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What is a Facelift?

Age, gravity and chronic sun damage (“photo aging”) act together to create characteristic Features of the Aging Face: deep facial lines (“rhytids”) form in predictable locations of the face, there is an actual loss of soft tissue volume and loss of facial muscle tone, the skin of the face descends downward to create sagging of the mid-face, the jowls and the neck, and the former youthful contour of the neck and jaw line is lost.

A facelift, also called a “Rhytidectomy”, is a surgical procedure designed to correct the visible signs of aging in the face. Most people interested in a facelift wish to refresh and rejuvenate their appearance; they feel that their face looks “tired” or “worn”, not accurately reflecting their real energy level, vitality and youthful spirit!

Some professionals are in competition with visibly younger and energetic colleagues, and feel that a rejuvenated and more youthful appearance would compliment their professional maturity and years of experience, giving them an additional edge. Others simply wish to look in the mirror and recognize the face that they had ten or fifteen years ago; the aged appearance does not coincide with how they feel on the inside!

A facelift has many different features and options, all designed to help smooth the skin of the face and neck, tighten the underlying tissues and muscle, and remove excess skin. Each facelift technique, used in the right setting, has outcomes that are consistently reliable and long-lasting. The results are a reversal of the effects of gravity and gentle redraping of the soft tissues to restore a more youthful contour to the face.

Facelift surgery will not change your overall appearance nor will it halt the aging process altogether. The results of a facelift are Subtle but Significant. The ultimate goal of a facelift is to look Refreshed, Natural and Rested, rather than looking “done”, pulled too tight or “plastic”!

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Who is a Good Candidate for Facelift Surgery?

Good candidates for a facelift include men or women who are healthy, in good physical shape, and at their ideal body weight (or a stable weight following major weight loss).

Smokers, patients with multiple or untreated medical problems, and individuals who are psychologically unprepared for surgery are not good candidates for a facelift. Learn more about Preparing for Plastic Surgery in our Preoperative Instructions section.

A facelift can be an extremely rewarding and empowering experience, but should be done at the right time and for the right reasons, by a Board-Certified Plastic Surgeon. Candidates for facelift surgery should be emotionally stable, have the support of their surrounding friends and/or family members, and be fully educated about the procedure they are contemplating. Visit our Preoperative section to learn more.

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What Are the Different Types of Facelift Surgery?

Traditional Facelift

A traditional facelift makes use of standard incisions for facelift surgery hidden in natural facial creases or in the hair-bearing region of the scalp, described in detail below. Traditional facelift techniques allow for the most reliable and long-lasting results in facial rejuvenation; scars are shortened whenever possible if a patient’s anatomy and specific situation allows. The outcome of a facelift is reversal of the effects of gravity, correction of age-related changes, and gentle repositioning of the soft tissues of the face to restore a more youthful and refreshed contour. Most traditional facelifts combine the techniques of subcutaneous and SMAS lift procedures.

Limited Incision (Short Scar) Facelift

A “short scar”, “limited incision” or “MACS” (minimal access cranial suspension) facelift makes a shorter, S-shaped incision at the temples that may also continue around to the ear, and can include additional incisions within the lower eyelids or under the chin. This procedure does not typically address as much facial laxity as a traditional facelift, and does not adequately address the lower face or neck. Learn more about the MACS lift, our preferred technique for the lower face and neck.

Subcutaneous Facelift

A “subcutaneous” facelift repositions and trims excess skin and superficial fat of the face but does not address the deeper muscles or soft tissues (SMAS) of the face. This technique is for excess skin and redraping only, and is often one part of a traditional facelift.

SMAS Facelift

The “SMAS” describes the “superficial musculo-aponeurotic system” of the face, a complex system of fine facial muscles and connective tissue that makes up the deeper soft tissue structure of the face. Repositioning, tightening and/or trimming the SMAS to restore volume after descent of facial structures with age (in addition to trimming and repositioning excess skin) is routinely performed in many traditional facelift procedures, when indicated. The SMAS facelift technique can provide significant cheek elevation and reduce sagging in the lower face and neck.

Deep Plane Facelift

A “deep plane” facelift involves dissection of the SMAS and repositioning this layer in an even deeper plane than a traditional and/or SMAS facelift. The deep plane lift is more extensive than other facelifts types and has a greater risk of injury to the facial nerves, which lie within or below the SMAS layer.

Lower Facelift / Neck Lift

A “lower facelift” addresses the mid-face region in addition to the neck, and is essentially a combination of a Facelift and Neck Lift. Lower facelift surgery corrects sagging jowls, loose neck skin and fatty accumulation beneath the chin but does not address the brow (forehead) or eyes.


A “mid-facelift” addresses the middle face region only, and does not address the neck or forehead. Incisions are made in the hairline, through the lower lids and/or inside the mouth to access and reposition the fatty layer of the SMAS over the cheekbones. A mid-facelift improves some facial lines and can help lift sagging cheeks, but creates only subtle improvements.

Endoscopic Facelift

An “endoscopic” facelift only addresses the brow and upper face. An endoscope is a rigid pencil-shaped probe with a small camera attached that is inserted in the temple region through small incisions and tunneled beneath the scalp, enabling the surgeon to see beneath the tissue on a video screen. This technique is commonly used for an endoscopic brow lift and upper facelift; only relatively young individuals with a very limited amount of skin and neck sagging are candidates for this procedure.

Nonsurgical “Liquid Facelift”

A final nonsurgical technique termed the “liquid facelift” uses injectable treatments to create subtle lifting of certain areas of the face such as the brow, eyes and cheeks and to fill in deep crevices in the face to achieve a rested and refreshed look. This procedure does not actually involve surgery. Learn more about the “Liquid Facelift” in our Minimally Invasive Cosmetic Enhancement section.

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What Really Happens During a Facelift?

Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery.

A facelift is performed in the operating room under general anesthesia or intravenous (also known as “twilight”) sedation for optimal comfort, control and safety. Incisions are made in the hairline at the temple region, in front of the ear hidden in a natural fold, around the earlobe and ending in the lower scalp behind the ear. A second incision may be required beneath the chin for chin and neck contouring. The skin of the face, cheeks, and neck is gently “elevated” off the deeper structures under surgical “loupe” magnification to protect delicate blood vessels and nerves of the face.

Depending on the details of the facial anatomy and the aging process, underlying fatty and/or muscle tissue (SMAS) is repositioned and sculpted to create a more youthful contour. The skin is gently redraped without any tension and any skin excess is trimmed. Dissolving stitches (“sutures”) are used wherever possible; it is common for surgical staples to be placed in the hair-bearing scalp region for easy removal in a week or two.

When you awake from your facelift, soft dressings will be in place and you will be comfortable. Facelift surgery is not normally very painful. Pain medication is prescribed for you to take after surgery as needed. A small, soft Drain is placed to gently remove “wound fluid” under the skin for 1 to 3 days after surgery. An overnight stay is often recommended, depending on the details of surgery.

Facelift incisions tend to heal very well with good quality scars due to the excellent blood supply of the face and absolute avoidance of tension on the skin closure. As mild swelling and any bruising subsides, visible improvements of the facelift procedure will appear over a few weeks.

Facelift scars are permanent, but remain concealed in the natural contours of the face and within the hairline. It takes several months up to a year for the final results to be evident and for all scars to become “mature”. As a component of Scar Therapy, it is important to minimize direct sun exposure to the face not only during healing, but as a life-long behavior to help maintain your rejuvenated appearance and to minimize future “photo-aging” (sun damage).

The final effect of a facelift is a rested, more youthful, natural result that can increase your confidence in “facing” the world as the young-at-heart, energetic and fabulous person that you are!

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How Long Will the Results of a Facelift Last?

A facelift in reality lasts forever, giving you a refreshed and rejuvenated look that will endure over many years to come. However, you will continue to age as appropriate after any type of facial Plastic Surgery. In the future, you will still appear younger than if you had not had your procedure, but you will never appear tight, “overdone” or abnormal.

Maintaining excellent Skin Care, smart sun avoidance and consideration of Non-Surgical Rejuvenative Procedures can often prolong the results of your facelift. Over a long period of time, additional facial aging may bring about recurrent signs of aging and a “Secondary Facelift” may be recommended. A secondary facelift is slightly more complicated and requires experience and judgment of your Plastic Surgeon to avoid complications. Long-term follow up with your surgeon will enable ongoing assessment of your results both in the short-term and over many years to come.

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Can other Surgical Procedures be Done Together with a Facelift?

A facelift by itself facilitates improvements to the jaw line, the cheeks and the “nasiolabial area” (from the nose to the corners of the mouth), but does not specifically address the neck, forehead (“brow”) or eyes. A full facial examination at your consultation will elucidate which surgical option(s) will tackle the specific features of aging present and best achieve your goals.

A facelift is often complimented and further enhanced by a variety of Complimentary Facial Plastic Surgery Procedures, including a:

  • Neck Lift to rejuvenate the neck, lift the “jowls”, remove crepe-like skin and recreate a well-defined jaw line.
  • Eyelid Lift (Blepharoplasty) to refresh and rejuvenate the eyes and remove excess, baggy eyelid skin.
  • Brow Lift (Forehead Lift) to gently lift and refresh the brow, helping to create a more youthful appearance to the eyes.
  • Neck and Chin Liposuction to remove excess fatty tissue stored in the neck and chin region, helping to better define the jaw line and neck.
  • Earlobe Repair to help balance the face and rejuvenate or repair aged or stretched-out earlobes.

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Are Non-Surgical Treatments Part of a Facelift?

Complimentary Non-Surgical Procedures are commonly added to a facelift to enhance its success. Pre-treatment of the face with minimally invasive procedures or skin care regimens can promote the best aesthetic outcome of facelift surgery, and help prolong its results.

Non-surgical procedures that may accompany a facelift include:

  • Minimally Invasive Procedures such as Botox, fillers, lasers and other skin treatments can compliment and enhance facelift surgery results.
  • Medical-Grade Skin Care adequately prepares the skin of the face and neck for surgery, assists in the recovery of the skin during the healing period, and in the long term, helps to prolong the results of surgery.
  • Medi-Spa Services can compliment facial Plastic Surgery and further pamper and rejuvenate the face, neck and décolletage (cleavage area).

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What is the Recovery After Facelift Surgery?

After any type of facial surgery, some swelling and bruising is expected. Initial asymmetry from swelling or an uneven appearance to the skin is quite common and will normalize as healing progresses. After approximately two weeks, obvious signs of surgery such as puffiness or discoloration should dissipate.

Sleeping with a few extra pillows to elevate the head can help speed the resolution of postop swelling. Strict sun avoidance and the regular use of sunblock of at least SPF 30 are vital to prevent permanent “hyperpigmentation” (darker color to the skin and incisions) and sunburn. Wearing makeup over sunblock is permitted at a week postoperatively and should continue as part of your morning beauty routine. Products that are recommended for postoperative skin protection are available at our office as part of our Medical-Grade Skin Care regime.

Prior to a facelift, some patients grow their hair a little longer than usual if it is short to help conceal their incisions in front of the ear during healing. Any chemical hair coloring should be avoided for at least a month after surgery; a trip to the salon before your facelift is a nice treat for many patients as they prepare for surgery.

Any sutures or staples that do not dissolve on their own will be painlessly removed in the office within a week or two. Please see our Postoperative Instructions section and Special Instructions for Facial Surgery for additional information pertaining to recovery from a facelift.

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What Are Potential Risks and Complications of Facelift Surgery?

When you are considering any type of surgery, you should be fully educated about potential risks and complications. Please see our Preparing for Surgery section to learn about general risks and potential complications, Special Considerations for Facial Plastic Surgery, and our section on Postoperative Instructions for additional information pertaining specifically to facelift surgery.

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Please click here to see before and after facelift surgery results.

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As women Plastic Surgeons, we intimately understand how an individual’s looks and their feelings about their appearance can influence self-image and self-esteem. At your facelift consultation, your surgeon will spend a great deal of time with you to get to know you personally and take a complete medical history.

Your facial bone structure, underlying skin composition, skin thickness, texture and elasticity, extent of facial wrinkles and folds will be carefully examined. Taken together, this information will be used to formulate an individualized plan to address your unique features of aging and your specific aesthetic goals. Your Plastic Surgeon will select the surgical technique she feels will obtain the best outcome for you and that offers the lowest potential risk.

We will explore in detail your reasons for seeking a facelift, and if you are an appropriate candidate for surgery, your options will be described in detail.

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Dr. Karen Horton has either authored or reviewed and approved this content.

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Dr. Karen M. Horton
2100 Webster St #506
San Francisco, CA 94115
Phone: 415.570.7352

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Dr. Karen M. Horton
2100 Webster St #506
San Francisco, CA 94115
Phone: 415.570.7352


*Please note: Cosmetic surgical and non-surgical procedures are not covered by insurance. Dr. Horton accepts limited insurance plans for breast reconstruction and breast reduction. Please contact our office to inquire about insurance coverage for reconstructive surgery.


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