There are several variations of a facelift procedure, or rhytidectomy, each tailored to meet specific skin needs and desired results. After assessing your skin and determining your unique needs, your surgeon will recommend a procedure that will address your individual concerns. The goal of each facelift technique is to essentially “lift up” portions of the face and neck that are showing unwanted signs of aging through the use of plastic surgery, thread lift surgery, or dermal filler injections.
Facelift is a surgical procedure aimed at providing you with a rejuvenated and refreshed face and neck. As we age, our skin thins which leads to increased wrinkling and sagging, especially around the eyes and along the jawline and neck. In addition, we lose fat volume in the cheeks which makes our once prominent and beautiful high cheek bones look flat and aged. There are a number of non-surgical options available for rejuvenating the aging face including neuromodulators, injectable filler, radiofrequency treatments, microneedling, laser skin resurfacing, threadlifting, and others. When you are ready to more permanently restore the youthful contours of your cheeks and reduce the sagging skin along your jawline and neck, you may be a good candidate for a facelift.
There are several variations of facelift, or rhytidectomy, and each is tailored to meet your specific facial needs. Together, you and your plastic surgeon will assess the specific aging changes seen on the face, and then recommend the cosmetic procedure that suits you best. You may not have the time to undergo a surgical facelift that might require a few weeks to recover from, in which case you might pursue less invasive strategies such as neck liposuction or non-surgical facial rejuvenation procedures that have very rapid recoveries. Alternatively, you might recognize that the changes that would make you most happy include the removal of sagging skin from along the jawline and neck. Perhaps you wish to remove the double chin you have developed over time and which you try to cover up with a turtle-neck or neck scarf. A facelift can restore the beautiful, youthful volume and fullness in the cheek region.
Facelift surgery essentially “lifts up” portions of the face and neck that are showing unwanted signs of aging through the use of various plastic surgery techniques. Although a facelift or neck lift is unable to stop the aging process from progressing, it can reverse signs of aging and make you look 10-15 years younger, or even more. Lost facial volume in the cheek and under-eye areas results in a flatness replacing the once high cheek bone that existed. Think of the fullness of a baby’s face: facelift aims to restore some of that youthful cheek fullness. Facelift also tightens the skin of your neck and lower face to help flatten your jowls which some people refer to as the “bull-dog” look, and to reduce the fat and sagginess of the neck which some people refer to as the “turkey neck”. Finally, facelift can really help to reduce the deep wrinkles in the face and neck quite dramatically, thereby restoring a youthful appearance. Facelift focuses mainly on the cheeks and the mid-to-lower portions of the face and neck, but it may often also be combined with brow lifts, eyelid surgery, skin resurfacing treatments (such as laser, dermabrasion, or chemical peels) to further enhance your overall rejuvenation results.
The majority of facelift options require incisions necessitating the use of anesthesia. The type of anesthesia used is determined by the facelift procedure you will undergo and your surgeon’s individual practice choices. Certain, more involved, types of facelift may call for general anesthesia while other, less involved types of facelifts may be performed comfortably with intravenous anesthesia, or even local anesthesia. Your surgeon will discuss the specific type of facelift that is most appropriate for you and along with that, the specific type of anesthesia that would be ideal. If undergoing anesthesia is a concern for you, it would be helpful to bring this to your surgeon’s attention during your consultation. This will allow your surgeon to determine a customized procedure that you will be comfortable with.
Different facelift procedure types include SMAS Facelift, Awake Facelift, Subperiosteal Facelift, Cutaneous Facelift, Plicated SMAS Facelift, Endoscopic Facelift, Deep Plane Facelift, Composite Facelift, Weekend/Mini Lift/Short Scar Facelift, Threadlift, Liquid Facelift, and Vampire Facelift. Do not be alarmed by the daunting list of procedure choices. Your surgeon will be able to provide you with a narrowed list of options upon evaluating you and hearing your concerns.
Facelift Cost Overview
Facial rejuvenation procedures and facelift surgery costs vary as much as the procedures themselves, with expenses ranging from $400 per treatment for non-surgical treatments and up to $25,000 for a surgical procedure. Something minimally invasive and temporary, such as Liquid Facelifts (Juvederm Ultra, Juvederm Ultra Plus, Juvederm Voluma, Radiesse, Sculptra and Botox) cost approximately $500-$2,000 per treatment, and will need to be repeated at regular intervals in order to maintain the desired results. Other types of minimally invasive procedures will cost more, depending on the type of procedure, the experience of the surgeon, and the anesthesia used. When considering the costs of minimally invasive procedures, patients should also understand that many of these options will need to be repeated in order to be maintained.
A procedure with medium-lasting results, such as a cutaneous or skin-only facelift, lasts 4-5 years and will cost between $6,000-$10,000. This type of facelift is especially helpful in patients who only need to address the issue of excess skin.
Other, more invasive procedure types, such as a SMAS facelift, deep plane facelift, or a composite facelift, cost in the range of $10,000-$25,000, but the results are expected to last an average of 10-15 years. These procedures address issues such as cheek flatness, neck sagging, and jawline irregularities most effectively. These have a greater risk and reward, with slightly longer recovery than the smaller procedures.
Keep in mind that no facelift surgery can promise permanent results as the face, neck, and the body in general will continue to naturally age and be affected by gravity. While some procedure types offer longer-lasting results, your skin will continue the natural process of maturing and you should expect even the most permanent results to last approximately 15 years. During that time, you might find that you will want other procedures, such as neuromodulators (Botox, Dysport, or Xeomin), eyelid lift, brow lift, injectable filler, skin resurfacing, and others to further enhance your results.
Contrary to popular belief, the recovery process following a facelift is a direct result of the surgical technique used, and not the anesthesia type. Almost all facelift patients experience a period of bruising, swelling, and redness around the incision or injection sites. The duration of these recovery steps vary according to the type of procedure, the extent of the facelift, and the natural healing capacity of each individual. You should expect these things to occur, though, and be prepared to ice, rest, and take proper care of the area as it heals.
Most of your recovery will take place within the first 8-10 weeks postoperatively, although it is common for facelift patients to experience slight residual swelling and changes in skin sensation for up to a year for some procedures types, such as with a SMAS or deep plane facelift. Other procedures require less recovery time, such as a liquid facelift, which only uses dermal filler injections.
You will be in contact with your plastic surgeon during your follow-up visits to monitor for any complications or side effects you might experience during your healing process. As with most things, it is always better to take the necessary time to recover, and to avoid trying to neglect or speed up the steps required for your best healing.
Before & After Overview
Take care to follow your surgeon’s before and after instructions carefully to ensure the best possible outcome. All cosmetic surgeries instruct you to avoid any alcohol or smoking and to limit sun exposure and heavy lifting. They also require that you avoid taking medications, particularly those with blood-thinning properties, such as Aspirin, as this will inhibit your healing capacity.
It is also necessary to inform your provider of any past medical histories, including herpes infections around the mouth, prior to surgery. This will help your surgeon provide you the best care before and after your facelift.
The specific requirements for each procedure type are discussed in detail during your consultation. Your plastic surgeon will also provide you with a list of things to know about your facelift and recovery.
Facelift Goals and Procedure Details
There are several facelift options available, and while your plastic surgeon will advise you on the route that will work best for your skin type, facial volume, jawline, and neck, it is helpful to have a working knowledge of what each technique entails before your consultation. The available facelift surgeries are summarized below:
SMAS Facelift SMAS stands for superficial musculoaponeurotic system. This refers to the thin, fibrous layer that covers the anterior (or “front”) face and neck, supports the mimetic muscles of the face (muscles of facial movement), and runs continuous with the platysma muscle in the neck (which runs from the chin to the collar bone) that covers the anterior neck. Your “mimetic muscles” control facial expression. In other words, the SMAS facelift addresses the mid and lower front of the face and neck, specifically focusing on areas that are experiencing signs of aging directly related to facial expression. This includes flattening the nasolabial folds (“smile lines”) as well as sagging cheeks or jowls (the loose skin between the cheek and chin along the jawline).
A plastic surgeon performs the SMAS facelift by making an incision that starts at the edge of the hairline in the temple region or right in front of the ear. This temporal incision runs down the side of the face, in front of ear, and behind the earlobe where it extends behind into the hairline into the crease between the backside of the ear and the skull. This type of incision allows for adequate re-draping of skin and potentially maximizes the amount of hairline preserved.
Once the incision is made, your surgeon will begin a superficial dissection using facelift scissors which preserves the hair tuft and avoids injuring your neck and facial nerves. This type of facelift surgery uses either general anesthesia or local anesthesia with sedation.
The goal of the SMAS facelift is to give your face and neck a rejuvenated, more youthful look. By “lifting” sagging cheeks and skin around the jawline and neck, excess skin is removed and the underlying facial tissues and muscles are tightened.
The results of an SMAS facelift typically last 10-15 years. Recovery for the SMAS Facelift lasts 2-3 weeks and costs anywhere from $10,000-$20,000.
Awake Facelift Some people who might benefit from a facelift might find themselves uncomfortable with the idea of needing anesthesia. An awake facelift could be a solution for you as it offers an alternative to general anesthesia during a facelift. An awake facelift does not necessarily refer to the type of surgical procedure being used. Instead, an awake facelift refers to the type of anesthesia, which is either local or local anesthesia with sedation.
Not all types of facelift procedures can be done with you awake (but numbed). Your candidacy for the type of anesthesia will be determined by you and your doctor based on the extent of the procedure, the length of time required to complete the procedure, and your anesthesia preference. If you are able to undergo an awake facelift, a doctor will use tumescent anesthesia – subcutaneous injection of a tumescent fluid composed of saline, a numbing medication (such as lidocaine), and epinephrine – combined with either oral or IV sedation in place of general anesthesia to anesthetize the treatment area.
The epinephrine (adrenaline) is used to constrict the blood vessels and reduce bleeding while the lidocaine works to numb the injection site. Once the area is sufficiently numbed, your facelift procedure will continue.
The goal of an awake facelift is to offer patients an alternative to general anesthesia during a facelift procedure.
The results from an awake facelift vary depending on the type of surgical technique used, but are typically noticeable immediately after surgery. They are long lasting, but not permanent. An awake facelift offers the advantage of a shorter recovery time (averaging between 2-3 weeks) because less surgery is usually performed, especially compared to a longer, more invasive facelift. The cost of an awake facelift is usually $7,000-$10,000.
Subperiosteal Facelift The subperiosteal facelift focuses its attention on the upper 2/3 of the face, providing a vertical lift to the soft tissues of the face. This type of facelift allows soft tissue remodeling and repositioning of the soft tissues at the level of their bony origins. The subperiosteal facelift removes a small amount of hair close to the hairline to allow for a 5cm lateral incision to be made across the front of the forehead. This facelift focuses on 3 main points of the face which will be lifted and stretched to correct a drop in the cheek region and enhance the nasolabial (smile line) groove.
The skin will then be sutured and a compressive dressing will be applied. This dressing can be removed in 7 days at the time the stitches are removed. You should expect to wear a compressive bandage for the first 6-10 hours after your surgery.
By “lifting” sagging cheeks and jawline skin, the goal of a subperiosteal facelift is to remove excess skin and tighten underlying tissue and muscle. It rejuvenates the face for a more youthful look and corrects sagging in the upper 2/3 of the face. It would be a good option for those who would like a forehead, cheek, or eyelid lift.
The subperiosteal facelift, or mid-facelift, only requires one treatment to see immediate results. Although not permanent, it is common for the results of the subperiosteal facelift to last for 10-15 years. This type of facelift requires a longer recovery time due to the depth of the incisions and degree of swelling. The external stitches are removed after 1 week, however, expect to see continued bruising and swelling for several weeks. This procedure will require a 3 week break from work, which might be an important factor to consider as recovery for the subperiosteal facelift may take 1-3 months for complete recovery. This facelift type costs between $6,000-$10,000.
Plicated SMAS Facelift Like the SMAS facelift, the plicated SMAS facelift focuses on the mid and lower face and aims to flatten nasolabial folds and treat sagging cheeks, necks, and jowls. A plicated SMAS is a variation of the SMAS facelift, differing in the way the suspension is performed. It effectively works to reduce wrinkles and sagging skin on the face and neck that are caused by aging or weight loss by removing excess skin, tightening the underlying muscles, and re-draping the skin in a higher position.
Although an incision is made starting in the temporal hairline and moving around the frontal edge of the face, the plicated SMAS facelift varies from an SMAS facelift, and is completed by using plication techniques for the SMAS suspension. This avoids further incision and undermining of the SMAS flap. The SMAS fascia is folded over on itself and held together with buried sutures. These sutures serve to pull the SMAS in 3 upward and outward directions. Excess SMAS in the infra-lobular region is excised and the excess skin is trimmed. The wound is then closed and covered by a facelift dressing.
The goal of the plicated SMAS facelift is to rejuvenate your face and neck, creating a more youthful appearance by “lifting” and correcting midface sagging, marionette lines, jowls, and double chins.
Patients see results from the plicated SMAS facelift immediately after surgery with results lasting 7-10 years depending on the effects of gravity and continued aging of your skin. Recovery often last 2-3 weeks and the cost fluctuates between $10,000-$15,000.
Endoscopic Facelift An endoscopic facelift is a minimally invasive surgery that focuses on the skin around the forehead, eyes, and cheeks. It is a great option for those who are unhappy with the appearance of cheek flatness or those with moderate imperfections caused by fatty tissue and loose facial muscles in those areas. It is a technique rarely done in patients who require repositioning of the underlying muscle, removal of excess fat and skin, or a fat transfer.
An endoscopic facelift begins with a dissection of the midface region through the temple or via the lower eyelid area. The surgeon continues to concentrate efforts around the upper portion of the face and split incisions are eventually closed without removing skin, except in the lower eyelid region, which generally requires excision of skin. Once the operation is complete, the surgeon applies a facial dressing.
The goal of the endoscopic facelift is to correct facial sagging by focusing on the upper part of the face and is often combined with rejuvenation of the eyebrows. Results from this type of procedure typically last about 5-10 years, although results are obvious immediately. Recovery typically takes 1-2 weeks, and the procedure itself costs between $6,000-$10,000.
Deep Plane Facelift A deep plane facelift goes deeper than a traditional facelift and improves upon the lift seen in the SMAS facelift as the long-term results it delivers along the nasolabial folds are thought by some to be superior. A deep plane facelift extends further towards the center of the face and is useful in lifting the cheek.
The deep place facelift begins with the same incision as the SMAS facelift. The dissection takes place in 3 different areas, depending on the area of the face or neck in need of lifting. It can be done in the neck, in the mid-face, or in the lower face. It is common to also have submental fat removal or a platysmaplasty during a deep plane facelift as well.
The goal of a deep plane facelift is to correct midface sagging, marionette lines, jowls and double chins.
Results from a deep plane facelift are noticeable immediately after surgery and last 10-15 years. The results vary from person to person depending on gravity and aging factors. Recovery lasts approximately 2-3 weeks and costs anywhere from $10,000-$20,000.
Mini-Facelift The mini-facelift involves suspension of the SMAS, but through a much smaller incision. It restores a youthful appearance by rejuvenating the cheeks and jowls. The mini-facelift goes by several different names including the “s-lift”, “weekend facelift”, “ponytail lift”, “lunchtime facelift” and “short scar facelift”. The name depends on the variation of the procedure, which may include either adjusting the length of the incision or the depth of the tissue affected.
Unlike the traditional facelift, the incision of a mini-facelift does not extend as far into the temporal region and it may not extend into the hairline behind the ear at all. Like the short-scar face lift, the SMAS layer is elevated along with the subcutaneous tissues. The SMAS is then able to either be plicated or imbricated. After the surgery, your incision will be closed and you will receive a head dressing.
The goal of a mini-facelift is to correct midface sagging, marionette lines, jowls and double chins.
The results of a mini-facelift are noticeable immediately after the surgery and last 5-10 years. Recovery takes 3 days to 2 weeks and costs between $6,000-$9,000.
Thread Lift A thread lift involves the subcutaneous placement of threads that are lifted and pulled to achieve the desired skin and soft tissue lift. It focuses on the midface, jowl, and neck regions. When performing a thread lift, the surgeon inserts a needle in a curved direction into the targeted area within the subdermal level. Another needle is inserted 1-1.5cm above this needle. These needles insert bi-directional threads of polypropylene which use barbs (which act like cogs) to grasp, lift and suspend the targeted facial area. As the needle is withdrawn, the tissue is “gathered” over the thread. Once the desired lift has been achieved, the ends of the thread are cut off.
Sutures dissolve naturally within 6 months leaving no residual material. During that time, new collagen and fibrous tissues form around the sutures and continue to hold up and tighten the skin.
The goal of a thread lift is to reposition facial and neck tissues to restore youthful proportions and appearances to the treated area. Thread lifts are also useful in for brow lifting, butt lifting and knee lifting.
The results of a thread lift are obvious immediately, however, maintenance treatments will be needed every 6-12 months. Texturized threads will produce more instantaneous results while smoother threads have less immediate results. Both thread types aim to stimulate collagen and produce a youthful appearance over time.
Liquid Facelift A liquid facelift restores volume and youthful contours to facial features through fillers that gently lift the face, reducing wrinkles, lines and folds. It also restores natural, curved facial contours to provide a more rested and energetic look. Different methods include Juvederm, Radiesse, and Sculptra.
Juvederm Ultra is a cross-linked hyaluronic acid dermal filler used to smooth moderate to severe facial wrinkles and folds, especially the nasolabial folds. Results typically last up to 1 year.
Juvederm Ultra Plus is more cross-linked than Juvederm Ultra and is used to treat deeper wrinkles.
Juvederm Voluma is a hyaluronic acid injective gel used to add volume to the cheek area. It lasts longer than other hyaluronic acid dermal fillers and lasts up to 2 years.
Radiesse uses a gel that provides a scaffold for collage production once it dissipates.
Sculptra is a collage-replacing dermal filler that works well for those with deep wrinkles or excessive fat loss in the face. It will not provide instant results as it stimulates collagen growth over time rather than filling immediately. Sculptra requires an average of 3 treatments over several months.
Botox is one of the most well-known dermal fillers, and is commonly used in conjunction with the above injectable fillers to prolong the duration of results.
The goal of a liquid facelift is to rejuvenate the face for a more youthful appearance.
1-2 treatments are needed to see results, and you will need to plan for an upkeep treatment cycle of once every 3 months. Afterwards, liquid facelifts last no more than 1-2 years and cost between $400 and $1800 per treatment.
Vampire Facelift As the name implies, the vampire facelift uses blood collected from your own arm as the key ingredient. This blood is spun through a centrifuge to spin apart the blood from the platelet-rich plasma (PRP). The PRP is then combined with a hyaluronic acid based dermal filler (ex: Restylane or Juvederm) to create a longer-lasting platelet-rich fibrin matrix (PRFM). A topical cream is then applied and will numb your face in about 30 minutes. The gel is then injected in different areas of the face to enhance facial volume.
The goal of a vampire facelift is to achieve healthy, youthful and rejuvenated skin during a quick, non-surgical procedure.
Vampire facelifts typically give noticeable results after the first procedure with continued benefits lasting from a few months to a few years. Results are temporary, though, and maintenance treatments will be needed approximately every 6 months for a continued effect. Any symptoms that you may experience typically resolve within 24-72 hours after surgery. Vampire facelifts cost between $1,500-$2,500.
Side Effects, Risks, and Complications
Almost all facelift procedure types share the following side effects: bruising, swelling, bleeding, numbness, discomfort or tightness, possible infection, potential hair loss, redness around injection site (liquid and vampire facelifts, potential facial nerve injury/damage, and facial asymmetry. Temporary loss of sensation or a feeling of tightness might occur due to the body adjusting to the feeling of newly repositioned connective tissues.
Necrosis of the skin flap, scarring, edema and ecchymosis are potential risks and complications of the SMAS facelift and the plicated SMAS facelift.
The superiosteal facelift might potentially cause nerve palsy or delayed wound healing.
Choosing a Plastic Surgeon
Do your homework before selecting a facial plastic surgeon. It is helpful to research surgeons in your area and see what others are saying about the surgeons on your list. You may also want to ask friends about their experiences with different plastic surgeons.
Either way, though, one of the most important things to check is whether or not the surgeons you are interested in are board-certified. You can determine that by looking to see if they are members of one of the following organizations:
- The American Academy of Facial Plastic and Reconstructive Surgery
- The American Academy of Dermatology
- The American Society of Plastic Surgeons
- The American Society for Dermatologic Surgery
Questions to Ask During a Consultation
Many plastic surgeons offer free consultations to their prospective patients. Once you have selected your surgeon, and determined your procedure type, you will have the opportunity to hone in on any specific questions you would like addressed before your scheduled facelift procedure. Be specific and thorough in your questions, taking care to address any areas of concern. This is also a great opportunity to ask for any clarification you might need regarding your cosmetic surgery. Make a list of your questions to bring with you to the consultation so that you are prepared and able to make effective use of the allotted time.
- Here are some things you might want to consider adding to your list:
- Are you board certified?
- How often/how much experience do you have performing this type of surgery?
- What form of anesthesia will you be using?
- What should I expect in terms of recovery?
- How much will this procedure cost?
- How do you handle any unexpected complications?
- Why am I a good candidate for this particular procedure?
- Do you have before and after photos of this procedure?