In short. A full facelift, or comprehensive rhytidectomy, repositions the SMAS and the skin over it, usually with a neck lift. It changes laxity and descent, not bone, fine lines or the ageing process. The trade-off is general anaesthesia, weeks of recovery and permanent scars around the ear and hairline, for a lift that no injectable or energy device matches.
Key points
- A full facelift repositions the SMAS; a skin-only lift relaxes within a couple of years.
- It restores jawline and neck contours but cannot change bone, fine lines or ageing.
- Most patients look roughly seven to ten years younger, then continue to age from there.
- Expect general anaesthesia, three to five hours of surgery and two to four weeks off work.
- Named risks include haematoma, facial nerve weakness, skin necrosis and permanent scars.
The anatomy behind the ageing face
Facial ageing happens on every level at once. Skin loses elasticity and develops laxity. The fat compartments of the cheeks descend and thin, while the jowls gain volume. Beneath the skin lies the SMAS, the superficial musculoaponeurotic system, a fibrous layer connected to the facial muscles. A facelift that only pulls skin relaxes within a couple of years; a modern full facelift repositions the SMAS and removes the redundant skin, which is what gives the result its durability. Understanding this distinction is the starting point for any honest consultation.
Who does a full facelift suit, and who should not have one?
The typical candidate is between the late forties and the seventies, with visible jowling, cheek descent and neck laxity, but skin that still has reasonable elasticity. General health matters more than the number on the birthday: controlled blood pressure, no active cardiac disease and no smoking are the baseline requirements. Smoking deserves special emphasis because it multiplies the risk of skin necrosis behind the ear. Unrealistic expectations are a genuine contraindication: a facelift can make someone look rested and younger, it cannot make a sixty-year-old look thirty, and a surgeon who promises otherwise should be avoided.
How do plication, excision and the deep plane compare?
Not every facelift is the same operation. Skin-only lifts are largely historical. Modern practice works on the SMAS, and the meaningful debate is how that layer is handled and how deep the dissection goes.
| SMAS plication | SMAS excision (imbrication) | Deep plane | |
|---|---|---|---|
| How the SMAS is handled | Folded and sutured without separating it | A strip of the layer is removed and the edges sutured | Released entirely, so skin and muscle move as one unit |
| Depth of dissection | Least | Intermediate | Deepest |
| Suits | Moderate laxity | A middle ground between them | Where the most natural midface result is wanted |
| Operating time | Shortest | Intermediate | Longer |
| Technical demand | Lower | Intermediate | Greater |
The choice depends on your anatomy, not on fashion.
Incisions, anaesthesia and operating time
The incision begins in the temple hairline, follows the natural curve in front of the ear, passes around the earlobe and continues into the hair behind the ear. When the neck is treated, a small incision under the chin is added. In a tertiary hospital setting the operation is performed under general anaesthesia or deep sedation with full anaesthetic monitoring, and an ICU is available in the rare event of an anaesthetic complication. The procedure typically takes three to five hours, longer when combined with a neck lift or fat grafting.
What can a full facelift change, and what can it not?
A facelift restores jawline definition, softens jowls, smooths the lower cheek and improves the neck. It cannot change bone structure, cannot erase fine lines around the mouth or crow's feet (those belong to resurfacing or injectables), and cannot stop ageing. Most patients look roughly seven to ten years younger; the face then continues to age from that new starting point. The clock is turned back, not halted.
Recovery, scars and named complications
Expect visible bruising for about two weeks and swelling that lingers for six to eight weeks. Most patients feel presentable at three weeks and return to work at two to four weeks depending on the job. Numbness of the cheeks and ears is normal and can persist for several months as sensory nerves recover. Final judgement of the result should wait until six to twelve months, when residual swelling has fully settled.
Scars are permanent, though they fade into the natural creases and are usually concealed by hair and ear contours. The named risks include haematoma (blood collecting under the skin, the most common early complication, occasionally requiring drainage), temporary or rarely permanent facial nerve weakness, skin necrosis (markedly more frequent in smokers), wide or visible scars, and altered hairline position. Each of these is discussed individually in consultation, not glossed over.
Revision, combination and follow-up
A facelift is frequently combined with a neck lift, fat grafting to restore cheek volume, or resurfacing for skin texture; staging these reduces risk. Touch-up procedures are not a sign of failure: small revisions of a scar or a minor asymmetry are sometimes appropriate after healing. A secondary facelift, years later, is a normal part of long-term planning rather than an admission that the first operation failed.
Preparation means a full medical assessment, stopping smoking at least four weeks before and after surgery, pausing blood-thinning medication under guidance, and arranging help at home for the first days. Follow-up visits at one week, one month, three months and one year allow the surgeon to track healing and address small problems early. Long-term skincare and sun protection preserve the investment.
Arrange a surgical review if:
- You have jowling, cheek descent or neck laxity that injectables no longer improve, and you are weighing a surgical option seriously.
- You smoke, have high blood pressure or diabetes, or take blood thinners, because these factors change the risk profile and must be assessed before any operation.
- A previous facelift has left visible scars, asymmetry, or a result that has relaxed, and you want an honest opinion on revision.
Sources
Internal links
Frequently asked questions
Why is a skin-only lift not enough?
Skin-only lifting relaxes within a couple of years. Modern practice repositions the SMAS, the fibrous layer connected to the facial muscles, because it is the descent of that layer that drags the cheek fat and jowls downward. Repositioning the SMAS is what gives the result its durability.
How much younger will I look, and for how long?
Most patients look roughly seven to ten years younger, and the face then continues to age from that new starting point. The clock is turned back, not halted. It cannot make a sixty-year-old look thirty, and a surgeon who promises otherwise should be avoided.
What are the risks of a full facelift?
Named plainly: hematoma, the most common early complication and occasionally needing drainage; temporary or rarely permanent facial nerve weakness; skin necrosis, markedly more frequent in smokers; wide or visible scars; and altered hairline position. Scars are permanent, though they fade into natural creases.
Risks & Limitations
- Bruising and swelling lasting weeks; after bone surgery, months pass before the final result is visible.
- Scars are permanent. They mature and fade over 6–12 months but never disappear.
- Numbness or altered sensation, which may be temporary or, after bone or nerve work, lasting.
- Asymmetry, under-correction or over-correction; final assessment is made at 6–12 months.
- Infection, bleeding or haematoma, which may need drainage or antibiotics.
- Breathing changes after nasal surgery, which may be temporary or require further treatment.
- Revision surgery carries higher risk and is less predictable than a first operation.
When to Seek Care
- Difficulty breathing or shortness of breath — seek emergency care immediately.
- Rapidly expanding swelling, or a tense, painful, tight area.
- Fever above 38 °C, spreading redness, warmth or pus.
- Bleeding that does not stop with gentle pressure.
- Any sudden change in vision after facial surgery or a facial injection.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- International Society of Aesthetic Plastic Surgery (ISAPS)
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews in facial plastic surgery
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.