Facelift and Neck Lift

A facelift, sometimes performed with a neck lift as part of the same operation, is a procedure to reposition the tissues of the face and neck that have descended with age. The operation lifts and repositions the deeper structures, removes excess skin, and restores definition to the jawline and neck. It’s one of the more established operations in facial plastic surgery, and while the general principle has been around for decades, the specific techniques have evolved significantly, with modern approaches focused on repositioning deeper tissue rather than pulling on the skin alone.

There isn’t a single facelift technique. Different approaches address different concerns, and the right choice depends on the pattern and degree of change, the quality of the skin, and what the patient is hoping to achieve. Dr Shepherd will assess your specific anatomy at consultation and recommend the technique that suits your situation, including whether a facelift is the right answer at all, or whether a different procedure would produce a better result.

These procedures suit patients with visible descent of the tissues of the face and neck, most commonly appearing as jowling along the jawline, loss of definition at the neckline, deepening of the folds between the nose and mouth, and vertical banding of the neck muscles. These changes are generally related to age, sun exposure, weight changes, or a combination, and they don’t respond to non-surgical treatments once they’ve progressed beyond a certain point.

Age isn’t the deciding factor. What matters is the pattern and degree of change, along with the patient’s overall health, skin quality, and expectations of what surgery can achieve. Some patients in their fifties show enough change to benefit from a facelift. Others don’t need surgery until later, or don’t need it at all. Patients who go into facelift surgery expecting to look like a different person, or to reverse ageing entirely, are generally disappointed. The realistic goal is to look like a more rested version of yourself, with the changes that have accumulated over time softened rather than eliminated.

Some patients aren’t good candidates for facelift surgery. Heavy smokers face a significantly higher risk of skin necrosis (loss of part of the skin flap), and Dr Shepherd will ask patients to stop smoking well before surgery. Patients with certain medical conditions, including uncontrolled hypertension and bleeding disorders, may be at higher risk of complications. Patients with unrealistic expectations, or who are considering surgery for reasons that don’t align with what the operation can actually deliver, are unlikely to be well served by proceeding.

The deep plane facelift is a modern technique that repositions the deeper layer of tissue in the face (the superficial musculoaponeurotic system, or SMAS) along with the skin, rather than treating the skin and deeper tissue as separate layers. The technique produces a more natural repositioning of the face because the skin and the deeper structures move together as a unit, avoiding the tight or pulled appearance that can result from older techniques that relied on skin tightening alone.

In a deep plane facelift, the surgeon dissects in a plane beneath the SMAS, releasing the fibrous attachments that tether the deeper tissue in place. Once these attachments are released, the deeper tissue can be repositioned vertically, restoring facial volume and definition to the areas that have descended with age. The skin then follows the deeper tissue into its new position, without needing to be pulled tightly to achieve the result. This approach can produce a more natural-appearing outcome, particularly around the midface and cheek area.

The deep plane technique isn’t right for every patient or every situation. Other techniques including standard SMAS facelifts, extended techniques and mini facelifts also have their place, and the choice depends on the anatomy and the pattern of change. Dr Shepherd will explain the technique he’s recommending for your situation and the reasoning behind the recommendation.

The neck is a common area of concern in patients considering facelift surgery, and the neck lift component is generally performed at the same time as the facelift rather than as a separate operation. Changes in the neck include loss of definition along the jawline, vertical banding of the platysma muscle in the midline, accumulation of fat under the chin, and loose skin.

The neck lift component is performed through small incisions in front of and behind the ears (the same incisions used for the facelift), often supplemented by a small incision under the chin. Through these incisions, the platysma muscle can be tightened in the midline, fat can be removed or repositioned, and the skin can be redraped. The exact approach depends on what needs to be addressed in your specific neck anatomy.

Some patients have concerns focused on the neck without significant change in the face itself, and in these patients a neck lift alone (without a full facelift) may be appropriate. This is a separate operation with a more limited scar pattern, and it’s an option we’ll discuss at consultation if your anatomy suits it.

Facelift and neck lift surgery is performed under general anaesthesia in an accredited hospital. The operation usually takes between four and six hours, depending on the technique and whether additional procedures (such as blepharoplasty or lip lift) are being performed at the same time. Most patients stay in hospital for one to two nights, with the longer stay reserved for larger operations or where pain control and observation of the surgical site benefit from continued inpatient care.

Incisions are placed in and around the ears, typically starting in the temporal hairline, running down in front of the ear, around the earlobe, and back into the hairline behind the ear. The exact pattern is adjusted for the individual anatomy and the technique used. A small incision may also be placed under the chin to allow access to the neck. All incisions are closed with fine sutures.

Drains are commonly placed to manage fluid that collects in the operated area, and these are typically removed at the first follow-up appointment. A compression dressing is worn around the face and neck initially, and this is often replaced with a lighter compression garment for the first several days.

Recovery from facelift and neck lift surgery involves a period of visible bruising and swelling, which is one of the more challenging parts of the process for most patients. Bruising is significant in the first week and settles progressively over two to three weeks. Swelling settles over several weeks, with the majority of it gone by about six weeks but subtle residual swelling continuing to settle over several months. Sutures are typically removed within the first ten days.

Most patients feel comfortable in social settings after two to three weeks, once the visible bruising has faded and the swelling has settled enough to be concealable with makeup. Full return to normal social and professional life typically happens by four to six weeks, although this varies between patients. Vigorous exercise is off the list for four to six weeks, and heavy lifting and any activity that raises blood pressure significantly is restricted in the early weeks because of the risk of bleeding into the operated area.

Numbness across the operated area is expected in the early recovery period, particularly around the ears and along the jawline. Sensation gradually returns over several weeks to months, although some areas may have lasting subtle changes in sensation. The final result develops over several months as swelling settles fully and the tissues consolidate in their new position. Scars take 12 to 18 months to reach their final appearance.

The recognised risks include:

Facelift and neck lift surgery is classified as a cosmetic procedure and doesn’t attract a Medicare rebate or private health fund coverage. A written quote covering all surgical, anaesthetic and hospital fees is provided after consultation so you have a clear picture of the total cost.

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545