How it works
Everything starts with a consultation. Your doctor listens to what concerns you, examines your facial skin, how much the tissue has dropped, the jawline, and the neck, and asks about your medical history, the medicines you take, and whether you smoke. From there your doctor discusses which areas should be lifted and by how much, the likely technique, and what surgery can and cannot do in your case. You also have routine pre-operative tests, and the anaesthetist sees you beforehand.
There are a few things to prepare before the day of surgery. You will be guided to stop certain medicines and substances that can cause bleeding, to stop smoking, and to fast as directed before your start time. Surgery is usually done under general anaesthesia, or under local anaesthesia with sedation depending on the case. The length of surgery varies with how much is involved.
The incision usually runs around the ear. It begins at the temple within the hairline, follows the crease in front of the ear, curves around the earlobe to behind the ear, and into the hairline at the back. Because of this, most of the scar sits hidden in the hair and along the natural creases around the ear. When the neck needs work, there may be a small extra incision under the chin. Through these openings, your doctor releases and lifts the SMAS layer underneath, repositions the tissue to a firmer place and secures it, and only then adjusts the overlying skin and removes the excess in measured amounts. A facelift done well tightens the deep layer beneath, not the skin pulled taut.
Throughout, your doctor works carefully around the branches of the facial nerve (which control the movement of your facial muscles) and the sensory nerves of the ear, because these are important structures within the surgical area. Once the shaping is complete, your doctor controls any bleeding thoroughly, closes the incision, and usually applies a supportive pressure dressing around the face and neck. In some cases a small drain is placed for a short time to let fluid escape. Whether you stay overnight for observation depends on the anaesthesia method and your condition.