A facelift, also called rhytidectomy, is surgery for lax skin and soft tissue of the lower face, cheeks, jawline and, in some operations, the upper neck. The surgeon tightens or repositions selected tissues and redrapes or removes excess skin. It may improve definition along the jawline and reduce skin that hangs below the chin, but it does not stop ageing, change facial bone, remove every facial crease or replace nonsurgical skin treatments.
Suitability depends on the pattern of laxity, skin thickness and elasticity, facial structure, fat distribution, health, medication use and smoking status. A facelift may be unsuitable when healing risk is high or when the main concern would be better treated with eyelid surgery, a brow lift, chin surgery, neck surgery or a skin treatment. The consultation should make clear which concerns facelift surgery can address and which it cannot.
A facelift mainly treats tissue descent and laxity. It is not designed to remove every line, change pigment, restore lost facial volume by itself or stop the natural effects of ageing. Fat grafting or another procedure may be considered when volume loss is part of the concern, but adding steps also adds operative time, risks and recovery.
Before surgery, the clinical team reviews medical history, allergies, previous facial procedures, current medicines and the desired change in function and appearance. The anaesthetic plan, incision pattern, tissue technique, closure, dressing and aftercare are planned for the individual. Recovery and results vary, and no operation can guarantee a particular duration or appearance. This guide explains the usual process, common decisions and risks that may require prompt medical review.
What a facelift can address
A facelift mainly addresses lower facial descent, jowls and jawline definition. It can include the upper neck, but a neck lift may be performed separately or as part of the same operation. It does not by itself correct heavy eyelids, a low brow, prominent nasolabial folds, skin pigmentation or loss of facial bone.
Who may be a suitable candidate
Factors include skin thickness, elasticity, facial structure, fat distribution, general health, previous surgery and smoking. A good result also depends on a clear, realistic goal and willingness to accept visible swelling, scars and a long recovery. Age alone does not determine suitability. The surgeon also considers whether the skin can tolerate repositioning, whether structural prominence would limit the correction, and whether another operation offers a safer or more direct solution. Smoking should be addressed before surgery because it can impair wound healing.
Consultation and preparation
During the first consultation, the surgeon examines the face at rest and during movement, then considers how the skin, underlying tissue, fat and facial structures relate to the concern being treated. The intended result, likely limitations, incision positions, anaesthesia, recovery and follow-up arrangements should be discussed before booking.
- Medical conditions, allergies, previous facial operations and current infections
- Prescription medicines, over-the-counter products, vitamins and supplements
- Smoking, alcohol use and previous complications from anaesthesia or surgery
- The facial areas that concern you and the result you hope to achieve
- Practical support, transport, recovery time and access to follow-up care
Do not stop or change a prescribed medicine without advice from the prescriber or surgical team. Blood thinners, diabetes medicines and other conditions may require specific planning. The team should provide written instructions about fasting, medicines, smoking, alcohol, wound care and the arrangements for the first night after surgery.
Before booking, patients can check a practitioner through the HPCSA website. It is also important to establish who will perform the operation, who will provide anaesthesia and who is responsible for postoperative concerns.
The facelift operation, step by step
The exact sequence varies according to facial anatomy and the selected technique. A facelift is not one standardised operation. The surgeon should explain which tissue planes will be used, why each incision is needed, what can be corrected and what may remain unchanged.
1. Anaesthesia and surgical setup
A facelift commonly requires general anaesthesia, although an anaesthetist may use combined sedation in selected cases. Before the incision is made, the team confirms the patient, procedure and operative site, allergies, monitoring, fluid plan and emergency arrangements. The anaesthetist remains responsible for airway management and physiological monitoring throughout the operation.
2. Incision placement
Incision design depends on hair position, skin quality, facial anatomy and whether the temple, cheek, jawline or neck is being treated.
Dr Deon strategically places incisions around the hairline, temples, and behind the ears. This placement helps conceal scars naturally.
Incision length and position differ between a limited lower facelift and an operation that also treats the neck or temporal region. The surgeon should mark the planned route and explain scar visibility, changes near the hairline and the need for any longer incision.
3. Tissue lifting and repositioning
Once the skin is elevated, the surgeon releases, tightens or repositions selected deeper tissue. The chosen plane may involve the superficial musculoaponeurotic system, also called the SMAS, or a deeper approach, depending on the anatomy and planned correction.
The underlying facial muscles and tissues are gently lifted and tightened to restore youthful contours.
Tissue quality and healing affect the final contour. Excess tension is avoided because it can increase distortion or impair wound healing. The amount and direction of correction should reflect the patient’s anatomy rather than a fixed template.
4. Skin redraping and closure
After the deeper tissue has been addressed, the skin is advanced, redraped and trimmed. Liposuction or fat grafting may be added if these form part of the agreed plan. Incisions are then closed with sutures, staples or an adhesive method appropriate to the location. Scars are visible early and change gradually over the following months.
5. Dressing, drains and discharge
Bleeding is controlled, wound edges are checked and a supportive dressing is applied. Drains may be used to remove fluid or blood, but not every facelift requires one. The team decides whether the patient can go home or needs overnight observation. Written wound-care instructions and a route for urgent clinical concerns should be provided before discharge.
Recovery timeline and aftercare
Initial recovery usually takes 2-3 weeks, with most swelling and bruising subsiding within this period. Full results are visible after several months.
Swelling may be uneven during early healing, and one side can feel or look different for a time. Numbness, tightness and tenderness are also common. The care plan governs wound cleaning, dressing changes, medicines, sleeping position, head elevation, hair washing and return to work or exercise. Individual instructions take priority over general recovery advice.
| Stage | Possible experience | General care focus |
|---|---|---|
| Immediately after surgery | A dressing may be in place. Swelling, bruising, tenderness, tightness and numbness are common. A drain may be present if one was used. | Follow the discharge instructions, prescribed medicines and contact plan. |
| Early recovery | Swelling and bruising change over time. Stiffness and reduced sensation may persist while nerves and tissues settle. | Attend scheduled reviews, protect the wound and avoid heavy activity unless cleared. |
| After the first few weeks | Many people can resume routine activities as the surgical team permits, although swelling or numbness may remain visible. | Return to work, exercise, hair washing and travel according to the individual plan. |
| Several months later | The contour and scars continue to settle. Final appearance varies with tissue behaviour, skin care and sun exposure. | Continue scar care and skin protection as advised. |
Walking may be encouraged early, but driving, exercise, lifting, bending and work depend on the operation and the individual recovery. The surgical team should explain when the next wound review, suture or staple review, and scar review will take place.
Risks, complications and warning signs
Every operation carries risk. The risk of an outcome depends on the operation, health, medicines, smoking, skin condition and the care provided. Consent should explain expected effects, possible complications, the purpose of any drain or dressing, and what the patient should do if a concern develops.
Expected effects and possible complications
- Swelling, bruising, tenderness, tightness or headache
- Temporary or prolonged numbness, itching or altered sensation
- Scarring or small contour irregularities around the incision sites
- Bleeding or a haematoma beneath the skin
- Infection or a fluid collection under the skin
- Nerve injury, facial weakness or persistent altered sensation
- Asymmetry, prolonged swelling or delayed healing
- Problems with skin perfusion, skin damage or an unsightly scar
- Anaesthetic complications or a blood clot in a leg or the lungs
When to seek urgent help
Contact the surgical team promptly for rapidly enlarging or one-sided swelling, severe or worsening pain, new facial weakness, persistent bleeding, fever, increasing redness, pus or wound separation. Difficulty breathing, chest pain, coughing blood, fainting, or one-sided calf swelling and pain require emergency medical care.
Questions to ask at your consultation
Before booking, consider asking the surgeon to clarify the following:
- Which facial concerns will the operation address, and which will remain?
- Why is the proposed technique and tissue plane appropriate for your anatomy?
- Where will each incision be placed, and what scar care will be required?
- What restrictions, dressings, drains and review appointments may be needed?
- Who is responsible for postoperative concerns after you go home?
To contact the practice, use the Online Consultation & Photo Review form or call 011 875 1694 about booking and practice contact.
Frequently asked questions
What happens during the first surgical consultation?
During the initial consultation, the surgeon reviews your medical history, examines your facial anatomy and skin, discusses the change you want, and explains the available technique, anaesthesia, recovery, risks and limits. Bring a list of diagnoses, allergies, previous operations, current medicines and supplements, plus any questions about aftercare.
How can I prepare for facelift surgery?
Follow the surgical team’s written instructions about fasting, medicines, smoking, alcohol, transport and wound care. Do not stop a prescribed medicine without advice from the prescriber or surgical team. Arrange adult support for the first day or night and keep the agreed follow-up appointments.
When will recovery milestones become visible?
Most early swelling and bruising settles over the first few weeks, while the final appearance continues to develop over several months. The written instructions and review schedule from the surgical team take priority because recovery varies.
How long can the effects of a facelift last?
Results typically last 7-10 years, depending on skin quality, age, and lifestyle habits.
This is not a guarantee. Ageing, genetics, sun exposure, smoking, skin care and changes in facial fat continue over time, so the timing of further changes differs between people.
Which procedures may be performed at the same time as a facelift?
Yes, facelifts can be combined with eyelid surgery, brow lifts, or neck lifts for a more comprehensive facial rejuvenation.
Combining procedures lengthens the operation and may change pain, swelling and recovery. The surgeon should explain which problems each procedure addresses, the order of treatment and the added risk.
How is pain managed after facelift surgery?
Anaesthesia controls pain during the operation. Afterwards, tenderness, tightness and swelling can cause discomfort, and prescribed medicines may be needed. The team should explain what pain is expected and how to obtain help if it is worsening or not controlled by the agreed medicines.
What should you know about facelift scars?
Scars are present early and may soften or fade over months, but they can remain visible. Final appearance depends on incision placement, skin biology, wound healing, smoking, sun exposure and aftercare. Ask the surgeon where each incision will be placed and how that specific skin area is likely to heal.
Which complications require attention after surgery?
Possible complications include bleeding or haematoma, infection, fluid collection, nerve injury, asymmetry, persistent numbness, scarring, skin-healing problems, anaesthesia complications and blood clots. Seek prompt assessment for rapidly enlarging one-sided swelling, worsening pain, fever, new facial weakness or wound discharge, and emergency care for breathing difficulty or chest pain.
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Medical disclaimer: This article provides general educational information about facelift surgery and cannot replace an examination, diagnosis or personalised medical advice from a suitably qualified healthcare professional. Treatment choices, risks, anaesthesia and recovery vary between individuals. Discuss your medical history, medicines, smoking status, expected outcomes and concerns with your surgical team before proceeding. Seek urgent medical care for new or worsening symptoms after surgery.
