Facelift Surgery (Rhytidectomy) Cost and Procedure Guide

What can a facelift achieve?

A facelift (rhytidectomy) can give patients a more youthful, rejuvenated appearance. As we age, our skin gradually loses its elasticity, and our facial muscles slacken. This creates the appearance of wrinkled, sagging skin, especially on the face. Lifestyle factors such as sun exposure, smoking and stress can also contribute to these changes. This can affect confidence and make patients look older than they feel. Thus, a facelift aims to restore the vitality in facial appearance.
By lifting and pulling back the skin and soft tissues of the face, a facelift can:

• Smooth the skin on the face.
• Reduce the appearance of fine lines and wrinkles.
• Reduce flabby or sagging skin around the face.
• Restore definition in the face.
• Give a more youthful appearance.

What a facelift will not resolve

A facelift will only smooth and tighten the skin of the lower half of the face. However, often the surgeon can combine a facelift with the following procedures to address other concerns:

• Brow lift – this can reduce wrinkles on the forehead.
• Blepharoplasty – this can correct the sagging of the eyelids.
• Neck lift – this tightens and lifts the skin of the neck.

The surgeon can perform these procedures at the same time as the facelift. Patients can discuss all options with the surgeon during the consultation.

Why choose to have a facelift?

Ageing is a natural process, and gradually signs will begin to show on the face. However, often lifestyle factors can lead to premature wrinkles and lines, leaving some people unhappy about their appearance. If this is the case, patients may be considering a facelift. The best facelift candidates will have features and concerns that a BAAPS/ BAPRAS approved surgeon can improve through this procedure. Patients may be suited for a facelift if:

• The appearance of the face is making the patient look older than they feel.
• The face is showing visible signs of ageing, such as fine lines and wrinkles.
• The patient wants to restore a youthful, more fresh appearance.
• The patient wants to redefine the face by reducing loose, sagging skin.

How much does facelift surgery cost?

Facelift Surgery usually costs between £5,000 and £12,000. Prices can vary significantly depending on several factors. These factors include:

• Surgeon experience
• Anaesthetist experience
• Which hospital or clinic is chosen for the procedure
• The complexity of the individual procedure
• Surgical techniques (for example, SMAS Facelift or the MACS Facelift)
• Combination surgeries (like a Facelift & Neck Lift)
• The time required in surgery for each patient’s case

During the free consultation, each patient has the opportunity to explain to their surgeon what they are hoping to achieve from the surgery. The surgeon will, in turn, offer suggestions on how best to achieve those goals; together, they will go through the list above to create a personally tailored procedure package. Only after the consultation can a fixed price be determined, which is reflective of the decisions met during the consultation

Once a price is set, there are no hidden fees. The price covers:

• Surgeon and anaesthetist costs
• Hospital costs
• Overnight stays (if required)
• Aftercare and follow-up appointments

Who are the best candidates for a facelift?

Some patients are more suited than others to a facelift procedure. This depends on a variety of factors. The ideal candidates for a facelift will have the following features:

Good skin elasticity & strong bone structure

It is best if the skin still has some natural elasticity and suppleness as it will conform to its new, improved contours. A well-defined bone structure also contributes to satisfying results.

Good general health

It is important to be in good general health before having facelift surgery. This may mean stopping smoking before surgery or losing weight before the procedure. This will reduce the risk of complications and help patients achieve better results from the surgery.

Loose skin, wrinkles & deep creases

A facelift is an excellent way to reduce flabby or sagging skin, reduce wrinkles, and smooth out deep creases.

How is a facelift procedure performed?

The facelift procedure involves raising and repositioning the soft tissues of the face. The surgeon will do this by making an incision on both sides of the face, in front of the ears. They will then remove excess skin and fat and then tighten the muscles and soft tissues. Finally, they will lift and pull back the skin before closing the incision.

There are a number of different techniques the surgeon can use for a facelift procedure. Patients will have met with their BAAPS/BAPRAS surgeon for a consultation prior to the surgery to discuss the different options and what technique would be most suitable for them to achieve their goals. A facelift can take anything between 2 to 5 hours. This also depends on whether patients will have additional procedures, such as a neck lift, performed at the same time. Below is an overview of what will happen on the day of the facelift procedure.

Consent

Patients will need to give consent for the operation in the form of writing. Patients will do this before the surgery. This ensures that they have had enough time to obtain information about the facelift procedure, including the benefits, risks, and complications involved. Before patients sign the consent form, they should also make sure that they have asked the surgeon any questions regarding the procedure. Once patients have done this, the surgeon will demonstrate where they will be making the incisions by drawing lines on the procedure area.

Anaesthesia

Patients will meet the anaesthetist. This is the doctor who will be responsible for giving the anaesthetic. The surgeon will have discussed what type of anaesthetic the patient will. This will either be a general or a local anaesthetic. A general anaesthetic will put the patient safely to sleep throughout the entire procedure. A local anaesthetic will numb the surgical area, and the anaesthetist will also give a sedative medication at the same time. This will help to keep the patient to be relaxed throughout the operation.

Incisions

In the operating theatre, the surgeon will prepare for the operation by cleaning the treatment area and draping over a sterile sheet. The surgeon will then make an incision. The incisions will vary slightly in size and location according to the technique used. The general technique involves the surgeon separating the skin from the underlying tissue before removing the excess fat and tightening the tissues. The surgeon will then use stitches to fixate the lifted tissue to its new position. Afterwards, they may reposition the excess fat to enhance the contours of the face. If there is not enough excess fat, the surgeon can also retrieve fat using liposuction.

The different areas the surgeon may perform the facelift include the following:

Mini facelift

If patients are only beginning to show signs of ageing, they may not need a full facelift surgery. A mini facelift may be an ideal alternative. This technique involves the surgeon making small incisions in front of or behind the ear. Depending on the degree of lift needed, the surgeon may also make a small incision along the hairline. They will then insert a stitch just under the skin and into the underlying fibrous tissue. The surgeon will use this stitch to lift the cheeks, jowls and upper neck.

Mid facelift

While the above techniques mainly focus on sagging around the jowls and jawline, a mid-facelift can address laxity and flatten the skin in the middle segment of the face. This includes the cheek area below the eyelids and next to the nose. The surgeon will make small incisions in the hairline and either the mouth or lower eyelid. The surgeon can then tighten the muscles and reposition the fatty tissue upwards. This restores volume in the cheeks to create a natural, youthful contour to the face. This technique is ideal for patients who want to achieve a subtle but noticeable lift and fullness to their cheeks.

Full facelift

A full facelift is more suitable for older patients looking for a more dramatic final result. The full facelift targets the cheeks, jowls, temples and upper neck. Often, it does not include the brow area or neck area and a brow lift or neck lift may need to be added on. The surgeon will discuss if the patient is a candidate for a full facelift or a mini facelift.

There are also different techniques that the surgeon may use, which include the following:

SMAS facelift

This is the traditional facelift technique and involves manipulating the Superficial Musculo Aponeurotic System (SMAS). This is a deep layer of tissue that contains muscles and support structures of the face. In this technique, the incision is made along the hairline, past the front of the ears to below the earlobe, and behind the ears. The incision is deep and extends under the SMAS layer. The surgeon can elevate and tighten the tissue of the SMAS and uses stitches to fixate it to its new position. Although it is a longer procedure with a longer recovery time, this technique produces long-lasting results. It is also more suitable for men and women who have more severe sagging of facial skin.

Minimal Access Cranial Suspension (MACS) facelift

With this technique, the surgeon will make a smaller incision that does not extend to the ear. The incision is more superficial and does not go under the SMAS layer. This technique is less extensive than the SMAS technique, so it is better suited to correcting milder laxity of facial skin. The advantages of this method are smaller scars and a shorter recovery time.

Closing of incisions

The surgeon will lift and pull back the remaining skin and stitch it to its new position. They will use absorbable and non-absorbable sutures to close the incision. Afterwards, they will apply a light dressing to the face to help minimise bruising and swelling. These bandages will come off after a couple of days. Patients may also have a small drainage tube placed under the skin behind the ear to drain any fluid.

Return to the ward

At the end of the surgery, the nurses will move the patient to a recovery room. Here, patients will gradually wake up from the anaesthetic under close supervision.

What to expect from a facelift consultation?

The facelift consultation is an opportunity for patients to meet with their prospective surgeon to discuss the procedure and what they would like to achieve from it. This will last 15 minutes to an hour. Patients will talk with their surgeon about their concerns, and they will assess the patient's face and the problem areas. The surgeon can then discuss with the patient the best surgical approach to the problems they have expressed. If appropriate, they may suggest procedures for other parts of the face such as the eyelids or brows. Often, these can be performed at the same time as a facelift. The surgeon will also discuss the potential risks and complications that come with a facelift procedure. It is important to be aware of these so that patients can make an informed decision on whether or not they wish to go ahead with the procedure.
To assess suitability for surgery, the surgeon may ask about the following:

• Any current medical conditions.
• Past medical history.
• Previous surgeries
• Medications (including over-the-counter and herbal remedies).
• Intake of alcohol.
• Smoking history.
• Any allergies.

During the facelift consultation, it is recommended that patients are as open as possible with the surgeon. Be honest about all expectations and desired outcomes. The surgeon is there to listen carefully and to help achieve the goals the patient wants. This also means letting the patient know if their expectations are not realistic. In this case, they may suggest better alternatives.

Questions to ask during a facelift consultation

Patients can ask the surgeon any questions they have about the procedure during the free facelift consultation. The following are some examples of questions that patients may consider asking:

• Will a facelift correct the concerns I have expressed?
• What scars will I be left with?
• What other options are available for me?
• Will I benefit from a neck lift/browlift/eyelid surgery too?
• Do you have any before and after pictures of previous facelift procedures you have performed?
• Will I be in pain after the surgery?
• How soon after a facelift can I return to work?

What are the main facelift risks and complications?

With any surgery, there are risks and complications that can occur. It is really important for patients to be aware of what these are so that they can feel fully confident in choosing to go ahead with the surgery. Below is listed the main facelift risks and complications. Patients should read these through carefully and take a while to think about them. The surgeon may also give a two-week “cooling-off” period after discussing the facelift risks and any of the concerns during the consultation. This will give patients time to decide if they are happy to proceed with the surgery.

Bruising & bleeding

Some bruising of the treated area is common after surgery. This should resolve over the first couple of weeks. Patients may also experience slight bleeding from the incision site. This typically occurs right after surgery but may occur a few weeks later. However, if patients notice significant bruising, pain, and facial swelling, inform the surgeon immediately. It is possible that patients may have a haematoma, which is a solid collection of blood under the skin. These usually occur within 24 hours of surgery and require medical attention to treat.

Tissue necrosis

Facelift surgery involves cutting into the skin and the underlying tissues of the face. Therefore, although uncommon, some areas of the skin or tissue can lose their blood supply during the operation. This can result in these areas of the tissue to necrose, or die, after the surgery. As this will affect the results, patients may need to have another operation to treat this.

Infection

Although every effort is made to minimise the risk of infection during surgery, it is still possible for an infection to occur in the treated area. Therefore, it is important that patients are aware of the signs of infection. Signs to watch out for:

1. Feeling feverish with a temperature over 38° C.
2. Redness at the incision line that is spreading after the first 48 hours.
3. Yellow pus-like or foul-smelling fluid seeping from the incision.
4. Increased pain or discomfort that pain medication does not resolve.

Scarring

Unfortunately, it is not possible to avoid scarring where the surgeon has made incisions. The size and location of the scars will vary according to the technique used. Patients should discuss what scarring to expect with the surgeon. Most scars will be minimal, and the surgeon will make them as discreet as possible. Remember that scars will also fade with time. How much they fade will depend on the healing ability of the skin. The surgeon may also offer more tips on how to care for the wounds, to minimise the scarring.

Skin discolouration

Sometimes the skin where the surgeon has operated on can change colour slightly after the surgery. This should settle over a few months. Patients should be able to easily cover this with makeup if it concerns them.

Nerve injury

If, during the surgery, the nerves in the face are injured, patients may lose some feeling or movement in their face. In most cases, this is temporary. However, rarely, more long-term loss of sensation or movement can occur. Choosing highly skilled and experience BAAPS/BAPRAS surgeons will minimise this risk.

Hair loss & hairline distortion

Hair loss can occur at the site of or around the incisions. This may be temporary, and the hair may grow back. However, it can also lead to a permanent reduction of hair growth. It is also possible for the hairline to become distorted after facelift surgery, depending on where the surgeon makes the incisions. In men, as a facelift procedure involves trimming, lifting and tightening the skin under the beard area, it is possible that a beard may grow closer to the patient's ears. Generally, this will only be noticeable to the patient and should not make a large difference.

Aesthetic

After cosmetic surgery, there is always the possibility that patients find they are unhappy with the procedure results. There is also a risk that after a facelift, a patient's facial features will look asymmetrical. For example, the position of the earlobe may be slightly higher up than the other side. Most of the time, this will not be noticeable to anyone other than the patient. It is advised that patients talk openly with their surgeon during the consultation about desired outcomes and expectations. This can help to ensure patients are not displeased with the results.

General surgical complications

All surgeries carry some common risks. These include the development of a blood clot, nausea and vomiting, and postoperative pain. As the surgery involves using an anaesthetic agent, it is also possible that patients may develop anaesthetic complications.

How to prepare for a facelift?

Preparation is key for a smooth and speedy recovery. Doing some household chores and planning ahead will make the patient's life easier after the surgery when they will need to take things slow as the wounds heal. Below are some simple facelift preparation tips that can help patients make a smooth recovery:

Household work

Patients might want to do certain tasks like cleaning the house, taking the bins out, or doing the washing, before the day of the operation. This way, you won’t have to do these chores during the recovery period. Coming home to a clean and tidy house is sure to make patients feel more comfortable and at ease.

Shopping

It’s good to stock up on some key food items that can be kept in the cupboard or the fridge. Patients may not feel like leaving the house for a couple of days after the surgery, so this will save patients from having to go to the supermarkets when they return home. Another good idea is to buy some frozen ready-meals or cooking meals ahead of the surgery and freeze them for later use 

Children and pets

Looking after pets and young children can often be a handful. After a surgical procedure like a facelift, it is understandable to be tired and lacking the usual energy. Asking friends or family to mind children or pets can, therefore, help lift some of the stress involved with this. As another option, patients might wish to get a babysitter or nanny to help them with the little ones for a short time during recovery.

Driving

After the surgery, patients will not be able to drive as the effects of the anaesthesia wear off. Therefore, be sure to have organised for someone to be on pick up duty. It's recommended to ask a friend or family member, rather than a taxi service, as patients generally, will feel more at ease having someone familiar with them.

Diet

A healthy diet is an important factor in helping to heal and recover after a facelift. Eat lots of healthy green vegetables, fresh fruit, and high-protein foods such as chicken, fish and legumes. Drink plenty of fluids – water is best. Tea and coffee are high in caffeine, so try to keep those to a minimum. Also, try to avoid foods that are high in sugar and salt as much as possible.

Clothing

Try to get clothing that fastens in the front or the back. Clothes that have to be pulled over the head will make contact with the treated area of the face and might cause friction against the wounds. Loose clothing such as jogging bottoms will be comfortable to relax at home during the recovery.

Sleeping

The face might feel delicate the first few days after surgery so patients may find it uncomfortable sleeping face down. Patients may, therefore, want to have some extra pillows prepared for after surgery so they can sleep propped up, on their back. Resting in an inclined position on pillows also has the benefit of reducing swelling around the treated area.

What to expect after a facelift?

Knowing what to expect after a facelift surgery can help to make patients feel more comfortable and at ease on the day of surgery. The surgeon will discuss the details of the facelift aftercare process during the consultation. They will provide information on how best to take care during the recovery.

As part of the facelift aftercare, the surgeon will also organise a follow-up appointment. This often takes place within two weeks of the surgery. During this appointment, the surgeon will check all wounds to see how they are healing, remove any non-dissolvable stitches, and remove or replace any dressings if necessary. They will also address any complications.

Waking up after surgery

If patients are put to sleep with a general anaesthetic, they will gradually wake up following surgery under close supervision. Patients will have dressings around their face and may also have drainage tubes in place. The nurses will often remove any drainage tubes before patients go home. The bandages will normally stay in place for one or two days. If a local anaesthetic was used, patients might feel a change in sensation in the treated area of the face. This will eventually wear off. The treatment area may also feel slightly tight and tender. The surgeon or the nurses in the recovery room will offer painkillers that patients can take if necessary.

The first 24 hours

Patients should have a responsible adult to stay over for at least 24 hours after the surgery. This is because, after a general anaesthetic, patients will feel tired and groggy. The anaesthetic can also affect memory and concentration for a few hours to up to 2 days. It is good to have someone there to help if, at any point, the patient feels dizzy or unsteady. It is, therefore, recommended patients ask a friend or relative in advance. Patients can also ask them to drive home after the surgery, as patients will not be able to drive themselves.

Time off work

The recovery period may depend on the surgeon's surgical technique and how extensive the particular facelift procedure is. In general, patients will need to take around 2 weeks off work. Some patients may need longer if their job is more active. Patients should therefore listen to the exact time frames that the surgeon provides.

Exercise and sports

Patients should avoid any strenuous activity and contact sports for at least 4 to 6 weeks after facelift surgery. However, patients should be fine to resume some light physical activity after two weeks. Start off gently, with light aerobic activity such as walking on a treadmill. Do not do any exercise during the first week, as this can increase the amount of swelling and bruising.

Swelling & bruising

This is common around the treated area for the first couple of weeks after facelift surgery. Generally, this will be at its worst 3 to 4 days after the operation and will then gradually begin to settle. Sleeping and resting with the head propped up with pillows for the first 10 to 14 days can also help to reduce any swelling. 

Scarring

For the first few weeks, scars typically appear raised. They will eventually fade to faint lines. Avoid too much sun exposure to the treatment area as this can cause permanent darkening of the area.

Saunas and heat

Avoid anything that may promote facial flushing for 4 to 6 weeks. This includes saunas, steam rooms, and steam face masks.

Compression bandage

The surgeon may advise wearing a compression bandage around the face for the first initial weeks post-operatively. How long each patient needs to wear the bandage will depend on the individual surgeon’s specific advice.

Final results

There will, of course, be a noticeable difference to the face immediately after surgery. Still, it is important to remember that patients may not be able to appreciate the final cosmetic results until 6 to 9 months after surgery. This is because there is often some residual swelling, some scarring may take longer to fade, and it may take a while for the area to heal fully. Immediately after the surgery, the skin on the face may at first look and feel too tight. This will gradually settle within 6 weeks. After some weeks, patients will gradually feel more like themselves and appreciate a rejuvenated and youthful look.

A facelift is not a permanent solution. No cosmetic procedure can stop the effects of time and ageing. Genetic factors and environmental factors such as sun exposure and smoking can also speed up the natural ageing process and reverse the effects of a facelift. However, the results achieved from facelift surgery are long-lasting.

This will also depend on the type of procedure you have, the technique used, and the quality of your facial tissue. The effects of a full facelift can remain for over a decade. This means that most patients only undergo one facelift in their lifetime. There are some precautions you can take to limit the effects of environmental factors. These include using sunscreen, wearing sunglasses and a hat when outside, moisturising regularly and staying healthy and hydrated.

You should not wear makeup until your surgeon gives you the approval to do this. Usually, it is possible to start wearing makeup again two weeks after your procedure. You can then use camouflage cosmetic products if you wish to cover any bruising you may have. Talk to your Patient Care Adviser if you're ever unsure of what you can and can't do following facelift surgery.

Your surgeon will give you specific advice on how to wash and bathe after the surgery.  In general, you may shower and wash your hair 48 hours after facelift surgery. Use a mild shampoo and be particularly careful around the surgical area. You can also blow dry your hair on a cool setting. Be gentle when brushing or combing your hair so that you do not catch your comb in the suture lines. You must follow your surgeon’s specific advice.

It is normal to feel a little self-conscious when you are in public due to the swelling, redness and bruising around the treated area after a facelift. However, the vast majority of bruising and swelling should have settled by around four weeks. By this time, most people feel comfortable enough to be seen by friends and colleagues. Full recovery, however, takes several months. We, therefore, advise that you plan ahead. If you have a major event coming up such as a wedding or birthday, plan your surgery two to three months before it.

The majority of patients do not need a GP referral to see a cosmetic surgeon for an initial facelift consultation. However, if you decide you want to go ahead with the procedure, your surgeon will require more detailed information on your medical history. In this case, they may contact your GP for this information, with your permission.

Certain medical conditions may also need a GP sign off prior to having the facelift surgery, but your Patient Care Adviser will let you know if this is necessary.

Smoking and drinking excessive amounts of alcohol can increase your risk of a number of complications from surgery. This is why we advise you to cut back on alcohol and stop smoking well in advance of the operation. Six weeks is the least we require you to be smoke and nicotine-free before your facelift surgery.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/cosmetic-procedures/facelift/ NHS
• https://baaps.org.uk/patients/procedures/12/facelift_and_necklift British Association Of Aesthetic Plastic Surgeons
• https://www.bapras.org.uk/public/patient-information/surgery-guides/face-and-brow-lift British Association of Plastic, Reconstructive and Aesthetic Surgeons
• Understand.com Understand

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.