Incisions are made above the hair line at the temples and extend in a discrete line down the front of the ear, or just along the edge of the cartilage at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear and backwards into the lower hair-bearing scalp. Occasionally, it may be necessary to make a small incision under the chin.

A facelift is carried out in a hospital and most techniques require a general anaesthetic. It is possible to carry out modifications of the procedure – e.g. the mini-facelift – under local anaesthetic and intravenous sedation but the patient would still be advised to spend ~1 night in the hospital unless rigorous local supervision arrangements are in place with a competent 24 hour chaperone and pre-approved with both the surgeon and hospital. The procedure, although long (3.5-5 hours), can be combined with other operations of all sorts. The neck can be further refined / tightened by a small incision under the chin, then some fat removal followed by joining together the platsyma muscles in the midline of the neck (technically known as a submental lipectomy and platysmal plication) and this can add a further ~ 1 hour to the procedure. Other common procedures sometimes performed together would be a brow lift and an eyelid reduction with or without a chemical peel. According to the individual case, other possible procedures performed with a facelift are malar (cheek bone) and chin augmentation and lip enhancement.  This is obviously to maximise the benefit of one general anaesthetic and condense the period of ‘down-time’ or recovery time outside of your social and professional network.

A skin-only facelift is where only the skin is lifted following separation from the underlying platysma muscle – while this may work occasionally in the right patient, this technique has been largely abandoned, as it probably does not last as long and the scars may stretch and become more visible.

After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend towards the neck / chest over time and changes colour as it resolves. Discomfort is usually mild and can be controlled with Paracetamol. It is normal for there to be some numbness of the skin of the cheeks and ears. This will usually disappear in a few weeks or months. Anyone undergoing facelift surgery must appreciate that it carries the small risk of weakness of muscles in the face which, if it occurs, is usually temporary but may be permanent. Part of the reason for the growing popularity of the procedure is that such complications are thankfully uncommon and the modern techniques are more predictable. It is better to keep the head elevated for a couple of days to reduce swelling. Avoid strenuous activity, saunas and massage for at least two weeks.

At the beginning your face will look a little puffy and may feel rather strange and stiff. Scar formation at the line of incision is a normal outcome of facelift surgery. The scars can be very well hidden by women with their hair and disc shaped earrings so that they should be able to resume work and social activities within a couple of weeks. Camouflage make-up can be helpful in masking bruising and the skin will be stable enough for make-up 7-10 days after surgery. Only make-up which is non-perfumed should be used – and which you have used/tested before without any adverse skin reaction. To conceal pink scars in the initial healing phase, a green pigment base powdered make-up can be used with skin tone foundation as the next layer.

Men find it more difficult to disguise the scars which can look pink for weeks – months and will need to shave their beard somewhat closer to the ear in front and also behind the ear where the skin has been lifted. Pink scars become pale again over 4-12 months but this process can be accelerated by the use of green light lasers to close the extra capillary vessels in the fresh scar wound – ask your surgeon if they offer this service / where it can be provided before proceeding with surgery if pink scars may concern you.

The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound. To keep the normal position of the hairline as the skin is lifted, it can be most cosmetic to have an additional scar immediately along the temporal hairline – it is helpful to discuss with your surgeon if you prefer a higher hairline position after surgery rather than this additional scar.

On the whole, scars are not “mature” and continue improving for at least one year after surgery. Sometimes scars may have to be revised if they are thick or visible. In a few patients with poorly elastic skin it may be necessary to tighten the face after six months or so.

Face-lifts have only achieved popularity because they are generally safe and largely predictable. As with any surgery, face-lifting is subject to complications which, although uncommon, do occur and your surgeon should have informed you about:

Bleeding / haematoma (collection of blood): this complication applies to almost any surgery. It generally occurs within the first 12 hours after surgery and usually needs a return visit to the operating theatre to drain any collection of blood and attain control of any bleeding points under general anaesthesia. The risk of this is approximately in the order of 1 in 100.

Wound infection: it is rare to have infection following a facelift, largely because antibiotics are used before surgery and the anatomical area has a great natural blood supply. If it occurs it is treated with further antibiotics and appropriate wound care.

Poor scarring: some individuals may develop thick and red scars, so-called hypertrophic scarring. Very rarely this may progress to keloid scars. These unfavourable scars can be treated with steroids and sometimes may have to have surgical or laser revision. It is advisable to avoid vigorous massage to new scars for 8 weeks, as it takes time for skin to develop adequate strength to withstand pressure without stretching.

Hair loss: this is rare and may occur as a result of tension swelling in the scalp or as a general reaction to the trauma of surgery – more so with repeated facelifts. Wound infection can also cause temporary hair loss in the vicinity of the wound. Fortunately, in most cases, hairloss is reversible but may take many months.

Numbness: follows most surgical procedures and gradually decreases with time. Sometimes, small areas of the face / ear lobes may develop permanent numbness – in the latter case, there is no remedy.

Bruising: this is a normal sequel to surgery and, therefore, is not a complication. The duration of bruising can vary from two to twelve weeks and depends on the extent and thickness of skin, among other factors.

Injury to the facial nerve: facial nerve controls the movement of muscles of facial expression. Injury to one or more of the nerve branches will result in paralysis the muscles of facial expression. Most injuries are caused by swelling or bruising around the nerve and are therefore temporary. Permanent injuries are quite rare.

Poor healing: some areas of facelift scars, especially behind ears are subjected to more tension and may receive poorer blood supply to its edges. This is particularly so in smokers and ex-smokers. It is very important to cease smoking prior to surgery for this reason alone. If healing is delayed, it may take up to eight weeks for the wound to close. Later, the scar may need revision.

Skin tethering: in some areas, e.g. in the neck, skin is attached to the underlying immature scar and this has a tethering effect. In most cases this problem corrects itself with time and it may take a year.

Asymmetry: most patients have some facial asymmetry and most of these cannot be corrected by face-lifting – a perfectly symmetrical result can never be guaranteed in any operation performed on both sides of the body. Any concerns about asymmetry should be discussed with your surgeon.

A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to always be there, in that you should not look as old as you would have done if it had not been carried out. You continue to age every year and some patients go on to choose to have another facelift about 10 years later. Thus, allowing subtle shifts in rejuvenation such that continue to look more youthful than your true age (rather than having major shifts in appearance).

A facelift is a skilled procedure and it is wise to choose a surgeon who has undergone a full training programme which includes facial cosmetic surgery. These surgeons will be on the Specialist Register at the General Medical Council and may be a specialist Facial Surgeon (Maxillo- Facial) – a specialist in facial surgery (both hard and soft tissue; reconstructive and cosmetic), Otolaryngology Head & Neck Surgeon (‘ENT’) – operating on the ears, nose, throat, sinuses or face – or a general Plastic Surgeon – and may operate on many body sites such as the abdomen, breasts, legs, groin, hands, arms and faces. Each individual surgeon may have an area of special interest which you can ask about.

There are members of the European Academy of Facial Plastic Surgery (AFPS) in the UK and the British Association of Aesthetic Plastic Surgeons (BAAPS) who are on the GMC Specialist Register and have a special interest in cosmetic surgery. You can ask if they are registered on the Royal College of Surgeons of England register of Certified Cosmetic Surgeons. It is important to consider not only your surgeon’s qualifications and training, but also – ask what anatomy they spend most of their week operating on! It is arguably a productive consultation if your surgeon ultimately directs you to another specialist whom they know to be sub-specialised in your area of concern e.g. another more generalised surgeon may choose to refer you to a facial cosmetic surgery specialist if you have an issue which requires revision surgery etc.