Face and neck lift: what the procedures involve

As we get older, facial skin loses some of its firmness, fat shifts or thins, and folds and jowls become more noticeable. Heredity, sun exposure and smoking can all play a part. Surgical lifts aim to reposition skin and fat to give a smoother, firmer contour. The terms facelift, neck lift and brow lift are often used together, but each treats a different area. This guide explains what each operation involves, what recovery usually looks like and what to discuss with a surgeon.

Facelift, neck lift and brow lift: which area each treats

The NHS describes a facelift, also called a rhytidectomy, as surgery that lifts and tightens the skin of the face, mainly loose skin of the lower face, such as the jowls, and the neck. The American Society of Plastic Surgeons (ASPS) adds that a facelift can address deepening folds between the nose and the corners of the mouth and fat that has shifted or been lost.

A neck lift concentrates on the jawline and neck. According to ASPS, it can address fat under the chin, loose neck skin, jowls and vertical bands caused by the neck muscle. It may be considered when the neck has aged more than the upper face, and it is often combined with other procedures.

A brow lift, also called a forehead lift, treats the area above the eyes. MedlinePlus explains that it can correct sagging of the forehead skin, eyebrows and upper eyelids and soften forehead wrinkles and frown lines. In some people, low brows can partly block the upper field of vision, and lifting them can help. A facelift can be combined with a brow lift or eyelid surgery when several areas are a concern.

Is a lift right for you?

A good first step is to be clear about what bothers you most. ASPS stresses that these operations do not change your basic appearance and cannot stop the ageing process, and BAPRAS reminds patients to understand the limits of surgery before deciding. The NHS suggests not rushing into the decision, because results cannot be promised and there are risks, and suggests talking to your GP first if you are in the UK.

Your general health matters too. MedlinePlus advises telling your surgeon about any medicines and supplements you take and about heavy alcohol use, and explains that conditions such as diabetes or heart disease may need input from your usual doctor. Smoking slows healing and raises the risk of blood clots, so you will be asked to cut down or stop. Previous upper eyelid surgery can sometimes make a brow lift inadvisable, because it may affect how well the eyelids close.

How a facelift and neck lift are done

The NHS explains that a facelift is usually carried out under general anaesthetic, although a local anaesthetic with sedation is sometimes used. The surgeon makes incisions above the hairline at the temples, running down in front of the ear, around the earlobe and behind the ear. If the jawline and neck are being treated as well, a small cut is often made under the chin.

Excess skin is removed and the remaining skin is lifted back and up, then stitched in place. Some surgeons also reposition or add fat. The face is usually bandaged afterwards to limit bruising and swelling, and a small drainage tube may be placed. The NHS says the operation usually takes 2 to 3 hours, while BAPRAS describes two to five hours, depending on what is being done. Most people stay in hospital overnight.

How a brow lift is done

MedlinePlus describes several approaches. In one, the surgeon makes a cut at ear level that continues across the upper forehead along or behind the hairline. For people who are balding, the cut may be placed differently to hide the scar. In an endoscopic brow lift, the surgeon works through several small cuts using a thin instrument with a camera. Excess tissue is removed and the cuts are closed with stitches or staples.

A brow lift is often done under local anaesthetic with medicine to help you relax, although a general anaesthetic is sometimes used. MedlinePlus notes that it is usually done without an overnight stay.

Recovery after a face or neck lift

Recovery is gradual, and your surgeon will advise you based on what was done. MedlinePlus explains that discomfort is usually mild and that keeping your head raised on pillows for a couple of days helps reduce swelling. A drainage tube, if used, is usually removed 1 to 2 days after surgery, and bandages after 1 to 5 days. BAPRAS notes that in the first week many people feel tightness when opening the mouth, swelling, bruising and some low mood, and suggests sleeping upright with cool packs on the cheeks.

The NHS gives the following general guide for a facelift:

• Keep the bandages dry and avoid showering for the first 2 days.
• Bruising is visible for at least 2 weeks.
• Avoid strenuous exercise, saunas and massages for at least 2 weeks.
• Stitches are removed after about 7 to 14 days unless they dissolve.
• Full recovery takes about 2 to 4 weeks, and you will need time off work.
• You cannot drive for a number of days; your surgeon will tell you when it is safe.

BAPRAS says many people consider returning to work or going out in public after 10 to 14 days. MedlinePlus notes that the face may look pale, bruised and puffy at first and should look normal again in about 4 to 6 weeks, while some numbness can take weeks to months to fade. The NHS says a stiff face and mouth usually ease within 6 weeks and that the full result can take 6 to 9 months to appear.

Recovery after a brow lift

MedlinePlus describes the following typical steps. Keep your head raised for 2 to 3 days. Bruising and swelling around the eyes and cheeks usually fade within a few days to a week, and bandages come off after 1 to 2 days. Stitches or clips are removed in two stages within 10 to 14 days. You will not be able to work for at least 7 days, and most people return to work or school within 10 days.

Vigorous activity such as jogging, heavy lifting or housework should be avoided for several weeks, contact sports for 6 to 8 weeks, and heat and sun exposure should be limited for several months. As the nerves recover, numbness of the forehead and scalp may give way to itching or tingling, which can take up to 6 months to settle. Most visible signs of surgery fade within 2 to 3 months.

Side effects and risks

The NHS lists the expected side effects of a facelift as a swollen or numb face, which may last weeks or months, a stiff face and mouth, bruising, some pain and low mood for a few days. Scars fade but do not disappear completely. Some people notice a raised hairline or sideburns, or less hair growth at the temples.

Possible complications include:

• injury to a nerve, causing loss of feeling or movement in part of the face; BAPRAS notes that weakness of this kind is uncommon and generally improves over several weeks
• an uneven result, including the position of the earlobes
• hair loss or permanent thinning around the scars
• thick or noticeable scars and slow healing
• heavy bleeding, blood clots in a vein, infection or a reaction to the anaesthetic, as with any operation

After a brow lift, MedlinePlus adds that moving the eyebrows or wrinkling the forehead can become difficult on one or both sides, that the brows can end up uneven and that hair loss along the scar can occur, although permanent hair loss is rare. A collection of blood under the skin (a haematoma) may need draining. Nerve damage is usually temporary but can occasionally be permanent. Your surgeon should explain how likely each risk is for you and how it would be treated.

The NHS advises contacting the clinic where you had surgery as soon as possible if you have severe pain or any unexpected symptoms. In the UK, you can also call NHS 111 or use NHS 111 online.

Next steps

If you are considering a face, neck or brow lift, a consultation is the place to talk through which areas concern you, which procedure or combination might suit you, and how recovery would fit around your life. You can read more about our plastic and aesthetic surgery specialists, or answer a few questions to be matched with a doctor: Find my physician.