Facelift questions

Among patients who returned to the same surgeon after a SMAS flap facelift, the second operation came about 12 years after the first on average. Reviews of secondary facelifts put the interval at 9 to 12 years. No randomized study has measured how long a facelift lasts.[1][2]

The first night carries the main risk, since most expanding hematomas appear in the first 12 hours. In one surgeon's patients the average return to social life was day 8. Recovery took about four weeks after both deep-plane and SMAS plication lifts, and swelling inside the face takes about six months to clear.[1][2][3]

Return to work averaged two weeks after a short-scar MACS lift. Return to normal social life ranged from day 5 to day 20 in one surgeon's series. Published time-off figures come from single-surgeon series.[1][2]

A SMAS facelift tightens the SMAS by folding it, removing a strip or lifting it as a flap separate from the skin. A deep plane facelift releases the cheek ligaments and lifts skin, fat and SMAS together as one flap. In a randomized trial, deep-plane, high SMAS and plication lifts lowered perceived age by a similar amount.[1][2][3]

Reviews have not shown that it gives a better midface or a longer-lasting result than other SMAS techniques. Patient satisfaction is high after both deep-plane and SMAS lifts in pooled studies. Pooled data found more major hematoma after deep-plane lifts than after plication.[1][2][3]

A short-scar lift uses an incision mostly in front of the ear and less skin undermining. The MACS lift holds the face up with purse-string sutures anchored at the temple. It suits jowls and sagging cheeks with limited loose neck skin, and its effect on the neck is limited.[1][2][3]

In a US registry, about 1 in 55 facelift patients needed an emergency visit, a hospital stay or a second operation, most often for a hematoma. Permanent facial nerve weakness followed about 1 in 2,000 facelifts in pooled data. Risk rises with combined procedures, long operations, smoking and male sex.[1][2][3]

The scar runs along the temple, in front of the ear, around the earlobe and behind the ear. Most heal flat and fine, and a raised scar formed in about 3 in 100 patients after deep-plane lifts. Scars are judged at 12 months or later.[1][2][3]

A male facelift follows the same principles, with incisions planned around the sideburn, beard and hairline. A national database put men at nearly 4 times the hematoma risk of women. Strict blood pressure control before, during and after surgery cut that rate in men by more than half.[1][2][3]

Patients returned about 9 to 12 years after the first lift in published series. Scar tissue makes the second operation harder, and in one series temporary nerve weakness was more common than after first lifts. Overall complication rates are close to those of a first facelift, and patients are at least as satisfied.[1][2][3]