The term facelift (surgical facelift) can be somewhat misleading, as it suggests correction of the entire face from the hairline to the neck. In reality, a facelift primarily rejuvenates the midface, lower face, and neck, while the upper third (forehead and eye area) is treated with procedures such as brow lift and eyelid surgery.

Despite the name, a facelift is a highly effective method for removing excess skin from the cheeks and lower face, softening nasolabial folds (the lines between the nose and the corners of the mouth), tightening the neck, erasing a double chin, and rejuvenating the jawline.

The primary goal of a facelift is to refresh and rejuvenate the face in a subtle, discreet way. Modern facelift techniques rewind the visible signs of ageing by about 10 to 15 years without creating the unnatural, overly tight look often associated with outdated surgical methods.

We truly “turn back time”, but we do not stop the ageing process itself. Most patients are satisfied with a single procedure; however, as facial tissues continue to age, a facelift can be repeated decades later if needed. Regular use of complementary, non-surgical rejuvenation treatments can further extend and enhance the results.

There are many techniques for lifting the lower face and neck. The most appropriate approach is chosen after a thorough examination and detailed discussion, during which we define both the possibilities and the patient’s expectations.

Most commonly, a facelift involves tightening the superficial musculoaponeurotic system (SMAS) and other deeper support structures. With age, the soft tissues of the face loosen and descend under the influence of gravity and reduced tissue quality. This leads to jowls along the jawline, deeper folds, and a tired appearance.

By lifting the deeper tissues and then redraping the skin over this new framework, we create a natural-looking, longer-lasting result. The face does not appear “pulled” or over-tightened, as it sometimes can after simple skin-only lifts.

Subcutaneous (skin-only) facelift

Subcutaneous lifting is mainly suitable for slim women with good deep support structures (fat pads, ligaments and bone structure) and excess skin only, or for patients who have already had a more extensive lift in the past and now require a minor “touch-up”.

With this technique, the results are less long-lasting than with deeper methods, because the underlying tissues continue to age and sag, which eventually pulls the skin down again. A classic, deeper facelift rejuvenates multiple layers of the face, providing more durable results. As a general rule, the shorter and less extensive the surgery, the shorter the duration of the effect.

Minilift

A minilift refers to several limited-lift techniques using shorter incisions. They are suitable for patients with early signs of ageing, typically in their thirties or forties. In many cases, a minilift produces more modest results – but that does not mean it is unsuitable. For the right candidate, a subtle, early intervention can be very effective and prevent more pronounced changes later on.

Deep plane facelift

The deep plane facelift allows the surgeon to work in the deeper layers of facial muscles and supporting tissues. This very popular technique focuses on releasing deep ligaments and repositioning the muscle and fat layers as a unit, rather than simply pulling on the skin.

This approach offers particularly natural rejuvenation of the face and neck with longer-lasting results, as the lift occurs where the ageing process actually takes place – in the deeper support structures.

S-lift

The S-lift is a classic facelift technique named after the S-shaped incision. The scar follows the hairline along the temple and extends in front of the ear. Since it does not extend behind the ear, this method is most appropriate for patients with minimal neck laxity or those in whom signs of ageing are just beginning to appear and who wish to refresh the lower face with smaller incisions.

Subperiosteal facelift

The subperiosteal facelift is a deep-layer lifting technique usually performed with the assistance of an endoscope – a small camera that allows the surgeon to work through several tiny, hidden incisions.

In this method, all soft tissues above the bone are lifted as a block and repositioned into a more youthful position. At the same time, facial implants can be placed on the bone in areas where additional projection or contour is desired.

This technique is associated with more pronounced swelling, but can achieve powerful structural rejuvenation in selected patients.

A facelift is usually carried out under general anaesthesia. The operation lasts around 4 hours; if additional procedures are performed at the same time (blepharoplasty, brow lift, lipofilling, etc.), the duration is longer.

After surgery, the patient remains at the clinic for observation and stays overnight. Our medical team ensures comfort and is ready to act immediately in case of complications such as haematoma (a larger collection of blood).

At the end of the operation, the wounds are covered with sterile gauze and a supportive bandage is applied around the head and neck area. The first dressing change takes place the day after surgery. At that time, the gauze and bandages are replaced, drains are removed and the patient can usually be discharged home.

Hair is washed in the operating theatre before the bandage is applied, as hair washing is not allowed immediately after surgery. Showering is generally allowed the day after the procedure.

Immediately after surgery, opening the mouth widely may be temporarily difficult, so we recommend bringing a soft (children’s) toothbrush or mouthwash to help with oral hygiene. Dental treatments should be postponed for at least one month.

After a facelift, all strenuous exercise, lifting heavy objects, housework, and similar activities are strictly prohibited until your surgeon allows them. Excessive activity too soon can lead to complications and delayed healing. Any impact or pressure on the operated area can cause haematoma, wound breakdown, infection, or even tissue loss. Considering the investment – both financial and emotional – careful protection of the surgical result is essential.

Postoperative swelling can be minimal, but it may also be extensive enough that the patient barely recognises themselves in the first few days. It is essential to thoroughly prepare both the patient and their caregivers for this temporary appearance. The patient is given the surgeon’s personal contact number and can call at any time. Anxiety and concern in this period are understandable, but must be balanced with the knowledge that this phase is normal, expected, and temporary.

Swelling usually increases over the first three days as part of the natural healing response. Applying cold compresses (20 minutes on, 20 minutes off) helps to reduce swelling and discomfort. It is crucial not to place ice packs directly on the skin, as reduced sensation may prevent the patient from feeling cold damage.

Resting with the head elevated and the upper body slightly raised is very important. Swelling may temporarily increase when the patient becomes more active, and blood pressure rises – this is normal.

In the cheek and under-chin area, swelling can feel firm or tight. This alone is not a cause for concern. However, if swelling becomes progressively larger, tens,e and reddish, the patient should contact the surgeon immediately, as this could indicate a haematoma that requires urgent surgical evacuation.

Bruises gradually fade, changing colour from red to purple, then green and yellow. Arnica, bromelain, and vitamin K may help bruises resolve faster, but any medication or supplement should be used only after consulting the surgeon.

Because of gravity, blood may track downward through the tissues, causing bruising to appear on the neck and lower face. Swelling and bruising generally subside within 1 to 2 weeks, and during this time the patient usually begins to recognise and enjoy their new appearance. The full effect of the facelift often becomes visible in 4 to 6 weeks, although minor residual swelling can persist for several months.

Sutures in the visible areas are usually removed after 5 to 7 days; those in the hair-bearing scalp may stay a little longer to provide extra support and are removed after about 10 to 14 days. The incision line typically heals well within 2 weeks, although the scar remains pink for several months. Once healed, it can be easily concealed with a hairstyle and light make-up.

Areas of reduced or altered sensation around the ears or cheeks are common after surgery. Numbness and decreased sensitivity usually improve over a few weeks to months. During this period, extra care is needed when using cold packs, hot rollers, or hairdryers, as the skin may not fully “feel” heat or cold. As sensation returns, tingling or itching can occur – this is normal and may be relieved with simple analgesics if needed, always after consulting your doctor.

Recovery from a facelift is usually not very painful. Patients most often report a feeling of tightness or pulling behind the ears. As the skin relaxes slightly and swelling decreases, this discomfort gradually subsides. If significant, increasing pain occurs, the surgeon should be notified immediately.

Patients can return to work after about 5 days, provided that residual swelling and bruising do not interfere with their professional role. Full social activity is usually possible after 2 to 3 weeks. For faster recovery and reduction of swelling, we often recommend supervised physiotherapy and lymphatic drainage of the face.

It is very important to avoid direct sun exposure for at least 6 months after surgery. If sun exposure cannot be avoided, a high-factor sunscreen is absolutely essential.

The most excellent satisfaction and the best confirmation of a good result occur when family and friends notice that the patient looks refreshed and younger, but cannot tell why. Achieving this kind of discreet, natural rejuvenation is the goal of every skilled surgeon.

However, in some cases, the result is not ideal, and the facelift may leave certain characteristic signs of a less successful procedure. It is essential that the surgeon be aware of these risks and take every possible step to avoid them.

• Attached earlobe (pixie ear)
  A flattened or “stuck-on” earlobe, fused to the side of the face, is a classic giveaway. It occurs when too much skin is removed from the earlobe, and the closure is under excessive tension.
• “Joker” smile
  An unnatural appearance of the nasolabial fold when smiling – tight, immobile, and overly accentuated – can be another sign. This can develop many years after an otherwise technically correct procedure, as facial tissues continue to thin with age. In such cases, injecting the area with the patient’s own fat can help restore a more natural look.
• Overly open ear canal
  Normally, the ear canal is partially covered by cartilage. If too much skin is removed in front of the ear, it can create a pull that exposes the cartilage and opens the ear canal, making it look unnatural.
• Over-tightened face
  An overly pulled, “wind-tunnel” look is a consequence of incorrect skin tension due to poorly tailored skin flaps or insufficient support from the deeper structures.

Hairline changes and loss of sideburns

In some techniques, the hairline in front of the ear can be shifted upwards and backwards. If the procedure is repeated several times, the sideburns may gradually disappear. With careful planning of incision placement and skin tailoring, the sideburns can be preserved, although this may sometimes increase the visibility of the scar. Here, the surgeon’s judgment and aesthetic sense are crucial in balancing scar placement and hairline preservation to achieve the best overall result.