A facelift is carried out in a hospital and most surgeons and patients prefer a general anaesthetic. It is possible to carry out the procedure under local anaesthetic and intravenous sedation but the patient would still be advised to spend the night in hospital. The procedure, although long, can be combined with other operations of all sorts. The most common, however, would be an endoscopic brow lift and an eyelid operation. Other extra procedures which can be used to enhance the face at the same time are malar (cheek bone) and chin augmentation and lip enhancement.
Incisions are made above the hair line at the temples and extend in a natural line down the front of the ear, just inside the cartilage at the front of the ear, or just inside the cartilage at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear and off into the lower scalp. Occasionally, it may be necessary to make a small incision under the chin. Sometimes only the skin is lifted following a separation from the underlying platysma muscle. More usually, however, the platysma muscle and its fibrous attachments (S.M.A.S.) is dissected free and sutured tightly to the solid structures in front of and behind the ear. At other times the skin and the S.M.A.S. layer are lifted together as a single layer, but will be sutured separately. Fat along the jaw line and under the chin may be removed by liposuction or on occasion through an incision under the chin. The skin is sutured so that it is lifted upwards and backwards, just as when one lifts the skin when looking in a mirror. Sometimes drains are inserted. Most surgeons will bandage the face to minimise bruising and swelling. These bandages will stay for one or two days and the sutures are removed in 7 to 8 days.
After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend into the neck. 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. It is better to keep the head elevated for a couple of days to reduce swelling. Drainage tubes will be removed a day or two after surgery. 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. The scars can be very well hidden by women with their hair and disc shaped earrings so that they should be able to return to work and social activities within a couple of weeks. Camouflage make-up can be helpful in masking bruising.
Men find it more difficult to disguise the scars and will need to shave their beard closer to the ear in front as well as behind the ear where the skin has also been lifted.
The scars in the hair do not usually show except that the hair is usually cut shorter around the wound. There may be some slight reduction in hair growth in the temples, but this is not usually a problem unless the hair is very thin and repeated facelifts are being carried out.
Choosing your surgeon
A facelift is a skilled procedure and we would recommend that you choose a surgeon who has undergone full training for cosmetic surgery. These surgeons will be on the Specialist Register in Plastic Surgery at the General Medical Council. Al members of the British Association of Aesthetic Plastic Surgeons (BAAPS) are on the Specialist Register.