Facelift and Neck Lift

Who it’s for

Mostly people in their forties and older, though age is a rough stand-in for what matters. What decides it is how the skin of your lower face and neck behaves. Pinch it along the jaw and see how quickly it snaps back. Look at yourself side-on and see whether the line from chin to neck is a clean angle or a soft slope.

The clearest candidates are people having jaw and chin contouring whose skin is already loose, and people who are older when they come to FFS and see sagging they would like dealt with at the same time. A heavy neck with visible bands under the chin is the other common reason.

Look elsewhere if your skin is tight and your concern is shape. A lift on young, elastic skin changes very little, and the money does more on bone. And for a square jaw, bone work is the operation that changes the shape.

Hormones are not required. Nicotine is a firmer line here than almost anywhere else on the face, because the lifted skin survives on a thinner blood supply. Most surgeons want nicotine stopped for weeks either side, and some test for it. Blood pressure also needs to be well controlled, for reasons the risks section explains.

Before your consultation

Take a photo of your face from the side with your chin level, then another looking slightly down. If the line under your jaw holds in both, your skin is probably doing its job. If it softens into your neck in the second, that is what a surgeon will be looking at.

How it’s done

The incision starts in the hair at the temple, runs down in front of the ear or just inside its front edge, curls around the lobe and goes back into the hairline behind the ear. Through it the surgeon lifts the skin off the cheek and upper neck.

Underneath is a layer of fibrous tissue and muscle, the SMAS, which is what actually holds the cheek and jowl up. Most modern facelifts work on that layer rather than the skin. The surgeon tightens it with stitches, trims it, or in a deep plane lift releases it and moves it as one unit with the skin. The skin is then redraped upwards and backwards, the excess is cut away, and it is closed without tension so the scar does not stretch.

A neck lift adds a short incision in the crease under the chin. Fat is removed, and the two edges of the platysma muscle, which show as vertical bands when they separate, are stitched together in the midline like a sling. A thin drain is often left for the first night.

In an FFS bundle the lift comes last in the day, after the bone work, so the surgeon drapes the skin over the new jaw rather than the old one. Some surgeons prefer a separate operation six months to a year later instead, once swelling has gone and it is clear how much the skin has tightened on its own. The first saves a second trip. The second means you only pay for the lift you need.

At the consultation

Ask the surgeon what would happen if you had the bone work and waited a year before deciding on the lift. The answer tells you whether they think your skin will tighten on its own, and how they are tailoring the plan to you.

Facelift recovery

The first days feel tight rather than sore. The face and neck are swollen and bruised, a compression garment or wrap is common for the first week, and turning your head feels like it is pulling on something, because it is. Most people are surprised how little pain there is and how much the tightness wears on them.

Sleeping on your back with your head raised matters more than anything else for the first fortnight. So does avoiding anything that raises blood pressure. No bending, lifting or straining, and no hot showers or saunas early on.

By the end of the second week most people are presentable with makeup and a scarf. The face keeps looking slightly too tight, sometimes a little pulled at the ears, for a month or two. That settles as the tissue relaxes, and it is completely expected.

The first two weeks

Set yourself up to sleep on your back with your head raised, and keep anything that makes you strain out of reach. A calm, cool, boring fortnight is the best protection you have against the main early complication.

Facelift scars

The scar runs from the temple hair, down in front of the ear, around the lobe and back into the hair behind it. Most of it is hidden by hair or by the folds of the ear, and on a well-healed lift it takes a close look to find.

Where it can show is the stretch in front of the ear and around the lobe. A pulled or pointed earlobe and a scar that has widened in front of the ear are what a careful, tension-free closure avoids. If you wear your hair up, ask to see photographs of healed scars from behind, not just the front.

The temple part moves your sideburn hairline a little upwards and back. If you have had or are planning hairline advancement, tell your surgeon early, because both operations are working on the same edge of hair.

The neck lift scar sits in the crease under the chin and is rarely seen.

Sensation after facelift

The skin of the cheeks, the front of the ear and the upper neck is numb afterwards. Small nerves are cut when it is lifted, and they regrow over months. The earlobe is often the last to come back, because a larger sensory nerve runs close to where the neck skin is lifted.

Most people have normal or near-normal feeling by a year. Some are left with a dull patch in front of the ear or on the lobe, which they notice when putting in earrings and very little otherwise.

Risks and complications

The complication your team watches for most closely is a hematoma, a collection of blood under the lifted skin, usually in the first day. It is the most common early problem after a facelift. Surgeons generally report it as more common in faces with male-pattern skin and beard growth, which have a denser blood supply, and raised blood pressure makes it likelier still. That is why the monitoring on the first night is strict. A large one needs a return to theatre to drain it.

Then the ones that show later. Skin at the edges of the flap that heals slowly or loses its surface, far more likely in smokers. Scars that widen or pull the earlobe down. A face that looks swept or windblown when the lift has been done in the wrong direction or too hard. Asymmetry, which is common early and usually settles.

The risk specific to this operation is the facial nerve, which moves the muscles of the face and runs underneath the layer being lifted. Temporary weakness of part of the smile or the lower lip happens and nearly always recovers over weeks to months. Permanent injury is rare. A deep plane lift works closer to those branches, so it is worth asking your surgeon how often they see temporary weakness and what they do when it happens.

Facelift results

A good result is a cleaner jawline, a sharper angle under the chin, and a face that looks rested rather than done. On an FFS list the change is more specific. A reduced jaw finally shows as narrower, because loose skin is no longer blurring its edge.

It works best with clear expectations. A lift changes how the skin sits on the structure, not the structure itself, which is why on an FFS list it is paired with the bone work that does the reshaping.

Duration is worth knowing too. A lift resets the clock rather than stopping it. The skin carries on ageing from its new starting point, and a good lift is usually thought of as lasting around a decade before the effect is noticeably lost.

Alternatives to facelift

For skin that is only a little loose, the simplest alternative is to wait. Reduce the bone first and see what the skin does over six to twelve months. It often tightens more than people expect, especially in their thirties and early forties, and a lift can still be done afterwards. I think that is the right default for anyone borderline, and plenty of surgeons plan it that way.

For a full neck without loose skin, liposuction under the chin on its own may be enough. It is a much smaller operation through a tiny incision.

Threads, energy devices and fillers are the non-surgical options. They give a modest, temporary lift and they do not remove skin. For someone who wants to try the direction of a change first, they are reasonable. They are not a substitute when there is real excess to take away.

Combining facelift with other surgery

This is usually one item on a longer list, and it goes last. Jaw and chin contouring is the natural partner, since the lift exists to deal with what the bone work leaves. A tracheal shave fits alongside the neck lift, and forehead and brow work lifts the upper face that a facelift does not reach.

A lift added to a full FFS bundle makes for a very long day. Some surgeons are happy with that and some split it, and it is worth hearing their reasoning. The facial feminisation hub covers how the bundle is quoted.

Facial hair removal should be finished or well under way first. A lift moves skin upwards and back, so skin that still grows beard hair ends up in front of the ear, and whether it does also decides where the incision can sit.

Facelift cost

Ask exactly what the quote means by facelift. A mini lift, a SMAS lift and a deep plane lift are different operations at different prices, and the neck may or may not be included. Get the neck named as a line of its own.

Inside an FFS bundle a lift costs less than on its own, because the anaesthetic and the stay are already paid for. It still adds hours in theatre, and theatre time is what surgeons price.

Plan on self-pay. Insurers and public systems treat a facelift as cosmetic, even where bone work is covered. Ask who pays if a hematoma needs a return to theatre, and whether a small scar or earlobe touch-up at a year is included.

Choosing a facelift surgeon

Facelifts are done by a great many cosmetic surgeons, most of whom never touch facial bone, and FFS surgeons, some of whom do few lifts. The two numbers I would ask for are how many lifts they do in a year, and how many of those are on faces where they have just reduced the jaw. The second number is the one that matters for you.

The question that reveals experience is how they decide between doing the lift now and waiting. A surgeon who does both kinds of work will have a view that depends on your skin, and will explain it. That tailored answer is what you want to hear.

In photographs, look at the earlobes and the skin in front of the ear at a year, and at the face from the side. A good lift leaves the lobe hanging naturally and the hairline in front of the ear where it was. Those details are the mark of a well-judged lift.

Once a lift is on your list

Tell your electrologist or laser clinic that a lift is on your list. They can prioritise the jaw and neck, where the skin will move, and you avoid finding beard hair in front of your ear a few months after surgery.

Frequently asked questions

Will a facelift make my face look more feminine?

It helps alongside bone work. It tightens skin rather than changing shape, and on an FFS list its job is to let the reduced bone show. See results.

Should I have it at the same time as jaw surgery?

Some surgeons do both in one day and some wait six months to a year to see how the skin settles. Ask which they recommend for your skin. See how it's done.

Where are the scars?

Around the ear and into the hairline, plus a short line under the chin for the neck. See scars.

How long does a facelift last?

It resets the clock rather than stopping it. The face keeps ageing from its new starting point, and the effect is usually thought of as lasting around a decade.