Face lifting is a surgical procedure that restores youthful contours to the mid and lower face and neck by repositioning the underlying soft tissues and removing excess skin. The term covers a family of techniques that differ in how deep the surgeon works, how much skin is lifted, and where the incisions sit. At the practice of Dr Deon, a board-certified plastic surgeon based in Johannesburg, face lifting is planned around each patient’s facial anatomy rather than applied as a single template. The aim is structural support that lasts, with scars hidden in natural skin creases.
Modern face lifting moved away from skin-only tightening in the 1970s and 1980s, when surgeons realised that pulling skin alone produced a stretched look that did not age well. The shift to working on the SMAS (superficial musculo-aponeurotic system), the fibrous layer that covers the facial muscles, allowed surgeons to lift the deeper scaffolding of the face. Subsequent refinements, including the deep plane approach and composite techniques, have further improved how natural and how long-lasting a face lift can be.
This guide explains what face lifting does, who it suits, the main techniques used today, the surgical journey from consultation to recovery, the risks patients should understand, and what to expect in the weeks and months after surgery. It is written for adults considering a face lift in South Africa and draws on publicly available guidance from the HPCSA, ISAPS, and peer-reviewed aesthetic surgery literature.
What Is Face Lifting?
A face lift (rhytidectomy) is an operation that addresses age-related changes in the lower two-thirds of the face and the neck. The surgeon lifts and tightens the SMAS layer and the platysma muscle in the neck, redrapes the skin, and trims the excess. Fat may be repositioned or reduced in the jowls and under the chin. The procedure does not lift the brows or the eyelids; those are addressed by a brow lift or blepharoplasty, often performed at the same time.
Modern face lifting is best understood as structural. The goal is to restore the position of deeper tissues to where they sat a decade or so earlier, then let the skin lie smoothly over them. Skin is closed without tension, which is what keeps scars fine and the result natural in animation.
What a face lift can and cannot do
A face lift can address sagging cheeks, deep creases between the nose and mouth (nasolabial folds), jowling along the jawline, and loose skin and banding in the neck. It can re-establish a defined cervicomental angle (the contour under the chin). It cannot, on its own, change skin surface quality such as fine lines, sun damage, or pigmentation, which are typically treated with laser, chemical peel, or medical-grade skincare. It also does not restore volume lost from the cheeks and temples, which may require fat grafting or dermal fillers as an adjunct.
Who Is a Good Candidate?
Good candidates are adults in good general health whose face shows structural descent rather than only surface ageing. Most are in their late 40s to 70s, though the appropriate age depends on anatomy rather than chronology. The best results come from patients who still have some skin elasticity, whose bone structure provides a stable platform for the lift, and who have realistic expectations of what surgery can achieve.
Health and lifestyle factors
Smokers are asked to stop smoking at least four weeks before and after surgery. Nicotine constricts blood vessels and impairs wound healing, increasing the risk of skin loss at the incision edges. Patients on blood thinners (warfarin, aspirin, clopidogrel, DOACs) need a plan with their prescribing doctor and usually the surgeon to stop or bridge these safely. Uncontrolled diabetes, untreated hypertension, and active skin infections around the face or scalp are reasons to delay surgery.
Key Concerns Addressed by Face Lifting
Face lifting is commonly used to improve:
- Sagging cheeks and midface descent
- Deep lines between the nose and mouth
- Jowling along the jawline
- Loose skin around the neck
At Dr Deon, each procedure is planned against the patient’s facial bone structure, fat distribution, and skin quality. The aim is to restore proportion rather than to maximise tension, which is what keeps the result harmonious rather than over-corrected.
Face Lifting Techniques
Face lifting is not a single operation. Three broad families are used today, and the choice depends on how much descent is present, the quality of the skin, the patient’s age, and what they want to see in the mirror afterwards.
SMAS Facelift Technique
The SMAS facelift lifts and tightens the superficial musculo-aponeurotic system, the fibrous layer that envelops the facial muscles. Working on this layer provides structural support rather than relying on skin pull alone. The technique suits most patients with moderate facial ageing and is the workhorse of modern face lifting. Variations include the lateral SMASectomy (a strip of SMAS is removed and the edges sutured together) and the high SMAS flap, which lifts the cheek as well as the jawline.
Deep Plane Facelift Approach
The deep plane technique works beneath the SMAS, releasing the zygomatic and masseteric retaining ligaments that tether the cheek to the bone. By mobilising the midface and jawline as one unit, the deep plane allows a natural lift of the cheek without the lateral sweep that older techniques could produce. It is particularly useful for patients with significant midface descent and deep nasolabial folds. The recovery is similar to a SMAS lift but the technique demands precise anatomical knowledge.
Mini Facelift for Early Signs of Aging
A mini facelift (short-scar face lift) uses a shorter incision that does not extend into the temporal hairline. It tightens the SMAS over the lower face and jawline and is best suited to patients in their late 30s to early 50s with mild to moderate jowling and reasonable skin elasticity. Recovery is faster (often a long weekend off work rather than two weeks) and the procedure can be done under local anaesthesia with sedation in suitable candidates.
| Technique | Depth of work | Best suited to | Typical scar | Anaesthesia |
|---|---|---|---|---|
| Mini facelift | SMAS, lower face only | Mild jowling, good skin quality, late 30s to early 50s | Short preauricular scar, no temporal extension | Local with sedation or general |
| SMAS facelift | SMAS, lower face and neck | Moderate ageing across mid and lower face | Preauricular scar extending into temporal hairline and behind the ear | General anaesthesia |
| Deep plane facelift | Sub-SMAS, releasing retaining ligaments | Significant midface descent, deep nasolabial folds, heavy neck | Same as SMAS, occasionally extended | General anaesthesia |
The Face Lifting Process Step by Step
Knowing the surgical journey helps patients feel prepared. Each step is explained in detail below.
Consultation and Facial Assessment
The process begins with a detailed consultation at the Johannesburg practice. Dr Deon examines the face at rest and in animation, assesses bone structure, fat distribution, skin quality, and the pattern of descent. Photographs are taken for planning and to compare against later results. Past medical history, current medication (including supplements and herbal preparations), smoking, and prior surgery are reviewed. Patients leave with a written surgical plan and a quote that reflects the specific technique recommended.
Surgical Procedure Overview
Face lifting is performed in an accredited hospital operating theatre under general anaesthesia, or under local anaesthesia with sedation for a mini lift in suitable patients. Incisions are placed in front of the ear, hidden in the crease where the ear meets the cheek, and extend upward into the temporal hairline and backward behind the ear into the occipital hair. Through these incisions the surgeon lifts the skin, works on the SMAS (and, in deep plane lifts, beneath it), repositions fat, tightens the platysma in the neck, and removes excess skin before closing without tension. Drains are often used for 24 to 48 hours. A face lift alone takes three to five hours; when combined with blepharoplasty or a brow lift it can run to six or seven.
Recovery and Healing Phase
Recovery after a face lift is gradual. Most patients go home the day after surgery once drains are removed, wearing a supportive head garment. Bruising and swelling peak at day three to five and settle over two to three weeks. Stitches or staples are removed at five to ten days. Most patients feel ready to be seen in public at two weeks, light exercise resumes at three weeks, and strenuous activity at six weeks. Numbness in the cheeks and ears is common and resolves over weeks to months as small sensory nerves recover. Final contour settles between three and six months, and scars continue to mature for 12 to 18 months.
| Phase | Timeframe | What to expect |
|---|---|---|
| Early | Days 1 to 7 | Drains in for 24 to 48 hours; head garment; swelling and bruising peak; rest, head elevated, no bending or straining |
| Intermediate | Weeks 2 to 3 | Sutures removed; bruising fades; most social activities resume; still no strenuous exercise |
| Late | Weeks 4 to 6 | Light exercise resumes; numbness starts to settle; swelling largely gone |
| Maturation | Months 3 to 12 | Final contour visible at three to six months; scars mature and fade over 12 to 18 months |
Benefits of Face Lifting
Choosing a qualified facial specialist is the single biggest determinant of outcome. The benefits of a well-executed face lift go beyond appearance.
Structural support and longevity
By repositioning the SMAS or working in the deep plane, modern face lifting produces results that last around 10 years on average, with some patients retaining a benefit at 12 to 15 years. Longevity depends on skin quality, genetics, sun exposure, smoking, and weight stability. Structural techniques age more gracefully than skin-only lifts because the deeper support does not stretch back as quickly.
Natural movement
When the lift is done on the deeper layers, the skin is not under tension. The face moves naturally when smiling, talking, and showing emotion. There is no wind-tunnel effect, and animation lines remain appropriate to the patient’s age. This is the difference between looking refreshed and looking like surgery has been done.
Psychological and social benefits
Peer-reviewed studies in aesthetic surgery consistently find improvements in self-esteem, body image, and social confidence after face lifting, with effects sustained for years. These benefits are contingent on realistic expectations. A face lift refreshes the face a decade or so; it does not produce a different face, and patients who understand that going in report the highest satisfaction.
Risks and Complications
Face lifting is a major operation carried out under general anaesthesia in most cases, and it carries real risks. The complication rates quoted below come from the larger published series and from guidance issued by the American Society of Plastic Surgeons and ISAPS. The figures are illustrative; individual risk depends on the patient’s anatomy, health, smoking status, and the surgeon’s experience.
| Complication | Approximate incidence | Notes |
|---|---|---|
| Hematoma (collection of blood under the skin) | 1 to 3 percent | Most common significant complication; higher in men and patients on blood thinners; usually requires prompt evacuation |
| Skin loss at incision edges | 1 to 2 percent | Strongly linked to smoking; usually heals with local wound care but can leave a wider scar |
| Nerve injury affecting facial movement | 0.5 to 1 percent for permanent injury; up to 3 percent for temporary weakness | The marginal mandibular and buccal branches of the facial nerve are most at risk; most temporary weakness recovers within weeks |
| Great auricular nerve numbness | Up to 5 percent | Causes numbness of the lower ear and adjacent skin; usually improves over months |
| Visible or widened scarring | Variable, around 2 to 4 percent | Hypertrophic or stretched scars are more common in smokers and in patients with thick or thin skin |
| Infection | Under 1 percent | Uncommon; prevented with perioperative antibiotics |
| Asymmetry or contour irregularity | Variable | Small asymmetries are common and usually settle; significant asymmetry may need revision |
| Anaesthesia-related complications | Low in healthy adults | Discussed at the pre-operative anaesthetic consultation |
The single best way to lower risk is to choose a surgeon who is registered with the Health Professions Council of South Africa (HPCSA) as a specialist plastic and reconstructive surgeon, to follow pre- and post-operative instructions (particularly around smoking and blood thinners), and to attend every scheduled follow-up.
Cost Considerations in South Africa
The cost of a face lift in South Africa varies with the technique, the anaesthetist’s fee, the facility fee, and whether adjunct procedures (blepharoplasty, brow lift, fat grafting) are performed at the same time. A mini facelift performed under local anaesthesia with sedation costs meaningfully less than a deep plane face lift under general anaesthesia in a hospital theatre. Most practices require a deposit to secure a surgical date, with the balance due on the day of surgery.
Medical aid schemes in South Africa generally classify face lifting as cosmetic and do not cover the surgeon’s fee, the anaesthetist’s fee, or the facility fee. Related hospital costs (for example, an overnight stay if clinically required) are sometimes partially covered. Patients are given a detailed breakdown at consultation and are encouraged to check with their medical aid before booking.
A face lift is a one-off cost that, for a well-done structural lift, should not need repeating for a decade or more. When compared over 10 years, the per-year cost is often modest, particularly when set against repeated spending on non-surgical treatments that do not address the underlying descent.
Preparing for Surgery
Pre-operative preparation starts at the consultation and continues in the weeks before the operation. Patients are asked to stop smoking at least four weeks before and after surgery. Blood-thinning medications, including aspirin (unless prescribed for a cardiac indication), clopidogrel, warfarin, and direct oral anticoagulants, are managed in conjunction with the prescribing physician. Herbal supplements such as ginkgo, garlic, ginseng, and omega-3 fish oil can also increase bleeding and are usually stopped two weeks before surgery.
On the practical side, patients are encouraged to fill any prescriptions ahead of time, prepare meals for the first week, and arrange transport home from the hospital and help at home for the first 48 to 72 hours. The face will be bruised and swollen, and bending, lifting, and straining should be avoided for the first week.
Long-Term Care After a Face Lift
A face lift does not stop the clock, but it sets it back. Long-term care focuses on protecting the result. Daily broad-spectrum sunscreen, a medical-grade skincare routine including a retinoid as tolerated, and avoidance of smoking all help the result age well. Many patients continue with non-surgical maintenance such as ultrasound- or radiofrequency-based skin tightening, light fillers to replace volume lost from the temples and cheeks, and occasional skin resurfacing. None of these replaces the structural lift, but they keep the skin in the best possible condition between and after surgery.
Weight stability matters. Significant weight gain or loss after a face lift can change facial fat distribution and compromise the result. Patients planning substantial weight loss are usually advised to reach their goal weight before surgery.
Why Surgeon Choice Matters
Face lifting is a high-stakes procedure. The differences between an excellent and a poor result come down to anatomical knowledge, judgement about how much to lift, and the discipline to close without tension. A face lift performed by an unqualified practitioner carries a markedly higher risk of nerve injury, poor scarring, and revision surgery.
In South Africa, patients should confirm that their surgeon is registered with the Health Professions Council of South Africa (HPCSA) as a specialist plastic and reconstructive surgeon (registration number visible on the HPCSA register), and that the procedure will be performed in an accredited hospital or day clinic. Membership of the Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa (APRASSA) is a further marker of appropriate training and ongoing continuing professional development.
How to Book a Consultation
The first step is a consultation. Dr Deon consults at the practice in Johannesburg and offers an online consultation and photo review for patients who travel from outside Gauteng or who want an initial opinion before committing to a visit. A consultation includes a full facial assessment, a discussion of which technique is appropriate, the risks specific to the patient, the recovery plan, and a written quote.
To book, use the online consultation and photo review form, email the practice, or call 011 875 1694 during office hours.
Frequently Asked Questions
At what age is a face lift most often performed?
Most patients who have a face lift are in their late 40s to 60s, but the appropriate age depends on anatomy rather than chronology. The right time is when there is structural descent of the cheeks, jawline, or neck that cannot be addressed with non-surgical treatments, and the patient is in good general health.
How long does a face lift last?
Modern structural face lifts, including SMAS and deep plane techniques, typically last around 10 years on average, with many patients retaining visible benefit at 12 to 15 years. Longevity depends on skin quality, sun exposure, smoking status, weight stability, and genetics.
Will I have visible scars after a face lift?
Scars are placed in front of the ear in the natural crease, behind the ear, and within the hairline. Once mature at 12 to 18 months, they are typically fine and hidden in these contours. Smokers and patients with thick or very thin skin have a higher chance of widened or hypertrophic scarring.
How much time will I need off work?
Most patients take two weeks off work for a full SMAS or deep plane face lift. Bruising is usually present for the first two weeks and can be covered with makeup after the sutures are removed at day five to ten. A mini facelift may require only a long weekend off work.
Is a face lift painful?
Face lifting is not typically described as painful. Most patients describe tightness, pressure, and a feeling of swelling rather than sharp pain. Discomfort is well controlled with oral analgesia for the first few days. Numbness in the cheeks and ears is common and settles over weeks to months.
Can a face lift be combined with other procedures?
Yes. Face lifting is commonly combined with blepharoplasty (eyelid surgery), brow lift, fat grafting to the cheeks and temples, and skin resurfacing such as laser or chemical peel. Combining procedures means one anaesthetic and one recovery, and it allows the surgeon to address the face as a whole rather than treating one zone in isolation.
Does medical aid cover a face lift in South Africa?
Medical aid schemes in South Africa generally classify face lifting as a cosmetic procedure and do not cover the surgeon’s fee, anaesthetist’s fee, or facility fee. Some schemes will partially cover related hospital costs, such as an overnight stay, if it is clinically required. Patients should confirm cover with their scheme before surgery.
How do I choose a face lift surgeon in South Africa?
Confirm that the surgeon is registered with the Health Professions Council of South Africa (HPCSA) as a specialist plastic and reconstructive surgeon, that the procedure will be performed in an accredited hospital or day clinic, and that the surgeon regularly performs face lifting. Membership of APRASSA is a further marker of appropriate training. Review before-and-after photos of the surgeon’s own patients and ask about the specific technique recommended for your anatomy.
Also Read:
- When Should You Get a Facelift? | Best Age & How Young Is Too Young
- Lifting Face Before and After | Facelift Results & Photos Guide
- Lifting Face Surgery | Facelift Surgery & Techniques Explained
Medical disclaimer: This article is for general information only and does not constitute medical advice. Face lifting is a surgical procedure with real risks, and the suitability of any technique depends on the individual patient’s anatomy, health, and goals. Always consult a qualified specialist plastic and reconstructive surgeon registered with the Health Professions Council of South Africa (HPCSA) before making a decision about surgery. The information here is current as of the publication date and may change as surgical techniques and evidence evolve.
