Facelift science
Each technique in the terms surgeons use, with the anatomy it relies on, the evidence for it and the papers behind every claim.
Facelift anatomy
The face is built in layers: skin, fat, a fibrous muscle sheet called the SMAS, a deep fascia, and the facial nerve branches under that fascia. Facelift techniques differ by which layer the surgeon lifts, which ligaments are released, and how close the dissection runs to the nerve.
Deep-plane facelift
A deep-plane facelift lifts the skin, fat and SMAS as one flap after releasing the ligaments that hold the cheek down, instead of lifting skin and SMAS separately. It dates to Hamra's 1990 paper and is now the most-used facelift among surveyed facial plastic surgeons, though head-to-head evidence of longer-lasting results is limited.
SMAS facelift techniques
Most facelifts tighten the SMAS, the fibrous layer under the facial fat, either by folding it with stitches (plication), cutting out a strip (SMASectomy) or lifting it as a separate flap. Reviews find high satisfaction with every SMAS method and no single method proven best.
Deep neck lift
A deep neck lift treats the structures under the platysma muscle (deep fat, the digastric muscles and the submandibular glands) as well as the skin and muscle on top. Surgeons add it when a neck stays full after skin and muscle tightening alone.
Hemostatic net and hematoma prevention in facelift
Hematoma, a collection of blood under the lifted skin, is the most common early complication of a facelift. Surgeons lower the risk by controlling blood pressure, by drugs such as tranexamic acid, and by the hemostatic net, a row of temporary stitches through the skin that closes the space where blood can collect.
Short-scar facelift and MACS lift
A short-scar facelift uses a shorter incision and less skin undermining than a conventional facelift, to limit scar visibility and recovery time. The best-known version, the MACS lift, holds the face up with purse-string sutures anchored at the temple; it acts mainly on the jowls and upper neck, and its effect on an aged neck is limited.
Subperiosteal, vertical and preservation facelifts
A subperiosteal lift raises the facial soft tissue from the bone, under the periosteum, and moves the whole "mask" upward. Vertical and "preservation" facelifts are newer variants that lift in a more upward direction and leave more tissue attached, often through endoscopic or hidden incisions.
Anesthesia and recovery in facelift surgery
Facelifts are done under general anesthesia, intravenous sedation, or local anesthesia with or without oral sedation, and most are outpatient operations in an accredited office facility. The anesthetic plan matters because blood pressure spikes, nausea and vomiting raise the risk of bleeding under the skin flap.
Fat grafting and volume with facelift
Faces age by losing volume as well as by sagging, so surgeons often inject the patient's own fat during a facelift to refill the cheeks, temples and folds. Part of the grafted fat does not survive, and some surgeons use injectable poly-L-lactic acid afterward to replace lost volume.
Facelift and neck lift after nonsurgical treatment and GLP-1 weight loss
Fat-dissolving injections, radiofrequency devices, threads and fillers can leave scar tissue that makes a later neck lift or facelift harder and less smooth. Rapid weight loss on GLP-1 drugs such as semaglutide removes facial fat, mostly from the superficial layer, and creates a new group of patients seeking volume and lifting surgery.
Facelift complications and outcomes
Serious complications after a facelift are uncommon: in a database of 11,300 facelifts, 1.8% had a complication needing an emergency visit, admission or reoperation, most often a hematoma. Patient-reported surveys show high satisfaction at 1 year that declines over a decade as aging continues.
Male facelift
Men are about one in ten facelift patients, and their operation differs in incision placement around the beard and hairline, in the goal of a masculine rather than youthful result, and in a higher bleeding risk. Male sex is the most consistent risk factor for hematoma after facelift across large series.
Secondary and revision facelift
A secondary facelift is a second facelift years after the first, usually for continued aging; a revision corrects a result that fell short or a deformity from the first operation. Secondary lifts are a growing share of facelift practice and carry a higher rate of temporary facial nerve weakness because scar tissue changes the anatomy.
History of the facelift
The facelift began in the early 1900s as excision of skin alone, moved to wide skin undermining in the 1920s, and in the 1970s shifted to lifting the deeper SMAS layer. Since 1990 the field has divided into deeper release techniques (deep plane, composite, subperiosteal) and shorter-scar, less-dissection techniques, with volume restoration added to both.
Research by topic
Every PubMed paper, tagged by topic.