Who it suits Why the face sags Techniques Neck Incision and scar Anesthesia Recovery Risks Combining FAQ

Facelift

A facelift lifts the cheeks, jawline and, usually, the neck by repositioning the deeper support layer of the face (the SMAS) and then re-draping the skin. It is meant for sagging that has gone beyond what a short-scar lift or an energy-based device can correct.

Dr. Young Jun Kim, Medical Director, Violacell Plastic Surgery · Board-certified plastic surgeon (Korea)

At Violacell Plastic Surgery, Dr. Kim currently provides non-surgical treatment and does not perform a facelift there. This page is a plastic surgeon's guide: what a facelift can and cannot do, and how to tell whether your concern needs surgery or can be treated without it, for example with Ulthera, Sculptra and Thermage.

What it treats: Sagging cheeks, jowls, a blurred jawline, loose neck skin and neck bands. It softens, but does not erase, the folds beside the nose and mouth.
Incision: From the temple, along the front of the ear, around the earlobe and behind the ear into the hair. A short cut under the chin is often added for the neck.
Anesthesia: Intravenous sedation with local anesthesia, or general anesthesia, depending on the extent of surgery and your health.
Operating time: Often around 3–5 hours. It varies with the technique, the neck work and combined procedures.
Return to daily life: Typically 2–3 weeks for most daily and social activities. Numbness, firmness and fine swelling settle over several months.
How long it lasts: Usually many years, but the face keeps aging. It varies with skin quality, bone structure, weight change, sun exposure and smoking.

What a Surgeon's View Adds to Non-Surgical Lifting

A facelift releases retaining ligaments and repositions deep tissue. The same anatomy decides where non-surgical lifting can and cannot work.

Ligaments and fat compartments

Facial ligaments anchor tissue at fixed points. Dr. Kim plans Ulthera lines around them, rather than spreading energy evenly over the face.

Volume as well as lift

Part of facial aging is lost volume. Sculptra rebuilds support gradually, so a face may need less lifting than it seems.

Honest about the limit

Repeated device sessions do not replace a facelift when tissue has clearly descended. Trained in facial surgery, he tells patients when that point has been reached.

Why Dr. Kim for Ulthera, Sculptra and Thermage

Who It Suits, and Who It Does Not

A facelift is considered when the lower face and neck have clearly descended: the jawline no longer reads as a straight line, jowls hang beside the chin, and the angle between the jaw and neck has softened. At this stage, tightening tissue in place usually cannot bring it back to where it was.

For milder change, a mini facelift or non-surgical treatment may be enough. A comparison is in Mini facelift or full facelift: which one fits your face?

Often a reasonable option

Established jowls and a jawline that has lost its edge
Loose skin under the chin and along the neck, or visible neck bands
Cheeks that have slid down, deepening the lines beside the mouth
Earlier lifts or energy treatments that no longer give enough change
Good general health and realistic expectations about what surgery can change

Usually reconsidered or postponed

Mild change only A smaller operation or a device is often a better first step.
Mainly brows or eyelids A facelift does not lift the brows or the eyelids. See forehead lift and eyelid surgery.
Large planned weight loss Surgery is usually best after weight has been stable for some time.
Health risks Uncontrolled high blood pressure, bleeding disorders, blood thinners that cannot be paused, poorly controlled diabetes and active smoking must be addressed first.

Why the Face Sags

Facial aging is not just loose skin. Several layers change together, and the plan depends on which ones matter most in a given face.

Layer	What changes	Can a facelift help?
Skin	Collagen and elastic fibers decrease. The skin thins, stretches and forms fine lines.	Excess skin is removed, but texture, pores and fine lines are not changed.
Fat compartments	Facial fat sits in separate pockets. Some shrink, while others slide down and gather above the jaw and beside the mouth.	Descended fat is moved back with the SMAS. Lost volume is not replaced.
SMAS	This support sheet over the cheek and neck loosens, letting the tissue on top of it descend.	Yes. Lifting the SMAS is the core of a modern facelift.
Retaining ligaments	Strong fibers tie soft tissue to bone. Tissue between them sags while the anchor points stay fixed, outlining jowls and folds.	Some ligaments may be released so tissue can be moved further.
Platysma	The thin neck muscle loosens and its front edges can separate into vertical bands.	Yes, through tightening from the side and, when needed, from under the chin.
Bone	The jaw, cheek bones and eye sockets slowly lose volume, so soft tissue has less support.	No.

Facelift Techniques Compared

“Facelift” covers several techniques. They differ in how much the skin is separated, how the SMAS is handled and whether ligaments are released. The name matters less than which tissue is moved, in which direction and how far.

SMAS plication or SMASectomy

After the skin is lifted, the SMAS is tightened with folding stitches (plication) or by removing a strip and closing the gap (SMASectomy).

Dissection under the SMAS is limited, which keeps it relatively predictable. Its pull on the midface is more limited.

High or extended SMAS

The SMAS is cut and lifted as a separate flap, starting higher, near the cheekbone, so the pull also reaches the upper cheek.

It can move the midface more than plication. Working under the SMAS needs careful attention to the nerve branches below it.

Deep plane

The surgeon works beneath the SMAS and releases key retaining ligaments. Skin, fat and SMAS are moved together as one unit, so the skin is not separated over a wide area.

It can move the cheek and jowl further with low skin tension. The working plane is close to the facial nerve branches, so anatomical precision is essential.

Skin-only facelift

Only the skin is lifted and trimmed. It is shorter, but tension falls on the skin edge, so scars may widen and the result tends to fade sooner. It is rarely recommended on its own today.

Published comparisons have not shown that one technique gives the best result for every patient. A deeper or wider operation is not automatically better: the plan should match where the face has sagged, skin thickness, earlier surgery and the balance between change and risk. At consultation, ask which layer will be lifted, in which direction, and how the neck will be handled, rather than only the name of the technique.

The Neck

Most facelifts treat the neck as well, because the jawline and neck age together. The platysma is a thin muscle sheet that covers the front of the neck and continues into the SMAS of the lower face. Tightening it from the side, through the facelift incision, sharpens the line of the jaw and the angle under it.

When there are strong vertical bands or heavy fullness under the chin, a short incision in the crease under the chin lets the surgeon stitch the inner edges of the muscle together (platysmaplasty) and remove excess fat. Fat lying just under the skin can also be reduced with liposuction. Too much fat removal can leave the neck hollow or irregular, so this is done with restraint.

What neck work cannot change

A short or weak chin bone, which limits how sharp the jawline can look
Horizontal neck lines that come from the skin itself
Crepey skin texture and sun damage
Fullness from structures deep under the muscle, which are usually not removed in a routine facelift

Incision and Scar

The incision usually starts in or along the temple hairline, follows the front of the ear, curves around the earlobe and continues up the groove behind the ear, then back into the hair. Each segment is placed where a scar is least likely to draw attention.

In front of the ear, the line may run just inside the small cartilage at the ear canal (the tragus) or just in front of it. Behind the ear, the incision is placed so that the hairline does not end up with a step. In men, beard-bearing skin is moved toward the ear, which may mean shaving closer to the ear than before.

How scars usually behave

A new scar is often pink and firm for a few months and usually fades over 6–12 months. Some people form thicker or darker scars, and East Asian skin can stay red or brown for longer.

Lifting the deeper layer lets the skin close without tension
Setting the earlobe back without pulling avoids a stretched lobe
Nicotine and strong sun slow healing and darken scars
Early follow-up allows thickening to be treated

Anesthesia and Preparation

A facelift is done under intravenous sedation with local anesthesia or under general anesthesia. The choice depends on the length of surgery, neck work, combined procedures and your health. Local anesthetic is used in either case to reduce bleeding and early discomfort.

Before surgery, a medical history, blood tests and, depending on age and health, an ECG and chest X-ray are usually checked.

Before surgery

Blood thinners and supplements Aspirin, anti-inflammatory painkillers, fish oil, vitamin E and ginkgo are usually paused. Never stop a prescribed blood thinner without your own doctor’s advice.
Nicotine Smoking greatly raises the risk of skin loss after a facelift. Stopping for several weeks before and after surgery is commonly advised.
Blood pressure Good control lowers the risk of bleeding.

If you travel for surgery

Allow time for early checks and suture removal. Many patients plan around 10–14 days; the right length is confirmed at consultation.
Discuss long-haul flight timing in advance, as early flights add strain and a small risk of blood clots.
Confirm the follow-up schedule with the clinic that performs your surgery.

Recovery Timeline

Timing	Typical course
Day of surgery	A dressing supports the face and neck. Many patients stay overnight. Keep the head raised and avoid bending or straining.
Days 1–3	Swelling and tightness usually peak. Discomfort is generally moderate and managed with prescribed medicine. Drains, if used, are usually removed in the first day or two.
Days 5–14	Sutures in front of the ear are commonly removed first, then those behind the ear and in the hair. Bruising moves down the neck and fades.
Around 2–3 weeks	Many people return to desk work and ordinary social activities, though some swelling may still show.
Weeks 4–6	Strenuous exercise, saunas and alcohol are reintroduced as advised.
Months 1–3	The cheeks and neck can feel firm or slightly lumpy, and patches of numbness slowly improve.
Months 6–12	Scars mature and the face settles. Subtle swelling can take this long to resolve completely.

A general guide only. Recovery differs with the technique, neck work, combined procedures and individual healing.

Risks and Limitations

A facelift is major surgery near blood vessels, sensory nerves and the nerves that move the face. Most people heal without serious problems, but complications do occur, and some need further treatment.

Possible complications

Hematoma Bleeding under the skin, usually within the first day, is the most common significant early complication. A large hematoma needs prompt drainage. The risk is higher in men and with high blood pressure, vomiting or blood-thinning medicines.
Facial nerve injury Temporary weakness of the smile, lip or brow is uncommon and usually recovers over weeks to months. Permanent weakness is rare.
Numbness The cheeks, neck and area around the ears are commonly numb for weeks to months. Injury to the nerve supplying the earlobe can leave lasting numbness.
Skin loss Skin behind the ear can lose blood supply and heal slowly, far more often in smokers.
Scar and contour problems Widened or thickened scars, a pulled earlobe, hairline steps, hair thinning near incisions, or an irregular neck.
Other problems Infection, asymmetry, a salivary fluid collection, and the general risks of anesthesia, including blood clots.

What a facelift cannot do

It does not stop aging; the face continues to change after surgery.
It softens but does not erase deep folds beside the nose and mouth.
It does not lift the brows or treat the eyelids.
It does not improve fine wrinkles, texture or pigmentation, or replace lost volume.
A heavily “pulled” look is a sign of excess tension, not a stronger lift.
No surgeon can guarantee a particular result or perfect symmetry.

Combining With Other Procedures

Dr. Kim’s non-surgical focus is Ulthera, Sculptra, and Thermage combined with Re2O. These do not replace a facelift when tissue has clearly descended, but they work on layers a facelift does not change.

Before surgery is needed

When laxity is mild, Ulthera (focused ultrasound guided by a live image) or Thermage with Re2O may tighten tissue in place without an incision. Related: Does a higher Ulthera shot count mean a better result?

After a facelift

Surgery repositions tissue but does not change skin quality or volume. Once healing and numbness have settled, devices or Sculptra may help maintain them. The timing is set at follow-up.

Upper face

A forehead lift or upper blepharoplasty is often combined so that the upper and lower face look consistent.

Under the chin

Liposuction of the neck is often part of the facelift plan when there is fat under the chin.

Each added procedure lengthens the operation and recovery. The benefit of doing them together is weighed against that load.

Glossary

SMAS: Superficial musculoaponeurotic system. A thin, firm layer under the skin and fat that supports the cheek and continues into the platysma of the neck.
Retaining ligaments: Strong fibers that tie soft tissue to the bone, acting like anchor points.
Deep plane: The space under the SMAS. A deep plane facelift works in this layer and moves skin, fat and SMAS together.
Platysma: A thin muscle sheet covering the front of the neck.
Platysmaplasty: Tightening the platysma, often by stitching its inner edges together under the chin.
Jowl: Soft tissue that has sagged below the jawline beside the chin.
Hematoma: A collection of blood under the skin after surgery.
Facial nerve: The nerve whose branches move the forehead, eyelids, cheeks and lips.

Frequently Asked Questions

What is the difference between an SMAS facelift and a deep plane facelift?

Both lift the SMAS, the support layer under the skin. In an SMAS facelift the skin is lifted first and the SMAS is tightened as a separate layer. In a deep plane facelift the surgeon works beneath the SMAS, releases key ligaments and moves skin, fat and SMAS together. Neither has been shown to be best for every face, so the choice depends on the pattern of sagging and the risks involved.

Does a facelift also treat the neck?

Usually, yes. Tightening the platysma from the side improves the jaw and neck line, and a short incision under the chin can be added for neck bands or fullness. The extent of neck work is planned separately from the cheek.

Will I look pulled or different?

A facelift aims to move tissue back toward its earlier position rather than to stretch the skin. A pulled or windswept look usually comes from placing tension on the skin. Your features stay your own, although the face will look different from before surgery.

How long does a facelift last?

Usually many years, but there is no fixed number. The face keeps aging after surgery. Skin quality, bone structure, weight change, sun exposure, smoking and the technique all affect how long the result holds.

How long should I stay near the clinic after surgery?

Many patients from abroad plan around 10–14 days to allow for early checks and suture removal. The right length depends on the extent of surgery and your healing, and is confirmed at consultation.

What are the most serious risks?

The most common significant early problem is a hematoma, a collection of blood under the skin, which may need drainage. Injury to facial nerve branches can cause weakness that is usually temporary and rarely permanent. Skin loss, mainly in smokers, scarring and asymmetry can also occur.

Can I have Ulthera or Thermage instead of a facelift?

Energy-based treatments can tighten mild laxity in place, but they cannot remove excess skin or move tissue that has clearly descended. When jowls and neck laxity are established, a facelift usually gives a more noticeable change. Devices can still play a role in maintaining skin quality later.

Can I have a facelift after a thread lift or fillers?

Often, yes. Threads, fillers and earlier surgery can change the tissue layers and create scar tissue, so they are taken into account when the operation is planned.