A facelift (rhytidectomy) is a surgical procedure that lifts and repositions the soft tissues of the lower face and neck to address jowling, mid-face descent, and neck laxity. Dr Deon van der Walt is a board-certified plastic surgeon based at the Dr Deon practice in Chartwell, Johannesburg, where she assesses and treats patients from across the broader Fourways, Lanseria, and Sandton catchment. Her training pathway includes a fellowship with the South African Society of Plastic Surgeons, and her HPCSA registration is verifiable through the public register at hpcsa.co.za.
This article covers what a facelift involves, who is a good candidate, the recovery timeline, and the risks and complications, with the level of detail required to have an informed first conversation at consultation. Patients considering a facelift in the Chartwell, Lanseria, or northern Johannesburg area can book a preliminary online consultation and photo review or call the practice on 011 875 1694 to arrange a face-to-face assessment.
What a facelift does, and what it does not
A facelift addresses the lower two thirds of the face: the jawline, the jowls, the area around the mouth, and the neck. It does not lift the brow, change the position of the eyes, or alter the skin surface texture in the way that a laser or chemical peel does. Many patients combine a facelift with a brow lift, eyelid surgery (blepharoplasty), or fat grafting to address the upper face at the same time, but each of those is a separate procedure with its own consent and recovery considerations.
The surgery itself works on the SMAS layer, the fibrous sheath under the skin that supports the facial fat compartments. By lifting and re-draping the SMAS rather than pulling the skin tight, a surgeon can restore the underlying contour of the cheek and jawline in a way that holds up over time. Skin is then re-draped without tension, which is what allows the scar to heal as a fine line in the hairline and around the ear rather than a stretched, visible scar in front of the ear.
The most important thing to understand before any consultation is that a facelift does not stop the clock. It resets the visible position of the soft tissues to a younger baseline, after which normal ageing continues. Most patients see a meaningful result for roughly 7 to 10 years, with individual variation based on skin quality, sun exposure, smoking history, and weight stability.
Types of facelift Dr Deon performs
Not every patient needs the same operation. The right choice depends on where the ageing sits, the elasticity of the skin, and what the patient is willing to trade off in terms of scar length and downtime. The main variations Dr Deon offers at her Chartwell practice are summarised below.
| Technique | What it addresses | Typical scar | Indicative operative time |
|---|---|---|---|
| SMAS facelift (standard) | Jowls, lower face, neck laxity | Pre-auricular, around ear, into hairline | 3 to 5 hours |
| Deep-plane / extended SMAS | Jowls, deep nasolabial folds, mid-face descent | Same as standard, sometimes slightly longer | 4 to 6 hours |
| Mini facelift (short-scar) | Early jowling in younger patients | Short scar in front of the ear only | 2 to 3 hours |
| Neck lift (often combined) | Platysmal bands, submental fat, neck laxity | Submental incision plus ear extension | 1.5 to 3 hours when combined |
| Revision facelift | Secondary procedure after prior surgery elsewhere | Variable, depends on prior scar | 4 to 7 hours |
The deep-plane variation is not appropriate for every patient. It is generally reserved for patients with heavier mid-face descent and deeper nasolabial folds, where releasing the ligaments that hold the SMAS down gives a more durable lift. The mini or short-scar approach suits patients in their late 30s to early 50s with early jowling and good skin elasticity, where a full scar would be excessive.
Who is a good candidate
The decision to operate is clinical, not aesthetic. Dr Deon uses a structured assessment at the first consultation that covers skin quality, underlying bone support, soft-tissue laxity, medical history, and the patient’s own goals. A patient who is a strong candidate for a facelift typically fits the following profile.
- Age range 45 to 70 is most common, although younger patients with significant weight loss or hereditary neck laxity are also appropriate.
- Good general health, with no uncontrolled cardiovascular disease, no active smoking, and a stable weight for at least 6 to 12 months.
- Realistic expectations: a facelift improves contour, not identity, and the goal is to look like a rested version of the patient rather than a different person.
- Skin with enough residual elasticity to re-drape over the repositioned SMAS; very thin, sun-damaged skin has a higher risk of poor scar quality.
- Willingness to accept the downtime: roughly 2 weeks before most social engagements are comfortable, and 6 to 8 weeks before strenuous exercise.
Patients who are actively smoking or vaping nicotine are asked to stop at least 4 weeks before surgery. Nicotine causes vasoconstriction and impairs wound healing, and the rate of flap complications in active smokers is high enough that most plastic surgeons will not operate on a current smoker for an elective facelift.
The consultation and surgical planning
The first consultation runs for 45 to 60 minutes and covers medical history, current medications, prior surgery, and the patient’s specific concerns. Dr Deon photographs the face from a standardised set of angles (front, oblique, lateral, and close-ups of the perioral and submental areas) and uses these to plan the procedure. The consultation is also where the operative plan is matched to the patient’s anatomy, including whether adjunct procedures such as blepharoplasty, brow lift, fat grafting, or a skin-resurfacing procedure should be done at the same time.
Patients are given a written quote, a consent form, and a pre-operative instruction sheet at the end of the consultation. The quote lists the surgical fee, the anaesthetist’s fee, the facility fee, and any implants or adjunct materials separately, so there is no ambiguity about what is included. A second consultation is offered at no charge if the patient wants to revisit the plan after thinking it over.
The day of surgery
Facelifts at the Dr Deon practice are performed under general anaesthetic in an accredited day-clinic or hospital theatre in the Chartwell / Fourways area. The patient is admitted on the morning of surgery, marked in the upright position before induction, and the operation itself takes between 3 and 6 hours depending on the technique and whether adjunct procedures are combined.
After the procedure, the patient spends one to two hours in recovery before transfer to the overnight ward. A light head-bandage and small drains are routine; the drains are usually removed the following morning. Most patients stay in the facility overnight and are reviewed the next day before being driven home by a responsible adult. A responsible adult must stay with the patient for the first 24 to 48 hours.
Recovery timeline
Recovery from a facelift is gradual rather than abrupt. The visible swelling and bruising settle in stages, and the final contour is not really apparent until the 3 to 6 month mark. The table below gives a realistic week-by-week outline for patients planning time off work and social commitments.
| Time after surgery | What to expect |
|---|---|
| Days 1 to 3 | Swelling and bruising at their peak; head elevated; soft diet; drains out by day 1 or 2. |
| Days 4 to 7 | Sutures or staples removed around day 5 to 7; bruising starting to fade. |
| Weeks 2 to 3 | Most patients feel comfortable returning to desk-based work and light social outings; residual swelling settles. |
| Weeks 4 to 6 | Light exercise resumed; most visible signs of surgery have resolved. |
| Weeks 6 to 8 | Strenuous exercise, heavy gym sessions, and contact sports resumed with clearance. |
| 3 to 6 months | Final contour, scar maturation, residual numbness resolving. |
| 12 months | Scar fully mature; final result assessed for any touch-up considerations. |
Patients are seen for follow-up at day 1, day 5 to 7, week 3, week 6, month 3, and month 12. Photographs are repeated at the month 3 and month 12 visits so the result can be tracked against the pre-operative images.
Risks and complications
Any surgical procedure carries risk, and a facelift is no exception. The complication rates quoted in published plastic surgery literature vary by technique and by patient population, but the categories of complication are well established. The most important are summarised below, with the approximate published incidence where it is consistently reported.
| Complication | Approximate incidence | Notes |
|---|---|---|
| Hematoma (collection of blood under the skin) | 1 to 3 percent in published series | Higher in men and in patients on anticoagulants; may require return to theatre for evacuation. |
| Seroma (fluid collection) | Less than 1 to 2 percent | Usually resolves with drainage in clinic. |
| Nerve injury (temporary, affecting smile or lower lip) | Up to 1 to 2 percent | Most cases recover over weeks to months as the nerve recovers from traction. |
| Permanent facial nerve injury | Less than 0.5 to 1 percent | Rare; higher risk in revision surgery and in deep-plane dissections. |
| Poor scar or hypertrophic scarring | 1 to 3 percent | More common in patients with a personal or family history of keloid scarring. |
| Skin flap compromise (healing problem at the edge of the lifted skin) | 1 to 2 percent, higher in smokers | Can lead to wound healing problems that need dressings or revision. |
| Infection | Less than 1 percent in clean facial surgery | Routine prophylactic antibiotics are used. |
| Asymmetry or under-correction | Variable | Sometimes a planned touch-up procedure is appropriate once healing is complete. |
The single biggest modifiable risk factor is smoking. Patients who smoke have a meaningfully higher rate of skin-flap compromise and poor wound healing, which is why active smoking is a contraindication to elective facelift surgery at most practices including Dr Deon’s. The second is blood-pressure control, since a post-operative spike in blood pressure is one of the recognised precipitants of haematoma formation.
Cost and what is included
The cost of a facelift is presented as a package rather than a single number, and it is worth understanding what is and is not included before comparing quotes. A facelift quote from a board-certified plastic surgeon in the Johannesburg area typically comprises four separate line items, and the table below shows what each covers and the order-of-magnitude range a patient should expect.
| Component | What it covers |
|---|---|
| Surgeon’s fee | The operative procedure, follow-up visits, and any in-clinic revisions within the first 12 months. |
| Anaesthetist’s fee | Time-based fee for the anaesthetist covering pre-op assessment, the anaesthetic itself, and recovery. |
| Facility fee | The theatre time, day-bed or overnight ward stay, drugs, consumables, and dressings. |
| Adjuncts (if any) | Implants, fat-grafting kits, compression garments, prescription medications on discharge. |
Medical aid coverage of a facelift is the exception rather than the rule. Most South African medical aids classify a facelift as a cosmetic procedure and do not reimburse it. Where there is a documented functional component, such as a significant neck deformity following weight loss, partial coverage may apply; this is assessed on a case-by-case basis and discussed with the practice’s billing coordinator before booking.
How to prepare
Preparation in the 4 weeks before surgery has a measurable effect on the recovery. The standard pre-operative checklist at the Dr Deon practice covers the following items.
- Stop smoking and vaping nicotine for at least 4 weeks before and 2 weeks after surgery.
- Avoid aspirin, ibuprofen, and other non-steroidal anti-inflammatories for 10 to 14 days before surgery, unless prescribed by another doctor.
- Stop herbal supplements such as arnica, ginkgo, garlic, and omega-3 fish oil at high dose 10 to 14 days before, as they affect bleeding.
- Arrange transport home and a responsible adult at home for the first 24 to 48 hours.
- Fill any pre-operative prescriptions before the day of surgery so they are ready on discharge.
- Prepare a recovery area at home: extra pillows for head elevation, easy meals, and a cooler pack ready in the freezer.
Choosing a facelift surgeon in the Chartwell and Lanseria area
Facelift surgery is a regulated procedure in South Africa. The minimum credentials to look for in a surgeon are registration with the HPCSA as a specialist plastic and reconstructive surgeon, and active membership of the South African Society of Plastic Surgeons (the body that administers the MMed or equivalent fellowship examination in plastic surgery). Both of these are publicly verifiable on the HPCSA website and on the society’s member directory.
Beyond the credential check, the practical questions to ask at consultation are: how many facelifts does the surgeon perform per year, what techniques do they offer, will they show you before-and-after photographs of patients with a similar starting anatomy, and what their revision policy is if the result needs adjustment. A surgeon who is comfortable answering these in detail is usually a surgeon who has performed the operation often enough to have a clear protocol for the common scenarios.
For patients in the Chartwell, Lanseria, Fourways, and broader northern Johannesburg area, the Dr Deon practice is based in Chartwell. The practice runs scheduled operating lists at accredited day-clinic and hospital facilities in the immediate area, so travel on the day of surgery is short. Parking and overnight-stay arrangements are arranged through the practice coordinator before the day of admission.
Frequently asked questions
How long does a facelift procedure take?
A standard SMAS facelift takes 3 to 5 hours. A deep-plane or extended facelift takes 4 to 6 hours. Adding a neck lift, blepharoplasty, or fat grafting adds 1 to 2 hours of operative time on top of the base procedure. The time spent under anaesthetic is the operative time plus the time required for waking up in recovery, which is typically another 1 to 2 hours before transfer to the ward.
How long is the recovery after a facelift?
Most patients are back to desk work and light social activity at 2 to 3 weeks. Light exercise resumes at 4 to 6 weeks. Strenuous exercise is cleared at 6 to 8 weeks. The final result is assessed at 3 to 6 months and again at 12 months. Throughout this period the scar matures, residual swelling resolves, and any temporary numbness of the cheeks or ears settles.
How long do facelift results last?
The repositioned soft tissues hold their lift for roughly 7 to 10 years on average, with individual variation based on skin quality, sun exposure, smoking history, and weight stability. The face continues to age normally from the new baseline rather than stopping. Patients who maintain a stable weight, protect their skin from sun damage, and do not smoke tend to keep their result at the longer end of that range.
Will there be visible scarring?
The scars sit in the hairline at the temple, in the crease in front of the ear, around the earlobe, and back into the hairline behind the ear. In most patients these heal as fine lines that are not visible at conversation distance. Patients with a personal or family history of keloid scarring have a higher rate of thicker scars, and this is discussed in detail at the consultation before booking.
What anaesthetic is used?
Facelifts are performed under general anaesthetic. The anaesthetist reviews the patient before surgery, administers the anaesthetic, monitors throughout, and is responsible for the immediate recovery period. The anaesthetist’s fee is a separate line item in the surgical quote and is itemised so the patient can see what is being charged.
Does a facelift address the neck as well?
In most patients, yes. A neck lift is often combined with the facelift to address platysmal bands, submental fat, and lax skin under the chin. The neck component adds 1.5 to 3 hours to the operative time and uses a small incision under the chin in addition to the ear incisions. Not every patient needs a neck lift, and Dr Deon assesses this at consultation based on the degree of platysmal banding and skin laxity under the chin.
Can a facelift be combined with other procedures?
Yes. Facelifts are commonly combined with blepharoplasty (eyelid surgery), brow lift, fat grafting to the cheeks or temples, and skin resurfacing procedures such as laser or chemical peel. Each combination is planned individually based on the patient’s anatomy, the time under anaesthetic the patient is willing to accept, and the recovery tolerance. Combining procedures does extend the operative time and can extend the recovery, but it avoids a second anaesthetic.
Is a facelift covered by medical aid?
Most South African medical aids classify a facelift as a cosmetic procedure and do not reimburse it. Where there is a documented functional component, such as a significant neck deformity following major weight loss, partial coverage may apply; this is assessed case by case with the practice’s billing coordinator before booking.
Dr Deon is based in Chartwell and sees patients from across the northern Johannesburg area, including Lanseria, Fourways, Douglasdale, and Sandton.
Also Read:
- Affordable Private Facelift Surgeon in Chartwell
- Reputable Board Certified Facelift Surgeon in Douglasdale for Men & Women
This article is for general information and does not constitute medical advice. Individual circumstances vary, and the only way to get reliable guidance specific to your situation is a face-to-face consultation with a board-certified plastic surgeon. Surgical outcomes depend on the patient’s starting anatomy, tissue quality, and adherence to pre- and post-operative instructions.
