Face lift surgery, also called a rhytidectomy, repositions descended facial soft tissues and removes redundant skin to address laxity in the lower two-thirds of the face and the neck. It does not correct upper eyelid hooding, brow descent or the surface quality of the skin, which may require separate procedures.
The supporting tissue beneath the skin, including the superficial musculoaponeurotic system, is the main structural target. The operation is planned according to the distribution of tissue descent, skin quality, facial movement and the patient's medical history.
A face lift can change visible lower-face contour, but it cannot stop ageing or create features that were not present. Expected changes, scar placement, anaesthesia, recovery and the need for revision must be discussed before consent.
Arrange a face lift consultation with Dr Deon Weyers
Call 011 875 1694 or visit Suite B22, Life Fourways Hospital, Cnr Cedar Road and Cedar Avenue West, Fourways.
Understanding Face Lift Surgery and Its Lasting Results
Rhytidectomy is derived from Greek roots associated with wrinkle removal, but a modern face lift is not simply an operation on loose skin. Techniques range from skin-only procedures to operations that dissect, release and reposition the deeper musculoaponeurotic system, commonly called the SMAS.
The structural aim is to restore descended tissue to a more appropriate position while redraping the skin without tension. Ageing continues after surgery, so the appearance of the face will change over time even when the deeper correction remains effective.
What a Face Lift Corrects
A face lift is selected according to the pattern of tissue descent rather than the name of a particular technique. It may be considered for lower-face and jowl laxity, a poorly defined jawline and selected forms of neck laxity.
- Repositioning of the superficial musculoaponeurotic system (SMAS), the deeper layer that has actually descended with age, rather than simply pulling on the skin.
- Redraping of the skin over the newly lifted contours so it lies smooth without horizontal tension across the ears.
- Removal of the small triangle of excess skin that remains once the deeper tissues have been lifted.
- Often, submental liposuction and platysma tightening to address the neck and the angle beneath the jaw.
- Optional fat grafting to the cheeks, temples, or tear troughs to restore volume that has been lost with age.
Deep plane dissection may release the zygomatic, masseteric-cutaneous and mandibular retaining ligaments so that the midface and jowl tissues can move as a more coherent unit. The extent of release depends on the anatomy and the intended correction.
What a Face Lift Does Not Address
A face lift should not be used as a substitute for procedures directed at other parts of the face or at skin texture. The following concerns may need separate assessment:
- Upper eyelid hooding, which may require blepharoplasty.
- Brow descent, which is treated with a brow procedure when indicated.
- Fine lines, pigmentation or uneven texture, which are managed with non-surgical skin treatments.
- Age-related volume loss, which may require fat transfer or filler in addition to repositioning tissue.
Face Lift Techniques Compared
Not every face lift is the same operation. The terminology below is the one Dr Deon Weyers uses during consultation to describe the increasing scope of each procedure.
| Technique | Scope | Typical candidate | Anaesthesia |
|---|---|---|---|
| Mini face lift (short-scar) | Lower face and jawline only, limited SMAS tightening | Younger patients (early forties to early fifties) with early jowling | Local with sedation, or general |
| Standard (full) face lift | Lower two-thirds of face, SMAS plication or SMASectomy, neck tightening | Patients with moderate jowling and neck laxity | General |
| Deep plane face lift | Release of the facial retaining ligaments, repositioning of the midface and jowl fat pads as a single unit | Patients with heavier midface descent and deeper nasolabial folds | General |
| Face and neck lift (combined) | Standard face lift plus submental liposuction and platysmaplasty | Patients with visible neck banding or a poorly defined cervicomental angle | General |
Technique selection follows the anatomy rather than age or a procedure name alone. A systematic review found comparable patient-reported outcomes when SMAS-platysma and deep plane methods were assessed at a matched depth, although revision reporting varied between studies and follow-up periods.
Combined Procedures
- A neck lift may be added when platysmal banding or submental laxity is present.
- Blepharoplasty or a brow lift may address structures outside the scope of a face lift.
- Fat transfer may restore selected areas of age-related volume loss.
Combining procedures increases operative time, anaesthesia exposure and recovery requirements. The decision is made after examining the face and considering the patient's health rather than selecting every available procedure in advance.
The Consultation
The consultation is where the surgical plan is built. Dr Deon Weyers takes a focused medical history (smoking status, blood pressure control, diabetes, anticoagulant use, previous facial surgery), examines the skin quality and bone structure, and photographs the face from standardised angles for the clinical record. Patients are asked to describe what bothers them most in the mirror, and the surgeon maps those concerns to specific operative steps.
For patients who live outside Gauteng, or whose schedule does not allow a same-day visit, the practice offers an online consultation and photo review. Three photographs (front, left profile, right profile) taken in even daylight are submitted with a brief history, and the practice responds with an indicative surgical plan and a fee estimate before the patient commits to travelling for an in-person consultation.
Risks and Complications
Face lift surgery requires anaesthesia and carries the standard risks of an operation. The individual risk profile depends on health, smoking, surgical technique and whether other procedures are performed. Important complications include:
- Haematoma (a collection of blood under the skin), the most common early complication, reported in roughly 1 to 3 percent of patients in published series. It usually presents within 24 hours and requires prompt return to theatre.
- Infection, uncommon because the face has a rich blood supply, but seen more often when a face lift is combined with a neck lift or fat grafting.
- Skin slough, particularly behind the ear in smokers, where a small patch of skin may not survive and heals by secondary intention or requires a small revision.
- Nerve injury, most often to the great auricular nerve (numbness around the ear) which recovers, and very rarely to the temporal or marginal mandibular branches of the facial nerve (weakness of the forehead or lower lip) which can take months to settle and occasionally requires revision.
- Visible or thickened scarring, hypertrophic scarring behind the ear is the commonest; keloid scarring is rare but more frequent in patients with darker skin types, a particular consideration in the South African patient population.
- Asymmetry and contour irregularity, usually minor and addressed at follow-up.
Smoking is the single biggest modifiable risk factor. Nicotine causes small-vessel constriction that compromises the blood supply to the lifted skin flaps, and the practice requires patients to stop smoking at least four weeks before and four weeks after surgery. Patients on anticoagulants (warfarin, rivaroxaban, apixaban, or chronic aspirin for cardiac reasons) need a coordinated plan with their prescribing physician, and the practice will not operate until that plan is in writing.
Permanent facial nerve injury is generally reported in well under 1% in modern series, while temporary sensory changes or weakness are more common. Rapidly increasing pain, one-sided swelling or a new neurological symptom after surgery requires prompt clinical assessment.
The Operation
A full face lift usually requires general anaesthesia and takes several hours. Incision placement, tissue dissection and the degree of undermining are planned according to the lower face, jowls, neck and any additional procedure being performed.
The incisions are planned to sit in the shadow of the hairline at the temple, follow the natural crease in front of the ear, curve around the earlobe, and finish in the hair behind the ear. For a deep plane face lift the temporal incision is extended slightly higher. Dissection proceeds through the SMAS layer, the retaining ligaments are released where required, and the deeper tissues are repositioned upward and backward before the skin is redraped without tension and the excess trimmed.
Drains are usually placed and removed the next morning. The patient is fitted with a light compression garment before leaving theatre, and the head is kept elevated for the first 48 to 72 hours to reduce swelling.
Recovery and Downtime
Recovery occurs in overlapping phases. The extent of dissection, smoking, medical factors and any combined procedures can change the timetable.
| Phase | Time after surgery | What to expect |
|---|---|---|
| Early | Days 1 to 3 | Swelling and bruising peak, mild discomfort controlled with prescribed analgesia, drains removed at day 1. |
| Acute | Days 4 to 10 | Bruising fades from purple to yellow, sutures in front of the ear removed at day 5 to 7, sutures behind the ear and in the hairline at day 10. |
| Subacute | Weeks 2 to 4 | Most patients look presentable for social or office work by the end of week 2; light exercise resumed at week 3. |
| Late | Weeks 6 to 12 | Residual swelling resolves, scars begin to fade from pink to skin-toned, full exercise and lifting resumed at week 6. |
| Maturation | Months 3 to 12 | Final contour visible at three months, scar maturation continues for a full year. |
Patients who have combined their face lift with blepharoplasty or a brow lift should expect a slightly longer bruising phase around the eyes, and those who have had fat grafting should expect some of the grafted volume to reduce over the first three months before settling.
Many patients return to social activities within 2–3 weeks, but swelling can remain visible for several months. Strenuous exercise and heavy lifting are usually delayed for 4–6 weeks, and the final contour should not be assessed during the early healing period.
How Long the Results Last
A face lift repositions tissue at one point in time, but ageing continues. No fixed number of years can be promised because genetics, skin quality, sun exposure, weight changes and smoking all affect the rate at which laxity returns.
Factors that influence how long the result holds include skin quality (thicker, less sun-damaged skin ages more slowly from the lifted position), bone structure (stronger cheekbones and jaw support the deeper tissues for longer), and ongoing lifestyle (smoking, weight fluctuation, and sun exposure all accelerate return of laxity). Patients who have a second face lift a decade or more after their first do so with a shorter scar and an easier recovery, because the deeper plane has already been established.
Who Is a Good Candidate
Suitability is assessed from medical stability, tissue quality and the extent of descent rather than chronological age alone. Smoking should be stopped, chronic conditions should be controlled, and the patient must understand the limits of the operation, including the need for possible touch-up or revision treatment.
Younger patients in their early forties with early jowling often do very well with a mini face lift or a short-scar technique, while patients in their sixties and seventies with substantial skin laxity usually require a full face and neck lift and may combine this with blepharoplasty. The chronological age is less important than the biological age of the tissues and the patient's overall health.
Cost and What Affects It
A face lift quotation depends on the planned dissection, anaesthesia, facility and any additional procedures. Patients should request an itemised written quote that identifies what is included and what may attract an additional fee.
- Surgeon's fee, which reflects the technique (mini, standard, or deep plane) and the time required.
- Anaesthetist's fee, billed by time and the American Society of Anesthesiologists (ASA) grade of the patient.
- Facility fee for the accredited day hospital or overnight stay.
- Combined procedures, blepharoplasty, brow lift, fat grafting, or a neck lift each add their own theatre, anaesthetic, and facility time.
- Compression garment, prescribed medication, and follow-up visits, usually included in the practice's surgical package.
An indicative fee range is provided at the online consultation and photo review stage once the practice has photographs and a brief history, and a binding quotation follows the in-person consultation. Medical aid schemes in South Africa generally do not cover cosmetic face lift surgery, although they may cover portions of the procedure if it is being done for a documented functional reason, such as a symptomatic post-weight-loss skin excess.
Choosing a Surgeon in South Africa
Face lift surgery is one of the procedures the Health Professions Council of South Africa (HPCSA) requires to be performed by, or under the supervision of, a registered specialist surgeon. Patients should confirm that their surgeon is on the HPCSA specialist register and that the procedure will be performed in an accredited day hospital or theatre. Looking at before-and-after photographs of the surgeon's own patients (rather than stock images) is the single most useful step a prospective patient can take before committing.
The practice is located in Pretoria and treats patients from Johannesburg, Centurion, and elsewhere in Gauteng, as well as from neighbouring provinces and from across the SADC region for those travelling for the online consultation and photo review pathway.
Before operating, ask who will perform the surgery, who will administer the anaesthesia, which facility will be used, what follow-up is included and how complications or revision needs are handled. Confirm the final scope and costs in writing.
Common Mistakes to Avoid
- Treating a face lift as an eyelid, brow or skin-resurfacing procedure.
- Selecting a named technique without examining the underlying anatomy.
- Continuing to smoke during the perioperative period.
- Returning to strenuous exercise or heavy lifting too soon.
- Judging the final contour while swelling remains present.
- Skipping the consent discussion about combined procedures, scarring and possible revision.
Frequently Asked Questions
Will a face lift make me look “different”?
A face lift repositions your own soft tissue and does not change your underlying bone structure. The intended effect is to reduce lower-face and neck laxity while preserving the features that make you recognisable.
How long does a face lift last?
Results from a face lift can last up to 10–15 years, depending on skin type, lifestyle, and aftercare.
Who is an ideal candidate for a face lift?
Younger patients with early jowling are well suited to a mini face lift, while patients with substantial skin laxity and neck banding usually require a full face and neck lift. The chronological age is less important than the biological age of the tissues and the patient's overall health.
What are the main risks of a face lift?
The most common early complication is haematoma (around 1–3% in published series), which usually presents within 24 hours and is managed by prompt return to theatre. Facial nerve injury is rare but is the complication patients ask about most, and the surgeon will discuss the specific branches at risk during the consultation.
Does a face lift leave visible scars?
The incisions are placed in the hairline at the temple, in the natural crease in front of the ear, around the earlobe, and in the hair behind the ear. Once healed, they are difficult to see in conversation, although the patient will always know where they are. Scar maturation continues for a full year, and the practice provides silicone-based scar therapy from week three onward.
Can I have a face lift under local anaesthetic?
Some limited procedures may be performed using local anaesthetic with sedation. Full face lift surgery is most commonly performed under general anaesthesia, and the anaesthetist will confirm the appropriate plan during pre-operative assessment.
Is a face lift covered by medical aid in South Africa?
Face lift surgery is generally classified as cosmetic and is not covered by medical aid. A documented functional component, such as facial palsy, trauma-related deformity or symptomatic post-weight-loss skin excess, may be considered separately with supporting documentation.
When can I return to work and exercise?
Most patients return to office-based work after two weeks and to light exercise after three weeks. Vigorous exercise, heavy lifting, and contact sports are resumed at six weeks. Patients whose work is public-facing (acting, presenting, client-facing sales) often plan for three weeks of social downtime.
Can a face lift be combined with other procedures?
Yes. The most common combinations are face lift with blepharoplasty (eyelid surgery), with a brow lift, and with fat grafting to the midface. Combining procedures adds anaesthetic time and extends the recovery slightly, but it is often more efficient than staging the operations months apart.
How do I book a consultation?
Consultations can be booked through the practice's online consultation and photo review form, or by calling 011 875 1694 during office hours. Patients from outside Gauteng are encouraged to use the photo review pathway first so that an indicative plan and fee range are available before travelling.
Also Read:
This article provides general information about face lift surgery and is not medical advice for an individual. Suitability, risks, scarring, recovery and expected changes require assessment by a HPCSA-registered specialist surgeon. Outcomes and recovery vary between individuals. If you are considering this procedure, arrange an individual consultation through DW Skin & Body or call 011 875 1694.
