A facelift, also known as rhytidectomy, is a cosmetic procedure designed to reduce visible signs of aging in the face and neck. Over time, natural factors such as sun exposure, gravity, and lifestyle habits can lead to sagging skin, deep lines, and loss of facial definition. A facelift works by tightening underlying tissues, repositioning facial structures, and smoothing the skin for a more youthful, natural appearance.
A facelift reshapes the lower face and neck by lifting the tissue beneath the skin, typically the SMAS layer, and re-draping the skin without tension. The procedure takes two to four hours under general anaesthetic, most patients go home the same day, and presentability for social settings usually returns at two to three weeks, with residual swelling settling over three to six months. Final scar maturation and the settled result take twelve to eighteen months.
What a Facelift Actually Does
A facelift (rhytidectomy) addresses laxity in the lower face and neck, including jowling, loss of jawline definition, deep nasolabial folds, and loose neck skin, by lifting and repositioning the tissue beneath the skin rather than pulling the skin tight on its own.
The SMAS (superficial musculoaponeurotic system) is the layer most commonly lifted. The deep plane variant releases the retaining ligaments and repositions the deeper tissue as a single unit.
A facelift does not lift the brow, correct upper-lid hooding, or change skin surface quality. Those are separate procedures, often combined with a facelift when clinically indicated.
Are You a Candidate?
Candidacy rests on three things: enough tissue laxity to make a lift worthwhile, skin with reasonable elasticity to re-drape cleanly, and a health status that makes elective surgery under general anaesthetic safe.
Common indications include jowling along the jawline, deepening nasolabial folds, loss of the neck angle, and visible platysmal banding. Common non-indications include early laxity better addressed by skin-quality or non-surgical treatments, and patients seeking to address a single feature (brow, eyelids, perioral lines) that a facelift does not target.
Smokers and patients with uncontrolled medical conditions need individualised assessment; surgery is usually deferred until the condition is optimised.
Final answer: candidacy is assessed at an in-person consultation by a HPCSA-registered specialist plastic surgeon. General information cannot replace that assessment.
The Techniques Worth Knowing About
The workhorse technique is the SMAS facelift, where the SMAS layer is lifted and re-suspended and the skin is re-draped without tension.
The deep plane facelift releases the SMAS and deeper soft tissue as a single unit by dividing the retaining ligaments. It is indicated in selected cases, particularly secondary facelifts and significant neck laxity.
The mini-facelift is a shorter-scar variant with more limited dissection, appropriate for earlier laxity in selected patients.
A thread lift is a non-surgical alternative using barbed sutures; results are typically modest and time-limited compared with a surgical lift. The practice does not offer thread lifts.
| Technique | Dissection depth | Best suited to | Anaesthetic | Recovery (typical) |
|---|---|---|---|---|
| SMAS facelift | SMAS layer | Most candidates with lower-face and neck laxity | General | 2–3 weeks presentable |
| Deep plane facelift | Below SMAS, ligaments released | Significant laxity, secondary cases, strong neck work | General | 2–3 weeks presentable |
| Mini-facelift | Limited SMAS | Earlier laxity, younger patients | General or sedation | 1–2 weeks presentable |
| Thread lift | None (suture only) | Mild laxity, patients declining surgery | Local | Days, not weeks |
How to Choose a Surgeon
Confirm HPCSA registration as a specialist plastic and reconstructive surgeon, not just a medical practitioner.
Confirm the operating facility is a hospital theatre with full anaesthetic support, not an office-based procedure room.
Ask how many facelifts the surgeon performs per year and whether they offer the technique appropriate to your case.
Ask to see unretouched before-and-after photographs of patients with similar starting anatomy.
Ask who manages the anaesthetic and what the overnight or day-surgery arrangements are.
Avoid any consultation that promises a specific outcome, a specific recovery time, or a particular look rather than addressing your anatomy.
Before the Procedure: The Consultation and Pre-Op Stage
Before undergoing a face lift, patients typically attend a detailed consultation with a qualified surgeon. The initial consultation covers history, examination, photographic documentation, discussion of goals, technique recommendation, and a written quote. A second consultation reviews the consent process, completes the anaesthetic assessment, and arranges pre-operative bloods or ECG where indicated.
Pre-operative instructions include stopping smoking at least four weeks before surgery, holding supplements and medications that affect bleeding (aspirin, NSAIDs, vitamin E, omega-3, herbal preparations) on the surgeon’s instructions, and arranging transport and a responsible adult for the first 24 hours.
Practical preparation makes the first week easier: button-front clothing, a recliner or extra pillows for sleeping upright, soft foods, and time off work already booked.
The Day of Surgery
Admission is to the hospital, followed by marking by the surgeon and an anaesthetic review.
Procedure length is two to four hours for a facelift alone; longer when combined with blepharoplasty, brow lift, fat grafting, or skin resurfacing.
Drains are often placed and usually removed within 24–48 hours.
Most patients go home the same day once stable; an overnight stay is arranged when clinically indicated.
The First Week
Days 1–3: swelling and bruising peak around day 2–3. Head elevation, cold compresses, and prescribed analgesia are the routine.
Days 4–5: drains are removed if still in place, and dressings are reviewed and lightened.
Stitches are typically removed within one to two weeks.
Day 5–7: sutures or staples are removed depending on the technique and site.
Activity during the first week is walking only; no bending, lifting, or straining. Sleep on the back with the head elevated.
Common experiences include tightness across the cheeks and neck, temporary numbness, and mild bruising tracking down the neck and onto the chest.
Weeks Two to Four
Bruising fades. Most patients resume light activities within two weeks, though strenuous exercise should be avoided for at least four weeks. Most patients are presentable for social settings at two to three weeks.
Camouflage makeup is usually acceptable once incisions are fully closed.
Most patients return to desk work at the end of week two; physical jobs require longer.
Months Two to Twelve
Residual swelling settles progressively; the final contour becomes readable around three to six months.
Incisions mature, firm and pink early, then flattening and fading over twelve to eighteen months.
Scars sit in front of and behind the ear (and sometimes under the chin) and are designed to follow natural contours. They are visible up close in the early months but typically inconspicuous once mature.
Numbness, tightness, and small irregularities continue to soften over the first year.
The follow-up schedule is typically at one week, two weeks, six weeks, three months, six months, and twelve months, tailored to the case.
Risks and Complications
Haematoma (collection of blood under the skin) is the most common early complication, reported in roughly 1–3% of facelift cases in published series. It may require a return to theatre for evacuation.
Infection is uncommon (typically under 1%) but serious when it occurs; it is treated with antibiotics and sometimes surgical washout.
Nerve injury: temporary weakness of the facial nerve branches is more common than permanent injury. Permanent motor nerve injury is reported at well under 1% in modern series. Temporary numbness of the skin is very common and resolves over weeks to months.
Skin loss or poor healing is rare; risk is higher in smokers, in patients with poor skin quality, and behind the ears where tension can concentrate.
Scarring: hypertrophic or widened scars occur in a small minority; revision is occasionally needed once the scar is mature.
Asymmetry: minor pre-existing asymmetry is often uncovered by the lift rather than caused by it; revision surgery is rarely required.
Anaesthetic risk is discussed at the anaesthetic consultation and quantified individually based on health status.
Deep vein thrombosis and pulmonary embolism are risks of any procedure under general anaesthetic; they are mitigated by early mobilisation, hydration, and mechanical prophylaxis when indicated.
Dissatisfaction with result is the most common “complication” in patient-reported outcome studies. It is managed by waiting for healing, then revision surgery where indicated.
Common Mistakes Patients Make
- Choosing a surgeon on price alone, without verifying specialist registration and operating facility.
- Smoking through the peri-operative period, the single most modifiable cause of skin-healing complications.
- Returning to strenuous activity too early, which raises the risk of haematoma and prolonged swelling.
- Judging the result at three to four weeks, when swelling and scar immaturity still dominate the appearance.
- Confusing a facelift with a brow lift, eyelid surgery, or skin-resurfacing procedure; each addresses a different part of the face and is often combined.
- Believing marketing language about “no scars”, “no downtime”, or guaranteed outcomes.
- Skipping the second consultation or the consent process in pursuit of a faster booking.
Frequently Asked Questions
How long does a facelift last?
A facelift sets the clock back but does not stop it. Most patients look five to ten years younger than they would have without surgery, and that relative difference holds for roughly seven to ten years before tissue laxity progresses again. Lifestyle, skin quality, and genetics all affect the duration.
Will I have visible scars?
Incisions sit in front of and behind the ear and sometimes under the chin, placed where they follow natural contours. They are visible up close in the early months, fade over twelve to eighteen months, and are typically inconspicuous once mature. Smokers and patients with poor skin quality have a higher risk of widened or hypertrophic scars.
When can I go back to work?
Most desk-based patients return at the end of week two. Physical jobs, public-facing work, and any role requiring strenuous activity usually require three to four weeks or longer. Your surgeon clears you on the basis of how you heal, not on a fixed calendar.
Does a facelift include the eyes and brow?
Not by default. A facelift addresses the lower face and neck. Eyelid surgery (blepharoplasty) and brow lifting are separate procedures, performed together with a facelift when indicated, but neither is included in a standard facelift.
Is a facelift covered by medical aid?
Medical aid in South Africa does not generally cover cosmetic procedures. A facelift may attract cover only when there is a documented functional or reconstructive indication, for example significant post-weight-loss skin redundancy or facial paralysis, and even then cover is at the medical aid’s discretion. Your practice will advise on the funding pathway at consultation.
Considering a Facelift?
DW Skin & Body offers SMAS and deep plane facelift surgery at Life Fourways Hospital, with consultations at the Fourways practice. If you are weighing whether a facelift is the right step for your anatomy and your goals, a consultation is the place to start. Candidacy, technique, recovery, and risks are all assessed individually.
Call 011 875 1694 or visit the Fourways practice to book.
Also Read:
- Face and Neck Lift Before and After | What to Expect
- What To Expect From a Facelift Before And After
This article is general information about what a facelift involves, not medical advice for any individual. Outcomes, recovery, scarring, and candidacy vary from patient to patient and can only be assessed in person by a HPCSA-registered specialist plastic surgeon. Consult such a practitioner about your own circumstances before deciding on any procedure.
