A facelift — rhytidectomy — works on two planes: the SMAS, the musculo-aponeurotic layer that holds the face up, is treated and the dropped tissues repositioned, and the spare skin is then redraped and removed. The difference from the old operations is not that the skin is left alone, but that the support comes from the deep plane, so the skin closes without tension.
The types are not rungs on a ladder: brow lift, mid-face lift, facelift and neck lift are chosen according to where the laxity is. The mini facelift is a more limited version of the lower third and does not replace a full facelift when the laxity is marked.
It is done under general anaesthetic and takes between two and three hours. The incisions are hidden in the hairline, around the ear and, if the neck is treated, back towards the nape; most patients go home the same day or after a night under observation.
Sutures out at 7-10 days, back to work between two and three weeks — five to seven days after a mini facelift — and the final result at around six months. As a guide, the effect lasts roughly seven to ten years.
The commonest complication is a haematoma, which appears in the first hours or days: that is why the earliest check-ups are the ones that matter most. It is commoner in men and the risk rises with uncontrolled blood pressure and with anticoagulants; smoking is the avoidable factor that weighs most, and we advise stopping at least four weeks beforehand.
Facial ageing changes more than how you look: it affects how you feel about yourself. As the years pass, loss of volume, lax skin and deep lines alter the natural expression of the face. For many people those changes create a disconnect between how they feel inside and how they look outside. A facelift offers a complete surgical answer, not only to rejuvenate the appearance but to restore confidence and self-esteem.
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A facelift, or rhytidectomy, is surgery that treats the signs of ageing in the face and neck by working on the deep layers. It is not simply a matter of pulling the skin: the tissues are repositioned and the SMAS — the musculo-aponeurotic layer that holds the face up — is treated, and only then is the spare skin removed. That is the difference between a natural result and the pulled look of the old operations.
It is indicated where there is structural laxity: sagging cheeks, a jawline that has lost its definition, marked folds or excess skin in the neck.
Types of facelift
They are not rungs on a ladder: they are chosen according to where the laxity is.
Brow or forehead lift. The forehead, the area between the eyebrows and the position of the brows.
Mid-face or malar lift. The middle third: cheekbones and nasolabial folds.
Facelift. The lower third: cheeks and jawline.
Face and neck lift. Adds the neck — muscle bands, excess skin and fat — in the same operation.
Mini facelift. A more limited version of the lower third, with less dissection and a shorter recovery. It does not replace a full facelift when the laxity is marked.
They are frequently combined with each other, or with a blepharoplasty, neck liposuction or facial fat transfer.
Each type of lift acts on a different storey of the face, which is why the choice is not “how much” but “where”. The brow lift works on the forehead, the area between the eyebrows and the position of the brows; the mid-face or malar lift, on the cheekbones and nasolabial folds; the facelift, on the cheeks and the jawline — the mini facelift is a more limited version of that same area, not a preliminary step; and the face and neck lift adds the neck, with its muscle bands and its excess skin and fat, in the same operation. What decides the indication is where the laxity is, not age or a wish to have something done; and they are frequently combined with each other or with a blepharoplasty, because a face does not age in independent bands. Original diagram by the Instituto de Cirugía Plástica del Mediterráneo, simplified for general readers.
When to consider a facelift
There is no “right” age, but there are signs that it is worth assessing:
Visible laxity in the cheeks, the jaw and the neck
A loss of definition in the shape of the face
Deep folds that no longer improve with surface treatments
Limited results from previous non-surgical treatments
The opposite is worth saying too: if the laxity is only beginning, a facelift is out of proportion and there are better options. And piling up fillers over years to put surgery off can distort the face and make the later result harder to achieve.
Who is a good candidate
People in good health, with laxity already established and with realistic expectations. Most patients are between 45 and 65, but age on its own decides nothing: anatomy governs.
Smoking is the modifiable factor that weighs most. It compromises the blood supply to the skin flaps and raises the risk of healing problems. The advice is to stop at least four weeks before surgery. Blood pressure and anticoagulants are also reviewed, because both raise the risk of the commonest complication of this operation.
What the operation involves
It is usually carried out under general anaesthetic and takes between two and three hours, depending on how extensive it is.
The incisions are designed to be hidden: in the hairline, around the ear and, if the neck is treated, back towards the nape.
The deep plane is reached and the SMAS is treated, repositioning the dropped tissues.
The spare skin is redraped and removed, without tension.
The wound is closed in layers and dressings are applied, with temporary drains in some cases.
Most patients go home the same day or after a night under observation.
Recovery
The timescales are a guide and the surgeon adjusts them at each review.
The first few days. Swelling, bruising and a feeling of tightness. You sleep with your head raised and avoid exertion.
7-10 days. Sutures out and the first check-ups.
2-3 weeks. Most of the swelling and bruising goes down. This is when most people go back to work after a full facelift; after a mini facelift it can be five to seven days.
2-3 months. The face settles and the feeling of tightness eases.
~6 months. The final result, with the tissues settled.
A haematoma is the commonest complication of this surgery and it appears early, so the first check-ups are the ones that matter most. It is worth keeping the first three weeks free of commitments.
Results and how long they last
The aim is not to change the face but to give it back the position it had years ago, while keeping its expression.
On how long it lasts: as a guide, the results usually hold for around seven to ten years. That is an order of magnitude, not a guarantee: it depends on the quality of the skin, on genetics, on sun and on habits. Ageing does not stop — a facelift acts on the current state of the face, not on the process — but the starting point is improved.
Risks and complications
A haematoma is the commonest complication of this surgery and it appears in the first hours or days, which is why the earliest check-ups are the important ones. It is commoner in men, because the skin of the face and neck that supports the beard follicle has a richer blood supply, and the risk rises with uncontrolled blood pressure and with anticoagulants.
Other complications described:
Injury to a motor nerve. The most exposed branches are the frontal and the marginal mandibular; it can show as asymmetry of the lower lip or a dropped brow. It is almost always temporary, although it can be permanent.
Altered sensation in the earlobe, from involvement of the great auricular nerve.
Healing problems or necrosis of the skin flap, clearly more likely in smokers.
Infection, hypertrophic scars, patches of temporary hair loss around the incisions, and irregularities in the contour.
Each person’s risk depends on their anatomy, their history and their habits, and it is assessed in consultation.
What a facelift improves
It redefines the contour of the face and the jawline
It reduces laxity in the cheeks and, when treated at the same time, in the neck
It softens marked folds without changing the expression
The incisions stay hidden in the hair and around the ear
It acts on the structure, not only on the surface, which is why it lasts years rather than months
Many patients also describe recognising themselves better in the mirror. That is an effect frequently reported, not a result that can be guaranteed.
Non-surgical alternatives
Collagen stimulators, focused ultrasound, radiofrequency and fillers have their place in the early stages of ageing, before there is structural laxity. They offer moderate, temporary improvement.
What they do not do is reposition tissues that have dropped. Once laxity is established, no surface treatment replaces surgery, and presenting them as equivalent produces nothing but frustration and expense.
Guide price
At the Instituto de Cirugía Plástica del Mediterráneo, a facelift comes to between 5,000 and 9,000 € as a guide, depending on the scope of the operation, the complexity of the case and whether it is combined with other procedures. The page on the price of a facelift in Valencia explains what the price includes, what drives the range, financing and what happens if a touch-up is needed.
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As a guide, around seven to ten years, with a great deal of variation depending on the skin, on genetics and on habits. Ageing carries on after surgery.
Will I end up with a pulled look?
That look comes from pulling the skin alone. Today’s techniques treat the deep plane and reposition the tissues, so the skin closes without tension. Preserving the expression is part of the goal, not an extra.
When can I go back to work?
As a guide, between two and three weeks after a full facelift. After a mini facelift five to seven days can be enough. The swelling and the bruising are what set the timing.
Do I have to stop smoking?
Yes, and it is not a formality: smoking compromises the blood supply to the mobilised skin and is the main avoidable risk factor for healing problems. The advice is to stop at least four weeks beforehand.
What is the commonest complication?
A haematoma, which appears in the first hours or days. It is commoner in men and the risk rises with uncontrolled blood pressure and with anticoagulants; that is why both are reviewed before surgery.
Does a facelift replace a blepharoplasty?
No. A facelift does not treat the eyelids. Where the eyes have changed as well, the two operations are combined in the same procedure.
Sources and clinical review
Facelift (Rhytidectomy). Cleveland Clinic. my.clevelandclinic.org. Indicative duration of the results (seven to ten years), what a SMAS lift consists of, and recovery timescales: bruising and swelling for two to three weeks, return to work in two or three weeks — five to seven days after a mini facelift — and settling at two or three months.
Cervicofacial Rhytidectomy. StatPearls, NCBI Bookshelf. NBK564338. Haematoma as the commonest complication and its higher incidence in men, with uncontrolled hypertension and on anticoagulants; the frontal and marginal mandibular branches of the facial nerve as the most exposed, and their usually temporary involvement; the recommendation to stop smoking at least four weeks beforehand.
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