A facelift, medically known as a rhytidectomy, repositions the soft tissues of the lower face and neck rather than pulling skin tight on its own. The technique a surgeon selects changes how long the result holds, where the scars sit, and what the recovery involves, so the choice of operation matters as much as the decision to have surgery at all.
In South Africa, the main surgical options are the skin-only lift, the SMAS facelift, the deep plane facelift, and short-scar or mini variants, often combined with a neck lift or fat transfer. Candidacy, scarring, and downtime all depend on which of these is used and whether other procedures are added to the operation.
What a Facelift Actually Addresses
Facial ageing is driven by three processes: descent of the soft tissues of the cheek and lower face, loss of deep fat volume, and loss of skin elasticity. A procedure that tightens skin alone does not correct the first two, which is why the plane of surgery matters so much to how long a result lasts.
A facelift targets the lower two-thirds of the face and the neck: jowls along the jawline, deep folds beside the nose and mouth, midface descent, and loose neck skin with visible platysmal banding. It does not treat the brow or upper eyelids, and it does not change surface skin quality, fine lines, or pigmentation. Those concerns belong to other procedures, such as eyelid surgery or a brow lift, or to skin treatments that are sometimes combined with a facelift.
One point worth stating plainly: a facelift repositions tissue to a more youthful position. It does not stop the ageing process from continuing afterwards.
The Main Facelift Techniques Available in South Africa
Dr Deon assesses each face individually and recommends a technique based on the degree of laxity, skin quality, facial structure, and the patient’s goals. The options below are the techniques most commonly performed in South African practice, and the right one for a given face is a clinical decision, not a preference for the newest name.
Skin-Only Facelift
The oldest approach. The skin is lifted from the underlying tissue, drawn back, and the excess is trimmed. Surgery is shorter and recovery is quicker, but because the lift is carried by the skin alone, results typically do not last as long as techniques that address the deeper layers. It is performed less often today.
SMAS Facelift
Targets the deeper structural layer beneath the skin for longer-lasting and more natural results. Ideal for moderate to significant sagging.
The SMAS, or superficial musculo-aponeurotic system, is the fibrous layer between the skin and the deeper facial structures. SMAS techniques include plication, where the layer is folded and sutured, SMASectomy, where a strip is removed, and extended SMAS dissection. Because it suits a broad range of candidates, the SMAS approach is the most commonly performed facelift in many practices.
Deep Plane Facelift
Dissection continues beneath the SMAS, releasing the retaining ligaments so the deeper tissue moves as a single unit. This is often discussed as producing longer-lasting correction of midface descent and a stronger neck result, with the trade-off of a longer, more involved procedure and somewhat more swelling in the early recovery weeks.
Mini Facelift
A less invasive option with smaller incisions and faster recovery. Perfect for early ageing concerns.
The incision usually sits in front of the ear only, without extending into the hairline behind it. It suits patients with earlier changes and good skin elasticity, and its correction of the neck is limited compared with a full lift.
Neck Lift Combination
Often paired with a facelift to eliminate loose neck skin and define the jawline for complete facial harmony.
Addressing platysmal banding and fullness under the chin directly is frequently what produces the defined jawline patients are aiming for, which is why the neck is assessed as part of every facelift plan.
Fat Transfer Enhancement
Restores lost facial volume using your body’s own fat, improving contours and softness while enhancing facelift results.
Fat is harvested from another area of the body, prepared, and placed into areas of volume loss, most commonly the midface and temples, either at the same time as the facelift or as a separate stage.
| Technique | Plane addressed | Best suited to | Typical longevity | Scar length |
|---|---|---|---|---|
| Skin-only | Skin only | Selected patients; performed less often today | Shortest | Around the ear |
| SMAS (plication, SMASectomy, extended) | On or above the SMAS layer | Most candidates with moderate ageing changes | Moderate | Around the ear, sometimes into the hairline |
| Deep plane | Beneath the SMAS, retaining ligaments released | Advanced midface descent, stronger neck correction | Often cited as the longest | Around the ear, sometimes into the hairline |
| Mini or short-scar | Limited SMAS work through a shorter incision | Earlier ageing changes, good skin elasticity | Variable, often shorter | In front of the ear only |
Longevity in this table is a general comparison, not a guarantee. Individual results depend on anatomy, skin quality, the technique used, and aftercare.
Before Surgery: Consultation and Planning
Personal Consultation
Dr Deon examines the face and neck, reviews your medical history, takes photographs, and discusses your goals and concerns. The consultation is where the technique is chosen and where expectations are set honestly about what surgery can and cannot achieve.
Pre-Operative Planning
You will receive written instructions covering medication, since blood thinners and anti-inflammatories are usually stopped beforehand, smoking cessation, fasting, and what to arrange at home for the first week. Careful preparation at this stage lowers complication risk and makes the early recovery smoother.
How a Facelift Is Performed
- Anaesthesia. Full facelifts are generally performed under general anaesthesia; some short-scar cases are done under sedation with local anaesthesia. The decision is made per case with the anaesthetist.
- Incisions. Placed in front of the ear, typically extending into the hairline above and behind the ear according to the technique. Mini lifts use the shorter front-of-ear incision.
- Dissection and lift. The skin is lifted, then the SMAS or deep plane is addressed according to the plan agreed before surgery.
- Closure. Excess skin is trimmed and the incisions are closed in layers. Drains are sometimes placed.
- Monitoring. Most patients go home the same day or stay one night in hospital, depending on the extent of surgery and the anaesthesia used.
Surgery usually takes several hours in theatre, and longer when procedures such as eyelid surgery or fat grafting are combined with the facelift.
Who Is a Good Candidate
The best candidates have laxity in the lower face and neck that non-surgical treatment cannot correct. Indications that a facelift is worth considering include:
- Sagging skin or jowls along the jawline
- Deep folds running from the nose to the corner of the mouth, or from the mouth to the chin
- Loose skin or banding in the neck
- Skin with enough remaining elasticity to redrape well after lifting
- Good general health and fitness for anaesthesia
- Being a non-smoker, or able to stop smoking before and after surgery, since smoking impairs wound healing
- Realistic expectations: surgery repositions tissue, it does not change bone structure or halt ageing
Candidacy can only be confirmed at an in-person assessment, because anatomy, skin quality, and goals all need direct examination. An online photograph review can give an early indication, but it is not a final answer. Age itself matters less than skin condition: many patients choose surgery in their 40s to 60s, and suitability is assessed individually.
Recovery: A Realistic Timeline
Healing determines the final result as much as the surgery itself. Close aftercare and scheduled follow-up visits are part of the treatment plan, and the timeline below describes what most patients experience.
First Week
Swelling and bruising are at their peak over the first three days. Keep the head elevated, use cold compresses as instructed, and rest. A compression garment may be used around the face and neck, and drains, when placed, usually come out within 24–48 hours. Light rest is the rule for the whole of the first week.
Weeks Two to Three
Most swelling subsides over these two weeks and sutures are usually removed around day 5–7. Most patients return to light daily activities and are presentable in public with make-up and a considered hairstyle by the end of week two or during week three.
One Month and Beyond
Results become more refined as residual swelling settles, with final contour typically visible at three to six months. Scars fade gradually over months to a year. Strenuous exercise is usually cleared at four to six weeks. Numbness around the ears is common early on and generally resolves within the first months, though it can persist longer.
| Phase | What to expect | Practical guidance |
|---|---|---|
| Days 1–3 | Swelling and bruising at their peak; drains removed if used | Head elevated, cold compresses, quiet rest |
| Days 4–7 | Bruising starts to fade; sutures removed around day 5–7 | Short gentle walks; no bending or lifting |
| Weeks 2–3 | Most swelling settles; presentable with make-up | Return to light daily activity and non-physical work |
| Weeks 4–6 | Swelling largely settled; contour refining | Strenuous exercise usually resumed |
| Months 3–6 | Residual swelling resolves; final contour visible | Scars continue fading for up to a year |
Technique shapes the recovery envelope. A short-scar or mini lift generally has a shorter early recovery than a deep plane or full SMAS lift, and combining procedures such as eyelid surgery or fat grafting extends the overall downtime. Following the aftercare instructions given at discharge protects the result.
Risks and Complications
Every surgical procedure carries risk, and a proper consultation discusses these openly. The recognised complications of facelift surgery include:
- Haematoma. A collection of blood under the skin is the most common early complication and may require a return to theatre. Risk is higher in smokers and patients on blood-thinning medication.
- Nerve injury. Branches of the facial nerve run through the operative field. Temporary weakness is more common than permanent injury, and permanent facial nerve injury is reported in low single-digit percentages in published series.
- Skin healing problems. Wound separation, delayed healing, or small areas of skin loss, markedly more common in smokers.
- Scarring. Incisions sit in natural creases and the hairline and most scars fade well, but thicker or stretched scars can occur, particularly behind the ear.
- Asymmetry. All faces are asymmetrical before surgery; noticeable asymmetry afterwards may need revision.
- Hairline changes. Temporary, and less commonly permanent, alteration of the hairline at the temples or behind the ears.
- Anaesthetic and general surgical risks. Infection, bleeding, deep vein thrombosis, pulmonary embolism, and adverse reactions to medication.
Risk falls with a surgeon registered as a specialist plastic and reconstructive surgeon, surgery in an accredited facility with an anaesthetist present, careful pre-operative screening, stopping smoking well before surgery, and close adherence to post-operative instructions.
How to Choose a Surgeon in South Africa
Registration comes first. Specialist plastic and reconstructive surgeons are registered with the Health Professions Council of South Africa, and registration can be checked on the HPCSA register. APRASSA, the Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa, is the recognised professional body, and membership signals ongoing engagement with the specialty.
The setting matters as much as the surgeon. The operation should take place in an accredited hospital or day-clinic theatre with an anaesthetist present, not in an office-based setting without these arrangements.
Questions worth asking at consultation: which technique do you recommend for my face and why; what is your experience with that technique; what complications have you seen in your own practice; what does follow-up include; and what happens if a revision is needed. Reluctance to discuss complications, pressure to decide on the day, no clear facility arrangement, or registration that cannot be verified are all warning signs.
Funding: Medical Aid vs Self-Pay
A facelift performed for appearance alone is classified as cosmetic, and South African medical aids do not cover cosmetic surgery. Most facelifts are therefore self-funded, with costs driven by the technique, theatre time, anaesthesia, and hospital stay.
A medical aid may contribute where there is a documented functional or reconstructive indication, for example significant facial asymmetry, post-traumatic or post-surgical deformity, or certain post-weight-loss situations. Pre-authorisation is required and each case is decided individually.
Patients travelling from outside Gauteng should plan to stay near the practice for at least 7–10 days after surgery, until sutures are removed and early healing has been reviewed. An online consultation and photograph review is a reasonable first step that can give an early view on candidacy before travel, but it does not replace the in-person examination required before surgery is scheduled.
Common Mistakes and Misconceptions
- Choosing a technique by name rather than by indication. The deep plane lift is often marketed as superior, but the right technique depends on anatomy, skin quality, and goals. For a given face, a SMAS lift may be the better operation.
- Comparing recovery claims without context. A “back to work in a week” claim almost always describes a short-scar or mini lift, not a full SMAS or deep plane procedure with combined treatments.
- Assuming non-surgical treatments are equivalent. Energy-based devices and thread lifts produce modest, temporary improvement and are not substitutes for surgery where tissue laxity is significant.
- Underestimating the recovery envelope. Even with an uncomplicated procedure, residual swelling takes months to settle fully, and planning around that matters.
- Skipping the facility and anaesthetist question. Surgeon skill matters, but so does where and how the operation is performed.
- Not planning travel and follow-up. Out-of-town patients need to factor in stay duration and review appointments.
Facelift in South Africa: Practical Considerations
South Africa has a small but well-established plastic surgery community, and the techniques described above, skin-only, SMAS, deep plane, and short-scar variants, are all performed by appropriately trained surgeons in the country. Because facelift surgery requires a pre-operative assessment and several post-operative reviews, typically a suture-removal visit around day 5–7 and a follow-up a few weeks later, patients travelling from outside Gauteng should plan to remain near the practice for at least seven to ten days after surgery.
An initial online consultation or photograph-based review is offered by many surgeons as a first step, giving an early view on candidacy before a patient commits to travel. It does not replace the in-person examination, which remains required before any procedure is scheduled. On funding, the position is straightforward in most cases: cosmetic facelift surgery is self-funded, and medical aid contributes only where there is a documented reconstructive indication with pre-authorisation.
Frequently Asked Questions
How long does a facelift last?
Results typically last 8–12 years, depending on lifestyle, skin quality, and ageing patterns.
Longevity also tracks the technique: a deep plane or well-performed SMAS lift generally holds longer than a skin-only lift. No facelift stops ageing; the face continues to age from its new, more youthful position, and some patients choose a revision procedure years later.
What is the difference between a SMAS facelift and a deep plane facelift?
Both work below the skin, but at different depths. A SMAS facelift tightens or refolds the fibrous layer on or above the SMAS, while a deep plane facelift dissects beneath the SMAS and releases the retaining ligaments so the deeper tissue moves as a single unit. Deep plane surgery is often selected for advanced midface descent; the SMAS approach covers a broad range of indications and is the more commonly performed of the two.
When can I go back to work after a facelift?
Most patients return to normal activities within 2–3 weeks, with continued improvement over several months.
Desk-based work is often manageable from the end of the second week once bruising is coverable, and strenuous exercise is usually cleared at four to six weeks. A mini or short-scar lift generally has a shorter early recovery than a full SMAS or deep plane procedure, especially when other treatments are combined.
Will facelift scars be visible?
Incisions are carefully placed along natural creases and hairlines to keep scars discreet and barely noticeable.
Scars are permanent but mature and fade over the first year. The area behind the ear is the most prone to a thicker scar, and any concerns are reviewed at follow-up visits.
Is a facelift painful?
Discomfort after surgery is usually mild to moderate and is managed with prescribed medication for the first few days. Most patients describe tightness, numbness, and swelling rather than sharp pain, and this settles progressively through the first weeks.
Does medical aid pay for a facelift in South Africa?
Generally no. Surgery performed for appearance alone is classified as cosmetic and is self-funded. A medical aid may contribute where there is a documented reconstructive or functional indication, such as correction of significant asymmetry or post-traumatic deformity, and that decision is made case by case with pre-authorisation.
Is a facelift safe?
Facelift surgery is well established when performed by a surgeon registered with the HPCSA as a specialist plastic and reconstructive surgeon, in an accredited facility with an anaesthetist present. As with any surgery it carries risks, including haematoma, nerve injury, healing problems, scarring, and anaesthetic risk, and these should be discussed openly at consultation. Smoking raises several of these risks substantially and is stopped before surgery.
Facelift surgery at DW Skin & Body, Dr Deon’s Fourways practice, begins with an in-person assessment where candidacy, technique, recovery, and funding are discussed directly. To arrange a consultation, contact the practice on 011 875 1694, or start with the online consultation and photo review form. The practice is at Suite B22, Life Fourways Hospital, Fourways.
Also Read:
- Expert Guide to Facelifting Procedures in South Africa
- Facelift Meaning | What Is The Procedure For A Face Lift In South Africa?
This article is general information about facelift surgery and is not medical advice for any individual. Outcomes, recovery, candidacy, and funding vary from person to person and can only be assessed in person by an HPCSA-registered specialist plastic surgeon. Consult a qualified practitioner about your own circumstances before making any decision about surgery.
