A facelift, or rhytidectomy, is a cosmetic surgical procedure designed to reduce the visible signs of aging on the face and neck by repositioning the soft tissue layer beneath the skin. Dr Deon Weyers, a HPCSA-registered specialist plastic surgeon and APRASSA member, offers advanced facelifting techniques that restore youthful contours while preserving natural facial expression. Facelift surgery in South Africa is typically self-funded, as medical aid schemes classify it as cosmetic in the majority of cases.
The procedure targets sagging skin, deep creases, jowls, and loose neck tissue, and is most often combined with complementary procedures such as blepharoplasty, fat grafting, or skin resurfacing to address the eyelids, brow, and skin surface, which a facelift alone does not treat.
The sections below cover the available techniques, who is and is not a candidate, what recovery looks like at each stage, and the complications a consent process should address.
What “facelift” actually covers in current surgical practice
A facelift (rhytidectomy) addresses descent of facial soft tissue, including jowls, mid-face flattening, and neck laxity, by repositioning the layer beneath the skin rather than by tightening skin alone. Modern facelift surgery works beneath the skin surface, and a result that relies on skin tension alone tends to relapse quickly and look unnatural.
The procedure sits within a broader facial-rejuvenation plan that may include blepharoplasty, fat grafting, brow lift, skin resurfacing, or non-surgical adjuncts. A facelift on its own does not treat the eyelids, brow, or skin surface (isaps.org, tier 3).
In South Africa, the operation is performed by plastic surgeons (registration with HPCSA as a specialist in plastic surgery) and, for some techniques, by maxillofacial surgeons working within their scope. Cosmetic-only practitioners without specialist registration are not authorised to perform it (hpcsa.co.za, tier 3, regulatory body).
The main facelift techniques, and what each one does
The table below summarises the main surgical and non-surgical options. Individual healing varies, and recovery figures are typical ranges rather than guarantees.
| Technique | Best suited to | Incision | Recovery (back to most activity) | Limitation |
|---|---|---|---|---|
| Mini / short-scar | Early jowling, younger patients | Limited, around the ear | ~1–2 weeks (individual, tier 3 estimate) | Limited lift in the neck and mid-face |
| SMAS | Moderate jowling and neck laxity | Around the ear, into the hairline | ~2–3 weeks (individual, tier 3 estimate) | Less effective on heavy mid-face descent |
| Deep plane | Significant mid-face descent, strong ligaments | Similar SMAS incisions, deeper dissection | ~3–4 weeks (individual, tier 3 estimate) | Longer operation, higher surgeon-skill requirement |
| Neck lift (often combined) | Platysmal bands, submental laxity | Submental and around the ear | ~2 weeks | Does not address mid-face |
SMAS facelift (superficial musculo-aponeurotic system)
The SMAS facelift is the workhorse technique. The SMAS layer is tightened and repositioned, with skin redraped over it. It is suitable for most candidates with mid-face and jawline descent.
Deep plane facelift
In a deep plane facelift, the dissection goes deeper, releasing the retaining ligaments and moving the SMAS and overlying tissue as a single unit. It is indicated where mid-face volume descent and strong ligamentous attachments are present; it is generally a longer operation with a more demanding recovery (isaps.org; ASPS, tier 3).
Mini facelift / short-scar facelift
The mini facelift uses a shorter incision and less dissection, suited to younger patients with early jowling. The trade-off is a more limited correction.
Mid-facelift
A mid-facelift focuses on the cheek and under-eye area rather than the jawline and neck.
Neck lift
A neck lift addresses platysmal bands and submental laxity. It is often combined with a facelift rather than performed alone.
Non-surgical options
Dr Deon also offers non-surgical treatments such as thread lifts and dermal fillers for patients seeking subtle enhancements without surgery. Thread lifts and HIFU are non-surgical or minimally invasive alternatives marketed as facelift alternatives. They are legitimate comparison subjects but are not surgical facelifts and do not produce equivalent repositioning of deep tissue (asps.org, tier 3).
Who is a candidate for a facelift
Good candidates are generally in good overall health, do not smoke (or are willing to stop well before and after surgery, as nicotine impairs healing), have realistic expectations about what surgery can and cannot change, and have specific concerns (jowls, mid-face descent, neck laxity) that a facelift is designed to address.
Facelift surgery is elective. Conditions that increase anaesthetic or wound-healing risk (uncontrolled blood pressure, bleeding disorders, active smoking, poorly controlled diabetes) need to be optimised before surgery is scheduled.
Age is a factor only in terms of tissue quality and health status; there is no fixed upper or lower age limit, and the question of candidacy is decided at consultation, not by a number (asps.org, tier 3).
A facelift is not a treatment for skin surface problems. Pigmentation, fine lines, texture, and sun damage need separate consideration (resurfacing, skincare, injectables).
How a facelift is performed: the stages of the operation
- Consultation and planning: history, photography, discussion of technique and what the operation can realistically achieve; informed consent includes the specific risks covered below.
- Anaesthesia: general anaesthetic is standard for full facelifts; some limited procedures may be performed under sedation with local anaesthetic. The anaesthetist is a HPCSA-registered specialist.
- Incision and dissection: placement depends on technique (around the ear, into the hairline, sometimes under the chin for neck work).
- Tissue repositioning: the SMAS or deep-plane plane is lifted, ligaments released where indicated, and the deeper layer fixed in its new position, typically with sutures.
- Skin redraping and closure: excess skin is trimmed; closure is usually with fine sutures and staples in the hair-bearing scalp.
- Dressings and recovery: a supportive dressing is applied; drains may be used and are usually removed within 24–48 hours.
- Follow-up: wound checks in the first week, suture removal typically by day 7–10, then staged reviews over the following months.
Recovery: what to expect at each stage
Recovery is staged rather than a single number. Most patients can return to work within 2–3 weeks, though full recovery may take several months. Individual healing varies, and every figure below is phrased as typical rather than guaranteed.
| Stage | Typical timeframe | What’s happening |
|---|---|---|
| First 48 hours | Days 0–2 | Dressings in place, swelling and bruising at their earliest peak, mild discomfort controlled with prescribed analgesia |
| First week | Days 3–7 | Bruising visible but beginning to settle; most patients comfortable moving around at home; sutures often removed by day 7–10 |
| Weeks 2–3 | – | Most bruising resolved or easily covered; many patients return to non-strenuous work and social activity |
| Weeks 4–6 | – | Swelling continues to reduce; light exercise resumed; strenuous activity still restricted |
| Months 3–6 | – | Residual swelling settles; final contour and scar maturation become apparent |
Return to driving depends on stopping opioid analgesia, comfortable neck rotation, and surgeon clearance, typically no earlier than the second week. Sun protection of the scars is essential for at least 12 months (asps.org, tier 3).
Risks and complications
Facelift surgery is a significant operation under general anaesthetic. The consent process must cover both anaesthetic and procedure-specific risks.
- Haematoma (collection of blood under the skin) is the most common early complication. Reported rates in the literature are typically in the 1–3% range for primary facelift and higher in male patients (peer-reviewed facelift outcome series, tier 1).
- Nerve injury: temporary weakness of the marginal mandibular or frontal branch of the facial nerve is reported in a small percentage of cases and usually resolves; permanent facial nerve injury is rare but documented.
- Skin necrosis is more common in smokers and after haematoma; wound-care management is usually effective but may affect scar quality.
- Scarring: scars are placed around the ear and in the hairline to minimise visibility; individual scar maturation varies and can include hypertrophy or wider scarring.
- Infection, asymmetry, contour irregularity, alopecia at incision sites, prolonged swelling, and dissatisfaction with the aesthetic result are all recognised outcomes that the consent process should address.
- Anaesthetic risk: general anaesthesia carries its own morbidity and mortality profile, discussed by the anaesthetist at the pre-operative visit.
Risk is reduced by choosing a HPCSA-registered specialist plastic surgeon, by an accredited surgical facility, by stopping nicotine well before and after surgery, and by following the post-operative instructions carefully (asps.org; aprassa.co.za, tier 3).
Cost and the medical-aid question in South Africa
Facelift surgery in South Africa is classified by medical aid schemes as a cosmetic procedure in the majority of cases and is therefore not covered from the medical aid benefit. The patient funds the procedure out of pocket.
Where there is a clear reconstructive indication (facial descent or deformity following trauma, congenital condition, or another reconstructive cause), APRASSA and medical aid schemes may consider partial funding under a reconstructive code. This is decided case by case and requires the surgeon to motivate to the scheme.
What drives the fee: surgeon time and complexity, anaesthetist fee, theatre time, facility fee, implants or adjuncts if used, post-operative garments, and follow-up visits. A defensible SA range is not stated on the practice’s own site; cost is best framed as a combination of these line items, with a personalised quote provided at consultation.
APRASSA and HPCSA expect a written, itemised quote and informed consent signed before any deposit is taken.
How to choose a surgeon in South Africa
- HPCSA registration as a specialist in plastic surgery is the baseline credential; verify on the HPCSA iRegister (hpcsa.co.za, tier 3).
- APRASSA membership (Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa) confirms specialist plastic surgical qualification in the SA context.
- The facility should be an accredited day-case or inpatient surgical facility; the anaesthetist should be a HPCSA-registered specialist anaesthetist.
- Questions to ask at consultation: which technique is being recommended and why, what the surgeon’s own complication and revision rates are, where the procedure will be performed, who the anaesthetist will be, what the consent process covers, and what follow-up schedule is offered.
A second opinion is reasonable for any elective cosmetic procedure.
Common mistakes and misconceptions
- Treating a facelift as a skin procedure. Modern facelift surgery repositions the layer beneath the skin; a result that relies on skin tension alone tends to relapse quickly and look unnatural.
- Equating a “mini” lift with no recovery. Shorter incision does not mean shorter healing time; bruising and swelling still occur.
- Assuming non-surgical treatments (thread lift, HIFU, injectables) are equivalent. These are different interventions with different indications, durations, and outcomes; a thread lift is not a surgical facelift and the practice does not offer it as one.
- Booking around a deadline. Recovery cannot be compressed; planning surgery around a wedding, public appearance, or holiday needs a realistic buffer of weeks, not days.
- Skipping the medical optimisation. Blood pressure, nicotine, anaemia, and medication review matter; surgery is safer when these are addressed first.
- Choosing on price alone. Surgeon, anaesthetist, and facility credentials are the safety variables; a lower quote that compromises any of these is a poor trade.
- Believing the result is permanent. A facelift addresses tissue that has descended; the face continues to age afterwards, and the result is durable rather than permanent.
Special considerations in the South African context
- Practice model: APRASSA-aligned practices follow a consultation-first pathway, with assessment, informed consent, and a cooling-off period before booking surgery.
- Travel for surgery: patients regularly travel from outside Gauteng. The surgeon is based at a single Fourways practice, and follow-up visits need to be planned in.
- Regulation: HPCSA is the registering authority for both surgeons and anaesthetists; complaints can be lodged with HPCSA.
- Facility standards: procedures should be performed in an HPCSA-licensed or accredited facility, not in rooms without appropriate anaesthetic backup.
Frequently Asked Questions
How long does a facelift result last?
A facelift repositions tissue that has descended. The result is durable but the face continues to age afterwards. Most patients find the improvement is clearly visible at five years and meaningful at ten, but the figure varies with technique, skin quality, sun exposure, and lifestyle (asps.org, tier 3).
Is a facelift covered by medical aid in South Africa?
In most cases, no. Facelift surgery is classified as cosmetic by South African medical aid schemes and is funded out of pocket. Where there is a clear reconstructive indication (trauma, congenital deformity, post-surgical reconstruction), the surgeon may motivate to the scheme for partial cover; this is decided case by case (ap rassa.co.za, tier 3).
What is the difference between a SMAS facelift and a deep plane facelift?
Both address the layer beneath the skin. A SMAS facelift tightens and repositions that layer, while a deep plane facelift releases the retaining ligaments and moves the SMAS and overlying tissue as a single unit. The deep plane approach is generally indicated where mid-face descent is significant and is a longer operation with a more demanding recovery (isaps.org, tier 3).
When can I go back to work after a facelift?
Most patients are comfortable returning to non-strenuous work at two to three weeks, with bruising easy to cover by the second week. Strenuous activity is usually restricted for four to six weeks. The exact timing depends on the technique used, whether other procedures were combined, and individual healing (asps.org, tier 3).
What is the most common complication of facelift surgery?
Haematoma, a collection of blood under the skin, is the most commonly reported early complication, occurring in roughly 1–3% of primary facelifts in published series and at higher rates in men. Most are managed promptly with a good outcome; the consent process should cover it explicitly (peer-reviewed facelift outcome series, tier 1).
Also Read:
- Facelifting Operation in South Africa | What to Expect
- Expert Guide to Facelifts in South Africa | Techniques & Recovery
This article is general information about facelift procedures in South Africa and does not constitute medical advice for any individual. Candidacy, the appropriate technique, recovery, risks, and outcomes vary from person to person and can only be assessed in person by a HPCSA-registered specialist plastic surgeon. Consult a registered practitioner about your own circumstances before making any decision about surgery.
