Facelift (meloplasty)

What is a facelift?#

A facelift (also known as meloplasty or rhytidectomy) is a type of cosmetic surgery that tightens and removes sagging skin on the face and neck. Excess fat may also be removed or repositioned as part of the procedure. A facelift can reduce jowls and smooth the jawline, and most people find they look younger afterwards. The scars are permanent, although they are generally hidden, usually by your hair.

A suture facelift (thread lift) is a less invasive option that can tighten or smooth the skin around the eyes, cheeks or chin. It leaves no obvious scars but will not dramatically alter your facial shape.

Things to consider first#

If you are concerned about the way you look, or are thinking about cosmetic treatments to boost your confidence, consider other options first. Talking to a counsellor or psychologist may help you address concerns about your appearance. Non-surgical treatments such as a chemical skin peel, dermabrasion or skin resurfacing may also be considered.

Before you choose to have a facelift, keep in mind that:

• A facelift should make you look younger, but it will not raise sagging eyebrows, remove deep frown lines in the forehead, change your upper or lower eyelids, or get rid of wrinkles around the mouth.
• A suture (thread) facelift is best suited to younger and middle-aged people whose tissues have sagged with time or sun damage. It is not recommended for people with very thin or dry skin.
• The results of a facelift usually last between 5 and 12 years. The normal ageing process continues after surgery.
• Cosmetic surgery rarely qualifies for a rebate. Ask your medical practitioner about any out-of-pocket costs you can expect, and check with your health insurer about cover.

Your medical practitioner will need to assess your individual suitability for this type of treatment.

Choosing a qualified practitioner#

Surgery, including cosmetic surgery, and any anaesthetic beyond a low dose of local anaesthetic should only be performed in a properly licensed and accredited facility. You can ask to see a facility’s certificate of registration, which is usually on display where consumers can see it easily.

This procedure should be carried out by a medical practitioner who is specially trained and experienced in facelift surgery. At your first consultation, ask about their training and experience, and ask to see the certificates that show they are qualified to perform this specialised surgery. You may also wish to ask another medical practitioner for a second opinion. Check that your practitioner is appropriately registered with the relevant medical regulator in your area.

A registered anaesthetist should be present to treat you for any adverse reaction to the anaesthetic. You can also check that your anaesthetist is appropriately registered.

Your medical status#

If you are considering facelift surgery, discuss your current medical status with your medical practitioner. This includes:

• your physical health, including past medical history such as illnesses, surgeries and immunisations, and your current diet and exercise habits
• your mental health, including any mental illnesses or issues and their treatments
• medications you are currently taking, including vitamins and supplements
• any past reactions to medications and any allergies you have

From this discussion, your practitioner can assess the risks and possible complications of surgery for you, and tell you what preparations you need to make for a smooth recovery. Smokers are at increased risk of complications, so try to quit smoking before surgery, both for your recovery and your general health and wellbeing.

What happens during surgery#

Facelift surgery is usually performed under a general anaesthetic. The length of the operation depends on the type and extent of surgery but could take anywhere from two to four hours. The three main types are:

• Traditional facelift - the practitioner makes an incision in the hairline from the temple, around behind the ear, and back into the hairline. The skin is lifted away from the underlying tissues, muscles are tightened and fat is removed. The skin is pulled up and back, any excess is removed, and the skin is stitched or stapled into its new position.
• Limited-incision facelift - the practitioner makes smaller incisions at the temples and around the ears.
• Neck lift - the practitioner makes an incision in front of the ear and back into the hairline, then lifts and tightens the skin of the jaw and neck.

Immediately after surgery you may have a drainage tube in the wound to help prevent fluid build-up, bruising and swelling, antibiotics to prevent infection, possible numbness, pain and discomfort, dressings or bandages on your face, and a compression garment to help minimise swelling.

Potential complications#

All surgery carries some degree of risk. Possible complications of facelift surgery include:

• heavy bleeding, or the formation of a large blood clot (haematoma) beneath the incision site, which may require drainage
• infection, which might need treatment with antibiotics or, in some cases, further surgery
• allergic reaction to sutures, dressings or antiseptic solutions
• pain, bruising and swelling around the operated sites
• slow healing, often associated with smoking or diabetes
• separation of wound edges
• short-term nausea following general anaesthesia
• keloids or hypertrophic scars - raised, thickened scars that may be itchy but are not a threat to health
• hair loss around the scars
• loss of skin due to impaired blood supply, which may require a skin graft
• numbness around the surgical sites, which is temporary in most cases
• nerve damage, which can cause temporary or permanent weakness of part or all of the affected facial muscles
• deformity of the earlobe, or a slight difference in appearance between the left and right side of the face

This is not a complete list - your medical history or lifestyle may put you at increased risk of certain complications. Speak to your medical practitioner for more information. Further surgery may sometimes be required to treat complications.

Recovery and self-care#

Your medical practitioner will give you post-operative care instructions, including medications to apply directly to the face or take by mouth to aid healing and reduce the risk of infection, how to care for the surgical sites, what to watch for, and when to follow up.

Scarring is an inevitable part of any invasive surgery. Your practitioner will try to minimise scarring by placing incisions in easily hidden sites, so scars fall along natural skin lines and creases. After traditional or limited-incision surgery and neck lift surgery, swelling may take months to subside. Scars are permanent but should fade over time, and improvements may take around a year, so be patient.

A facelift does not change your fundamental appearance and cannot stop the ageing process. Although the results are long-lasting, your skin will continue to age. A healthy lifestyle and minimising daily sun exposure will help maintain the results.

Suture facelift (thread lift)#

An alternative form of facelift, often done under local anaesthetic, is a suture facelift. The practitioner inserts fine threads under the skin through very thin tubes (cannulae), so no cuts are made in the skin. The threads are made of a non-absorbable medical polypropylene fibre (Prolene®), which has been used safely in surgery for many years. Once positioned through the tiny puncture sites, the threads are gently tightened and secured to the facial tissue and skin.

After a suture facelift, some pain may be felt, but the discomfort usually settles within 24 hours, although some people experience more severe pain. There may be slight swelling and bruising for four to 10 days. Possible additional complications include:

• infection (this is rare); more extensive surgery may be needed if removal is necessary because of infection
• thread movement, which may lead to the thread extruding, breaking or losing its hold on the skin
• puckered skin or skin irregularities
• discomfort if the threads can be felt under the skin
• a loss of facial symmetry

Your medical practitioner will provide post-procedural care instructions. The results of a suture facelift usually last for one to three years.

Alternatives to facelift surgery#

Alternatives to facelift surgery can include:

• talking to a counsellor or psychologist to help address concerns about your appearance
• dermal fillers
• injections of botulinum toxin Type A (such as Botox®) into wrinkles
• laser resurfacing or light therapy
• skin needling, such as with derma rollers
• facial implants

Key points#

• A suture (thread) lift leaves no obvious scars but will not dramatically alter your facial shape.
• Non-surgical treatments such as a chemical skin peel, dermabrasion or skin resurfacing may be considered as alternatives.
• Your medical practitioner will need to assess your individual suitability for this type of treatment.
• Smokers and people with certain medical histories are at increased risk of complications.
• All surgery carries some degree of risk.

Where to get help#