The decision to get a facelift is deeply personal and riddled with all kinds of important questions: how much does a facelift cost? Will I still look like myself? Is it even safe? “When people think about facelifts, they think about stretched lips, joker smiles, windswept faces,” says Beverly Hills plastic surgeon Dr. Catherine Chang. “But the reality today is that if you have a good surgeon, you can’t tell if somebody has had [one].” Thanks to advances over the last few decades, you might not realize how common facelifts actually are (according to the American Society of Plastic Surgeons, they’ve increased by 75% in the last 20 years). “A lot of celebrities, friends, and family have actually had these lifts,” says Dr. Chang, who hopes to remove the stigma of cosmetic surgery.
As invasive as it may seem, a facelift is no longer considered the last resort for older patients seeking the most extreme results. In many cases, a more minimal facelift at a younger age translates to less intervention (whether surgical or injectable) over time. “It is preventative,” says Chicago-based plastic surgeon Dr. Julius Few, who also practices in Los Angeles (where 90% of his patients work on-screen). “You do a reset and then that ages, but it doesn't age typically at the same rate as it would in the natural face.” This may explain why younger people are seeking facelifts at higher rates. “The average age of my facelifts last year was 47,” says Manhattan plastic surgeon Dr. Steven Levine. “Half were younger.”
Toronto-based makeup artist Sabrina Rinaldi decided to get a face lift late last year at the age of 42. “I grew up around the beauty industry and now work on models and some celebrities, so I know the minutiae of faces really well,” she explains of her decision. “I saw my own face started looking lower and heavier and I came to this conclusion: If you work with a pantsuit that’s just one size up and do micro-revisions, you'll have a better chance of keeping the lines of the original suit. You don't take a pantsuit 10 sizes too big and ask the tailor to make it look like the correct size.”
The facelift is also being welcomed into the beauty transparency movement, with the most notable participant being Marc Jacobs. The 58-year-old designer uploaded a bandaged, post-facelift photo to Instagram in July 2021, and followed it with more recovery selfies during the 10 days after, as well as a tell-all to the media. “His admirable transparency has impacted my practice,” says his surgeon Dr. Andrew Jacono (who, coincidentally, also treated Rinaldi). “We’ve seen approximately a 30% rise in men seeking facelifts.”
What makes Jacobs’ candor even more striking is that plastic surgery has never been easier to hide. Doctors believe the new normalcy of face masks and working from home likely account for a marked uptick. According to the American Academy of Facial Plastic Surgery and Reconstructive Surgery, 69% of member surgeons saw an increase in demand for facelifts in 2020.
Still, a facelift is major surgery with risks and not everyone is a candidate. Keep reading to learn everything you might want to know about a facelift, from the technical aspects to the experience in the operating room, and what to expect during recovery.
Why Would Someone “Need” A Facelift?
Facial aging is due to “gravity, where the tissue falls; laxity, where the tissue separates from the underlying structures; and volume loss,” says Dr. Levine, adding that “the only [treatment] that I'm aware of that lifts and tightens reliably and effectively is a face and neck lift.” Comparatively, for sagging issues (such as the appearance of jowls) there’s only so much neurotoxins, filler, and lasers can do to minimize those effects. A facelift (which is technically called a rhytidectomy), helps to actually reverse that sagging of facial skin, muscle, and fat that occurs with age and time, and typically addresses from the top of the cheek to the middle of the neck.
How effective is the procedure from an aesthetics standpoint? A 2011 study in the journal Plastic and Reconstructive Surgery found that on average a facelift patient looks 12 years younger post-procedure.
What Are The Different Types Of Facelifts?
Facelift surgery was developed by doctors in Europe and the United States in the early 20th century and was accelerated by reconstructive surgery advances after WWI. The approach in the decades following was to pull at the skin itself, but by the 1970s, surgeons began operating deeper under the skin, developing what is called a SMAS facelift (superficial muscular aponeurotic system). This is when facelifts really began to advance, says Dr. Chang. Additional medical innovation has contributed to better results today, like using lasers to improve skin quality and/or fat grafting, which uses the patient’s own fat as a filler (and can be performed while the patient is still under anesthesia — for an additional fee). Still, Dr. Chang says it’s not uncommon for people to keep the youthful results going by returning for second and third facelifts in 5- to 10-year intervals.
As for the technique, an Instagram or Google rabbit hole will reveal terms like deep plane facelift, mini facelift, lower facelift, short scar facelift, and more. But, Dr. Levine warns, patients should not get fixated on this point.
“No one has ever proven that one technique is better than another,” he says. In fact, studies comparing results on identical twins whose doctors used different facelift techniques showed no significant difference in outcome quality. “The biggest difference between surgeons is aesthetic judgment,” Dr. Levine emphasizes, and their ability to tailor the surgery to each patient. Some doctors say the best trained surgeons have multiple techniques they can adapt to each patient, and it could be considered a red flag if a surgeon insists that their singular technique is a one-size-fits-all.
What Makes a Good Consultation?
At your initial consultation a doctor will first determine if you are healthy enough to go under anesthesia and rule out any other health risks ahead of surgery (like a heart condition or whether you’re prone to keloid scars). Then they will assess your skin quality, volume, and degree of sagging (sometimes this can be done over Zoom) and you’ll look at pictures of the surgeon’s work to discuss aesthetic goals. “I ask patients to bring in photos of their parents,” says Dr. Few. “I'm also looking at how their face moves. I look at ticks or what they do to animate in an off-center way, and I make sure to maintain that signature. This is especially important for my actors.”
Some surgeons will charge a consultation fee (Dr. Few’s fee, for example, is $1000), but that can often be applied to the cost of the surgery. However, this shouldn’t be used to push your decision. Be wary of “somebody that's rushing you or forces you to commit to a procedure at the consultation,” says Dr. Chang. A good surgeon will usually recommend that you meet with a couple other doctors besides themselves to make sure you are confident in your final choice. Ultimately, you're looking for both a sterling reputation and an aesthetic common ground.
Along with gathering images of your biological parents, you should also prep by jotting down your questions ahead of time. For example, you’ll want to ask to see the doctor’s before and after images (including after photos reflecting results that are a few years down the road), what the doctor considers a good aesthetic outcome, and their advice on a proper healing plan. Take a look at recommendations from plastic surgery societies such as the American Academy of Facial Plastic and Reconstructive Surgery to help craft your list.
How Does It Go Down in the OR?
Every doctor does things a bit differently but there are some basic pillars of the big day. You will speak to your anesthesiologist pre-surgery (night before or day-of), review the surgery face-to-face with your doctor, and sign final paperwork. Your doctor will use a marker to draw lines on the face. “These marks are landmarks for the surgeon,” explains Dr. Chang. “You want to mark things in the natural position with the patient sitting up as the positioning shifts when you lay down.” Then, you will be put under twilight or general anesthesia.
The surgeon makes incisions in the creases in front and around the bottom of your ears (this makes scars nearly invisible in the shadows and folds) and occasionally just under the chin as well. They will surgically separates the skin from the inner lining or fascia (“think of it like lifting the blanket to get to the sheet underneath,” explains Dr. Few), often down into the neck. These days, good surgeons know that noticeable scarring is often caused by tension, says Dr. Levine, so they should have a clear philosophy on incision positioning.
From here, techniques can vary as noted above, but the surgeon will move the deeper tissues into the positions they were in when you were younger, sew them down to immobile tissues on the face that are closer to the bone, and then refit the skin on top, removing excess if necessary. An operation may take three to four hours actually under the knife, with an hour or two both before and after surgery for prep and recovery processes.
Is The Healing Process Bad?
“Twenty-five years ago, if you did a facelift, somebody looked like a trauma victim,” say Dr. Few. Older techniques led to more bruising and swelling, plus multiple weeks of stay-at-home recovery. “It’s not like that anymore — they can actually show themselves days later,” he says. When the surgery ends, you’ll be bandaged (some plastic surgeons also use drainage tubes to help release fluid build-up and speed healing), and go to a recovery room, a local hospital, or your home. The level of aftercare can vary depending on needs and budget, but often a nurse will look after you in the day or two following the surgery to monitor your heart rate and blood pressure, help ice your face, and make sure your head stays upright as you sleep. Over the 10 or so days following, you go in for post-op check ups and removal of the stitches.
Pain can be managed with both prescription and OTC medications. “The pain level after my face and brow lift was five out of 10, more like a discomfort,” says Rinaldi. “The main feeling is just excessive tightness on your face, like your hair is in a very tight ponytail.” She also reported a numbness in her face near the incisions that took about six months to fully subside (this would be the case for any surgical incision — in fact, the face can actually regain feeling faster than other body parts). Minimizing sun exposure in the months after surgery is also crucial to prevent visible scarring.
So, when are the visible results final final? “I tell my patients three weeks for social events if you don't want anyone to know you did anything,” says Dr. Levine. “But if you have a big event like a wedding, I say six weeks for the mother of the bride and 12 weeks if you're the bride.”
How Much Does It Cost?
It may seem obvious by now, but this type of surgery doesn’t come cheap. “Facelift fees vary widely depending on multiple issues including geography,” says New Jersey facial plastic surgeon and AAFPRS President Dr. Paul Carniol. Once you factor in a surgeon’s fees plus fees for use of a surgical facility and anesthesia, he says a typical range would be $18,000 to $37,000. A less involved surgery in a less expensive region of the country could go below five figures. However, some surgeons have the additional training, experience, location, and/or pedigree to command a significantly higher rate. “While each patient’s need is different, my extended deep plane facelift starts at $80,000,” says Dr. Jacono, who operates in Manhattan’s Upper East Side and Long Island, NY.
Many patients weigh how the cost compares to the facials, lasers, and temporary injectables that may amount to thousands of dollars a year. Rinaldi, for example, says she spent a few years opting out of injectables and other treatments to save for her surgery.
Deciding If A Facelift Is Right For You
At the end of the day, a facelift is elective surgery and a very personal choice. “Everyone’s journey to self love is as diverse as the people seeking it,” says Rinaldi. “The more that we talk about it, the more we foster acceptance.”
Many doctors say that patients come to them apologetically or explaining how they’re not really “the kind of person” who gets a facelift — but the cloud of stigma may be shrinking. “I think people are slowly becoming more transparent,” says Dr. Chang. “[Surgery] is not something to be ashamed of. Aging is natural, but it’s also okay to want to look how you feel.”