What a facelift does, how it is performed, and what to expect.

Facial aging combines sagging soft tissue, loss of volume and changes in the skin surface.² A facelift addresses the sagging. Beneath the skin and fat lies a layer of fibrous tissue and facial muscle called the superficial musculoaponeurotic system, or SMAS, and most modern facelifts reposition this layer rather than relying on skin tension.¹ Textbooks describe the SMAS as the structural layer that can hold a lift, while pulling on skin alone risks a tight, unnatural look and poor scars.²

A facelift mainly improves the jowls, jawline, lower cheeks and neck.^1,5 It has little effect on skin texture, elasticity or discoloration, and deep lines around the mouth need skin resurfacing.^1,2 Lost volume is often restored at the same time with fat grafting, and a drooping outer brow calls for a brow lift rather than eyelid surgery.^2,8

Facelift is one of the most commonly performed aesthetic operations, and it is often combined with other procedures. In a national registry, patients had an average of 2.3 procedures in the same operation, most often including eyelid surgery.^4,9

Typical candidates are healthy adults with sagging of the lower face and neck. In the national registry the average age was 60, and 98% of patients were in the two healthiest anesthesia risk classes.⁴ Published series include patients from their 30s to their 80s.¹⁰

Several factors raise risk. In the registry, male sex, obesity, current smoking, longer operations, combined procedures, general anesthesia and office-based surgery were each associated with more adverse events.⁴ Smoking impairs healing of the lifted skin, and one frequently cited study found skin loss in 7.5% of smokers vs 2.5% of non-smokers.¹ Surgeons generally require stopping all nicotine, including nicotine replacement products, at least 3 weeks before surgery.^3,11

Some conditions argue against elective surgery altogether, including inherited connective tissue disorders such as Ehlers-Danlos syndrome that make wound healing unpredictable.¹ Realistic expectations matter too. Surgery repositions tissue but does not stop aging, results are not guaranteed to last, and wrinkle treatments may still be needed afterward.¹²

There are many named facelifts, but they differ mainly in how deep the dissection goes and how the SMAS is moved.^1,13

Short-scar lifts avoid the incision behind the ear and suit people with little loose skin in the neck.^1,12 A small meta-analysis of 286 patients found results and complications similar to deep SMAS lifts, with shorter operations.¹⁷

Facial tissue sags as a unit, because the skin, fat and SMAS are closely attached to one another.³ A deep plane facelift treats them as a unit. It releases the retaining ligaments, the fibrous bands that tether the cheek, jowl and neck tissue in place, and then moves the skin and SMAS together as a single composite flap.^1,3,18 Because the ligaments are released, the tissue can be repositioned rather than pulled, and the lift is carried by the deeper layer so the skin closes without tension.^3,19

• Ligament Release: Freeing the zygomatic, masseteric, mandibular and cervical retaining ligaments lets the midface, jawline and neck move further than they can when the ligaments are left intact.^18,19
• Composite Flap: The skin and SMAS stay attached and move as one. In a cadaver study, composite flaps held sutures under greater force than skin or SMAS flaps and stretched less over time than skin flaps, a property that may help results last.²⁰
• Blood Supply: The flap keeps the blood vessels that pass from the deeper layer to the skin. Textbooks credit this for the rarity of skin loss and describe the technique as an option for people at higher risk of healing problems.^1,3
• Natural Result: With the tension held by the deeper layer instead of the skin, the face is lifted without a tight or pulled look.^2,3
• Midface: Moving the composite flap upward also lifts the cheek, restoring volume where it has descended.^18,21

Outcomes are favorable. In a 2026 meta-analysis of 45 studies and 10,784 deep plane facelifts, the overall complication rate was 6.6%, skin necrosis occurred in 0.1%, temporary facial nerve weakness in 1.2%, and no permanent facial nerve injuries were reported.⁶ The same review found greater aesthetic improvement than with skin-only and SMAS facelifts, and another meta-analysis reported satisfaction of 94.4% vs 87.8% for SMAS lifts.^6,22

Like any technique, it depends on precise anatomy. In one surgeon's 240 consecutive deep plane facelifts, complications fell from 16.7% in the first 60 cases to 8.3% in the last 60, and skin necrosis fell to zero.²³

A preservation deep plane facelift, also called a limited delamination facelift, refines the deep plane approach by keeping as much of the skin attached to the deeper tissue as possible.^15,16 Traditional facelifts separate the skin from the tissue beneath it across much of the cheek and neck, a step sometimes called degloving. In a preservation lift, the skin is separated only over a limited area near the incision before the surgeon enters the deep plane, and the rest of the face moves as one connected unit.^15,16,24

• Skin Blood Supply: Skin that stays attached keeps the vessels that feed it from below, which protects it from healing problems.^3,16
• Natural Connections: The skin keeps its normal attachment to the fat and SMAS beneath it, so the face moves and looks like itself after surgery.^16,24
• Flap Handling: Surgeons using the technique report easier handling of the flap, better biomechanics and less skin discoloration.¹⁵

In a multicenter review of 3,964 face and neck lifts by six surgeons, the limited delamination approach had low rates of hematoma, seroma and infection and few revisions.¹⁵ Another group reported 864 deep plane facelifts with limited undermining over five years with no nerve complications.²⁴

Faces do not age in one pattern. The amount of sagging in the midface, jowls and neck, the strength and position of the retaining ligaments, skin quality and volume loss all differ from person to person.^2,19 For that reason, reviews conclude that the operation should be built around each patient's anatomy rather than a single fixed technique, and this is the most important principle in modern facelift planning.^19,24

• Dissection Extent: The deep plane release can be limited for early neck and jowl changes or extended across the midface when the cheek has descended, and a more limited dissection shortens recovery.³
• Ligament Release: Ligament anatomy varies, so which ligaments are released, and how far, is planned for each face.^18,19
• Skin Undermining: How much skin is separated from the deeper layer is kept to what each face requires.^15,24
• Neck: The neck plan ranges from liposuction to platysma tightening and deep neck procedures, depending on the anatomy beneath the skin.^1,25
• Volume: Fat grafting is added when volume loss, not only sagging, contributes to an aged appearance.^2,8

• Anesthesia: Facelifts are done under general anesthesia or under local anesthesia with or without sedation. General anesthesia was used in 63% of registry cases, and a review of 7,115 procedures under local anesthesia found low complication rates and fewer blood clots than with general anesthesia.^4,26
• Incisions: The incision usually runs from the temple hairline down in front of the ear, around the earlobe and behind the ear into the hairline. Short-scar versions stop at the earlobe.^1,12
• Deep Layer: The SMAS is repositioned by folding it, removing a strip of it or lifting it as a flap. In a deep plane lift, the retaining ligaments are released and the SMAS and skin are moved together, usually in an upward direction.^1-3
• Neck: Many patients also have neck work, such as liposuction, tightening of the platysma muscle or reduction of deep fat and the submandibular glands.^1,27
• Closure: The skin is redraped and only true excess is removed, so the incision closes under normal tension.²
• Length: In the registry, an operation averaged 3.8 hours, usually with other procedures added.⁴

Drains are optional. In a randomized trial, drains did not change hematoma or swelling but did reduce bruising, and another randomized trial found a sutured hemostatic net performed similarly to drains.^28,29 Tranexamic acid, a medication that reduces bleeding, lowered minor hematoma and drain output in a meta-analysis but did not reduce major hematoma.³⁰

Neck techniques continue to evolve. In a 79-patient study of deep plane neck lifting, anchoring the tissue deeper behind the ear increased definition below the jaw angle by an average of 8.1 mm.²⁵ A systematic review of 2,971 patients found that reducing prominent submandibular glands improved neck contour but carried a 15.1% complication rate, most often temporary weakness of the lower lip.²⁷

Recovery time is rarely measured in studies, so the typical course below comes from surgical textbooks and varies with technique and with any added procedures.^1,11

Swelling lasts longer after deeper dissection, because more of the lymphatic drainage is disrupted, and it is greater when other procedures are added.^2,32 Smoking is usually prohibited for at least 6 weeks after surgery as well as before it.¹¹

Facelift is considered a safe operation, with an adverse event rate of 5.1% among 13,346 patients in a national outcomes registry.⁴ Hematoma, a collection of blood under the skin, is the most common complication.^1,33

Hematomas usually appear early, within the first day or two, and large ones need prompt drainage.^1,2 Men have historically had higher hematoma rates, but a 2026 matched study using modern prevention protocols found no difference between men and women.^1,34 Careful blood pressure control is a cornerstone of prevention.^1,3

Most nerve injuries are temporary. The great auricular nerve, which supplies feeling to the earlobe, is the most commonly injured, and weakness of facial nerve branches usually recovers within weeks to a few months.^1,2 Permanent motor nerve injury occurred in fewer than 1 / 1,000 patients in a meta-analysis of 67 studies.⁷

Other problems include unfavorable or widened scars, which made up about a quarter of reported complications in a 2025 review, and the pixie ear deformity, in which the earlobe is pulled forward by tension at closure.^1,33,35

The most rigorous long-term data come from a study of 50 patients measured on standardized photographs 5.5 years after surgery. Jowl correction was largely maintained, with 21% relapse, while correction of the neck angle relapsed more, by 69%, and 76% of patients were still judged to look younger than before surgery.⁵

In a 35-year observational study, results were reported as stable up to 10 years, and satisfaction remained high even 20 years later.³⁶ Aging continues after surgery at its usual pace, and secondary facelifts are performed on average about a decade after the first.^1,3

In a FACE-Q study in which about half of patients responded, satisfaction with the decision to have a facelift averaged 90.5 / 100, and patients felt they looked 6.9 years younger. They were least satisfied with the area under the chin.³⁷

Different signs of aging respond to different treatments. Skin texture and discoloration respond to skin care and resurfacing, and wrinkles that appear with expression respond to neuromodulators, but neither lifts sagging tissue.¹

Thread lifts use barbed sutures placed under the skin. A meta-analysis of 26 studies found frequent minor complications, including swelling in 35% and skin dimpling in 10%, and satisfaction fell from 98% immediately after treatment to 88% at six months.³⁸

Fat grafting restores lost volume rather than lifting, and it is often combined with a facelift. A systematic review of 15 studies found the combination safe, with improvements in facial volume.⁸ About 30% - 50% of transferred fat is typically lost, so more than one session may be needed.²

• Direct Trials: Deep plane results are strong in large series and meta-analyses, but randomized trials comparing it directly with other techniques have not yet been done.^6,21
• Inconsistent Outcome Measures: Studies define complications and results differently, which makes rates hard to compare.^21,33
• Limited Long-Term Data: Objective measurements beyond about five years are rare.⁵
• Recovery Timelines: How long recovery takes is rarely measured directly, so most guidance comes from expert experience.
• Best Hematoma Prevention: Tranexamic acid, tissue sealants and hemostatic nets each lower risk in some studies, but none is clearly superior.^10,30