Short answer
A facelift (rhytidectomy) is surgery that lifts and tightens the deeper tissues of the lower face and neck and removes surplus skin.12 It may address jowls, sagging cheeks, deep folds along the jawline and loose neck skin. It does not treat fine lines, sun damage, skin colour changes or lost volume on its own, and it does not stop ageing.2 Which technique, if any, makes sense depends on the cause of the change, your skin, your health and your goals, so individual assessment matters.
Decision snapshot
| Question | Snapshot |
|---|---|
| What it is | Surgical lift of the lower face and often the neck, through incisions around the ears |
| Anaesthesia | General anaesthesia, or local anaesthesia with sedation |
| Operating time | About 2 to 6 hours, longer if combined with other procedures |
| Hospital stay | Often one night |
| Visible bruising | At least 2 weeks |
| Final result | Up to 6 to 9 months |
| Most common serious complication | Haematoma (a collection of blood under the skin) |
On this page
- What a facelift is
- What may be causing the concern
- Who may be considered
- Alternatives
- Procedure and anaesthesia
- Recovery and results timeline
- How long results last
- Pain and comfort
- Risks and complications
- How strong is the evidence?
- SMAS, deep plane and mini lifts
- Cost drivers
- Frequently asked questions
- Sources
What a facelift is and how it works
A facelift works on two layers. Beneath the skin lies the SMAS (superficial musculoaponeurotic system), a sheet of fibrous tissue and muscle that supports the lower face. Most modern facelifts tighten or reposition this layer, sculpt or redistribute fat where needed, then redrape the skin and trim the excess.25
Incisions usually start in the temple hairline, run in front of and around the ear, and end in the lower scalp; a small cut under the chin may be added for the neck.15 Once healed, scars are generally hidden by the hairline and the contours of the ear, but they are permanent.2
What may be causing the concern
An older-looking lower face rarely has a single cause. The ASPS (American Society of Plastic Surgeons) lists thinning skin, loss of facial fat, gravity, sun damage, smoking, heredity and stress as contributors.3 A facelift addresses only some of these.
- Tissue descent and laxity: the SMAS and skin loosen, forming jowls and a softer jawline. This is what a facelift treats.
- Volume loss: fat and bone change with age, hollowing the cheeks and temples. Lifting alone does not replace volume.3
- Skin quality: sun damage, fine lines and pigment changes sit in the skin itself.2
- Neck fat and muscle bands: may need a neck lift rather than, or as well as, a facelift. See neck lift.
- Weight change: repeated gain and loss alters facial shape and skin.2
What it may change
- Sagging in the cheeks and jowls along the jaw
- Excess skin at the lower jaw and, with a neck lift, the neck
- Depth of the folds from the nose to the corners of the mouth, to a degree2
Who may be considered
A clinician may consider a facelift for a healthy adult whose main concern is laxity of the lower face and neck, who does not smoke, and who understands what the operation will and will not change. Suitability depends on skin, bone structure, medical history and medicines as much as on age.2
Who may not benefit or may face additional risk
- Smokers: smoking greatly raises the risk of poor healing, haematoma and skin loss.2
- Men: in 11,300 facelift patients, men had about four times the relative risk of haematoma.7
- People on blood thinners or certain supplements such as aspirin, ibuprofen, ginkgo or fish oil, which raise haematoma risk.2
- Poorly controlled diabetes or high blood pressure: higher risk of poor healing, haematoma and heart complications.2
- People with mainly skin-quality or volume concerns, who may gain less than expected.
When a responsible clinician may advise against it
When a clotting disorder is present, which Mayo Clinic says makes surgery not possible; when someone will not stop smoking or relevant medicines; when expectations cannot be met; or when the concern is mainly one a facelift does not treat.2 The NHS also advises not rushing the decision.1
Alternatives
| Option | What it may do | Main trade-off |
|---|---|---|
| Neck lift | Targets loose neck skin and fat under the chin | Does not lift the cheeks |
| Fat transfer or filler | Replaces lost volume | Does not remove loose skin |
| Energy-based skin tightening | Mild tightening of early laxity | ASPS states minimally invasive treatments cannot match surgical results |
| Laser, peels, IPL | Improve skin texture and pigment | No lift |
Related non-surgical pages: Ultherapy Prime, dermal fillers and when surgery may be better.
No treatment is a legitimate option
Facial ageing is not a medical problem that needs correcting. Daily sun protection and a healthy lifestyle remain worthwhile whatever you decide.6
Procedure, preparation and anaesthesia
Preparation includes a review of medical history, medicines and supplements, previous cosmetic treatments and goals, plus photographs. Blood thinners, some supplements and hormone replacement therapy may need to be stopped about three weeks beforehand, on the surgeon’s advice.2
The operation is done under general anaesthesia or intravenous sedation with local anaesthesia.15 The NHS gives 2 to 3 hours and Mayo Clinic 3 to 6 hours, depending on extent and added procedures.12 A pressure bandage is applied, a small drain may sit behind the ear until the next day, and most people stay one night.12
Recovery and results timeline
| Time after surgery | What is typical |
|---|---|
| First 24 hours | The period when haematoma usually forms; head raised; a drain, if used, may be removed the next day |
| First days | Pain, swelling, bruising, numbness; no driving for several days |
| 7 to 14 days | Stitches removed; bruising visible for at least 2 weeks |
| 2 to 4 weeks | The NHS gives 2 to 4 weeks for full recovery; strenuous activity, saunas and massage avoided for at least 2 weeks |
| 6 weeks | Facial stiffness usually settled; hair colouring possible |
| 2 to 3 months | The face feels close to normal |
| 6 to 9 months | Final result visible |
Numbness and swelling can persist for weeks or months, and scars, skin colour changes and bruising fade over several weeks.1 Mayo Clinic advises keeping incisions out of the sun for three weeks and then using SPF 30 or higher.2 More detail in facelift recovery.
How long results last
Results last for years but are not lifelong. The face keeps ageing after surgery and the skin may sag again over time.2 ASPS notes that daily sun protection and a healthy lifestyle help extend results, and that one operation does not always achieve the optimal result.6 We did not find a reliable figure for how many years a facelift lasts, or reliable head-to-head data on whether one technique lasts longer than another, so we do not give one.
Pain and comfort
You are asleep or deeply sedated during the operation. Afterwards, expect pain, tightness, swelling and numbness; prescribed pain medicine, a raised head and cool packs are the usual measures.2 The face and mouth may feel stiff for up to about six weeks, and low mood for a few days is common.1 Pain that is severe and on one side only is not normal discomfort; see the warning box below.
Risks and complications
Expected temporary effects: swelling, bruising, numbness, stiffness, tightness and some pain; a raised hairline or sideburns and reduced hair growth at the temples.1
Recognised complications:
- Haematoma: the most common complication, usually within 24 hours, and needs prompt treatment to protect skin.2 In a prospective cohort of 11,300 patients, haematoma needing an emergency visit, admission or reoperation within 30 days occurred in 1.1%.7
- Temporary facial nerve weakness: pooled rates were highest for the high lateral SMAS (1.85%) and composite (1.52%) techniques.8 Recovery may take months to a year.2
- Scarring and hair loss around the incisions, asymmetry including earlobe position, and healing problems.14
- Infection: 0.3% in the large cohort; combining procedures and a BMI (body mass index) of 25 or more raised infection risk.7
Rare serious complications: permanent facial nerve injury, skin loss from reduced blood supply, and deep vein thrombosis with possible pulmonary embolism.24 Overall, 1.8% of facelift patients had a major complication within 30 days, rising to as much as 3.7% when combined with other procedures, against 1.5% for facelift alone.7
How strong is the evidence?
| Claim | Vireon assessment | What supports it | Important limitation |
|---|---|---|---|
| Major complications within 30 days are uncommon (about 2%) | Moderate | Prospective cohort (CosmetAssure database), 11,300 patients7 | Captures only events needing emergency care, admission or reoperation |
| Men have higher haematoma risk | Moderate | Relative risk about 3.9 in the same cohort7 | Registry data; reasons not explored |
| Complication profiles differ by SMAS technique | Limited | Meta-analysis of 183 studies8 | Only abstract-level figures reviewed; permanent injury rates not reported |
| Permanent facial nerve injury rate | Uncertain incidence | Described as rare; did not differ between techniques28 | Rates not reliably reported |
| Smoking raises wound-healing risk | Limited | Mayo Clinic guidance2 | Not identified as a risk factor in the 30-day cohort, where 4.8% smoked7 |
| Deep plane lasts longer than SMAS techniques | Insufficient | No head-to-head long-term data in the sources reviewed | Absence of comparative data is not evidence of no difference |
The figures above come from a prospective registry cohort and a pooled analysis of published studies. Neither measures how natural a result looks or how long it lasts, and none of the sources reviewed reported long-term comparative follow-up. The meta-analysis authors themselves concluded that technique should be chosen on the quality of results rather than on complication profile.8
SMAS, deep plane and mini lifts
- SMAS plication or imbrication: the SMAS is folded or trimmed and stitched, without lifting it as a separate flap.
- SMAS flap and high lateral SMAS: the SMAS is raised as its own layer and repositioned.
- Deep plane: dissection goes beneath the SMAS so skin and SMAS move together. Pooled major haematoma was 1.22% with this approach.8 See deep plane facelift.
- Mini (limited-incision) lift: shorter incisions, usually reserved for people with less skin laxity because the effect is less pronounced.5
Red flags include a technique name presented as the answer before your face has been examined, no discussion of smoking or medicines, unproven add-ons such as “stem cell facelifts” (which ASPS describes as of unproven benefit), and no plan for the first 24 hours.3 See medical travel red flags.
Cost drivers and what a quote should include
Cost depends on the extent of surgery (mini, full face, neck), added procedures such as eyelid surgery or fat transfer, operating time, the surgeon’s and anaesthetist’s fees, the facility, the overnight stay and follow-up. A clear quote should state:
- Exactly which procedures and technique are planned
- Anaesthesia, facility, overnight stay, garments, drains and medicines
- Follow-up visits and stitch removal
- Who treats a haematoma or other complication, and at whose cost
See reading a treatment quote.
If you are travelling for treatment
- Assessment of skin, neck and medical risk factors needs an in-person examination.
- Haematoma usually develops within 24 hours, so stay close to the treating team at least through that period, and until stitch removal at 7 to 14 days if possible.12
- Ask about flying and clot risk; see DVT and travel.
- Arrange follow-up at home; Mayo Clinic describes follow-up visits over two months.2
Questions worth asking a clinician
- Which of my concerns will a facelift address, and which will it not?
- Which layer will you work on, and why that technique for me?
- What is your own rate of haematoma and facial nerve weakness?
- Which medicines and supplements should I stop, and when?
- Where will the scars be, and how will my hairline change?
- Who sees me in the first night and in the following weeks?
Frequently asked questions
Does a facelift hurt?
There is some pain, tightness and numbness afterwards, usually managed with prescribed medicine and cool packs.2 Severe one-sided pain is a warning sign, not normal recovery.
How long until I look normal?
ASPS says most people are presentable to the public within 10 to 14 days, though the face can take two to three months to feel back to normal, and the NHS says the final result takes 6 to 9 months to appear.16
When can I drive, work and exercise?
Driving is usually avoided for several days, many return to work within two to four weeks, and strenuous activity waits at least two weeks; your surgeon will advise on your case.1
How long does a facelift last?
Results last years but not for life, because ageing continues.2 We found no reliable figure to give.
Is a mini facelift a smaller version of the same result?
Not quite: it uses shorter incisions and gives a less pronounced lift, so it tends to suit people with milder laxity.5
Will the scars show?
Scars are permanent but usually sit in the hairline and around the ear; raised scars are rare.2
Bottom line
A facelift repositions tissue; it does not renew skin or restore volume, and it does not stop the clock. The most predictable risk sits in the first 24 hours, and the most controllable ones, smoking and medicines, sit with preparation. The technique name matters less than whether the plan matches the actual cause of the change.
Related reading
Sources
- NHS. Facelift (rhytidectomy). NHS website; reviewed 2023. https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/facelift/. Accessed 5 November 2026.
- Mayo Clinic. Face-lift. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/tests-procedures/face-lift/about/pac-20394059. Accessed 5 November 2026.
- American Society of Plastic Surgeons. Facelift Surgery. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift. Accessed 5 November 2026.
- American Society of Plastic Surgeons. Facelift risks and safety. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift/safety. Accessed 5 November 2026.
- American Society of Plastic Surgeons. Facelift procedure steps. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift/procedure. Accessed 5 November 2026.
- American Society of Plastic Surgeons. Facelift results. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/facelift/results. Accessed 5 November 2026.
- Gupta V, Winocour J, Shi H, Shack RB, Grotting JC, Higdon KK. Preoperative Risk Factors and Complication Rates in Facelift: Analysis of 11,300 Patients. Aesthetic Surgery Journal; 2016;36(1):1–13. DOI: 10.1093/asj/sjv162. https://academic.oup.com/asj/article-abstract/36/1/1/2613999. Accessed 5 November 2026.
- Jacono AA, Alemi AS, Russell JL. A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthetic Surgery Journal; 2019;39(9):927–942. DOI: 10.1093/asj/sjz045. https://academic.oup.com/asj/article-abstract/39/9/927/5320438. Accessed 5 November 2026.
Article history
- — First published.