recovery. Some practices offer an overnight stay, and some surgeons prefer to keep patients in for one night. The decision depends on the extent of the procedure, the patient’s health, and the surgeon’s preference.
Considering a facelift and want to understand the procedure? Candidacy is assessed in person. Dr Deon Weyers is a board-certified plastic and reconstructive surgeon registered with the HPCSA, and sees patients at the Fourways practice. Call 011 875 1694.
Also Read:
- What Is a Facelift Procedure? | Step-by-Step Guide
- Facelift Surgery Guide | Step-by-Step Facelift Operation Process
General information only; not medical advice. Procedure details vary by surgeon, technique, and patient anatomy. Confirm specifics at consultation.
