Dr. Esin Özlem Atmış
Facelift and Neck Lift
A deep plane facelift and neck lift in Istanbul, planned around the structures that have actually changed, so that the face looks rested and still like you.
Facial surgery · Cheeks, jawline and neck
Repositioning, not pulling.
A facelift lifts and repositions the skin and the deeper supporting tissues of the face to soften sagging in the cheeks, jowls and jawline; a neck lift, often done at the same time, tightens loose skin and muscle bands in the neck.1,2 Dr. Atmış plans facelifts with a deep plane approach, in which the deeper support layer and the skin are moved together instead of the skin being stretched on its own.3
This page explains what a facelift can and cannot change, who it suits, how the deep plane technique works, how to prepare (including blood thinners), what recovery looks like and how to plan a stay in Istanbul.
In short
- Treats sagging of the mid and lower face, jowls and neck. It does not treat fine lines, sun damage or skin colour.1
- Deep plane technique: the deeper support layer (SMAS) is released from its ligaments and lifted together with the skin.3
- Usually one night in hospital. Plan about seven days in Istanbul and two to four weeks before you feel socially comfortable.4
- Blood thinners, supplements, smoking and blood pressure are reviewed weeks before surgery, never on the day.1,5
- Results last for years, but the face continues to age.1
Who a facelift and neck lift can help
People usually ask about a facelift when they notice one or more of these changes:
- the cheeks look heavier and lower, and the fold between the nose and the mouth deepens;
- jowls break the clean line of the jaw;
- loose skin, fat or vertical muscle bands appear under the chin and in the neck.2
A facelift changes position and support. It does not correct sun damage, fine lines or changes in skin colour; those need other treatments, sometimes in addition to surgery.1
Is it the right time? Age alone does not decide. What matters is how far the deeper structures have descended, the quality of your skin, your general health and what you expect. Some people are better served by a smaller procedure, such as an endoscopic midface lift or a double chin procedure, or by waiting.
A facelift may not be advisable if you smoke and cannot stop, if blood pressure or diabetes is poorly controlled, if your weight is still changing significantly, or if your blood cannot clot normally.1
What “deep plane” means
Beneath the skin of the cheek lies a supporting layer called the SMAS, which continues into the platysma muscle of the neck. With age, the ligaments that hold this layer and the cheek fat in place loosen, and tissue descends towards the jaw.3
In a deep plane facelift the surgeon works beneath the SMAS, releases the retaining ligaments of the cheek and jaw, and lifts skin and SMAS as one layer. The cheek fat pad moves back up, which softens the fold beside the nose, and releasing the mandibular ligament is key to reducing the jowls. Because the deeper layer carries the lift, the skin can be closed without tension.3
| What has changed | Usual part of the plan |
|---|---|
| Cheek descent, deeper nasolabial fold | Deep plane release and repositioning of the cheek fat pad3 |
| Jowls | Release of the mandibular ligament3 |
| Loose neck skin, muscle bands | Neck lift, often in the same operation2,1 |
| Fat under the chin | Conservative fat reduction; see double chin surgery |
| Low, heavy brows or upper eyelid hooding | A separate brow lift or eyelid surgery |
The technique is chosen for the face, not the other way round. A 2026 meta-analysis comparing deeper SMAS facelifts with a shorter-scar suspension technique found similar short-term results and complication rates, while noting that the evidence is still limited.6
The consultation
A useful consultation looks at the whole face, not a single photo. It covers four things:
01 · Listen
What bothers you, since when, and what you would and would not like to change.
02 · Examine
Skin quality, fat, muscle bands, bone support, symmetry, earlobes and the hairline, plus previous fillers or threads.
03 · Check health
Medicines, bleeding history, blood pressure, diabetes, smoking and anaesthesia risk.1
04 · Decide together
Scars, recovery time, whether the eyes or brows should be included, and what a realistic result looks like.
When concern about appearance feels overwhelming or out of proportion, surgery is unlikely to help, and this is discussed openly.3 International patients usually begin with an online consultation; the final examination is in person before surgery.
Before surgery: blood thinners, supplements and smoking
Preparation for a facelift starts two to six weeks before the operation. Hormone replacement therapy may also need a pause of about three weeks, because it raises the risk of blood clots.1
Bring a written list of every medicine, injection and supplement you take, including doses. The table shows what usually happens; it is not an instruction to stop anything yourself. Blood thinners protect against stroke and clots, so any pause is agreed with the doctor who prescribed them.5
| Medicine | What usually happens before planned surgery |
|---|---|
| Warfarin | Usually stopped about five days before surgery; some patients need a temporary heparin injection plan.5 |
| Apixaban, rivaroxaban, edoxaban, dabigatran | Usually paused one to two days before, depending on bleeding risk; dabigatran needs longer when kidney function is reduced.5 |
| Clopidogrel, ticagrelor, prasugrel | If the cardiologist agrees, usually stopped about 5, 3 to 5, and 7 to 10 days before respectively. After a recent coronary stent, planned surgery is often postponed.5 |
| Aspirin | Often continued when it is taken to protect the heart; the decision is individual and made with your prescribing doctor.5 |
| Ibuprofen, naproxen and similar painkillers | Increase bleeding and are usually avoided before surgery; paracetamol is the usual alternative.7 |
| Vitamin E, ginkgo, garlic, ginseng and other supplements | Can increase bleeding; usually stopped at least two weeks before, sometimes three.8,1 |
| Weight-loss or diabetes injections (GLP-1 medicines such as semaglutide or tirzepatide) | Most people can continue them, but the anaesthesia team must know. Surgery may be postponed during dose increases or if you have nausea or vomiting; some patients need a liquid diet for 24 hours before.9 |
Bleeding disorders. Tell us at the first contact if you have a diagnosed bleeding disorder (for example von Willebrand disease or haemophilia), a low platelet count, liver disease, or a history of unusual bleeding after tooth extractions, operations or with periods. Blood tests and a haematology opinion come before any surgical plan. People whose blood cannot clot normally are not candidates for a facelift.1
Blood pressure and diabetes. Poorly controlled blood pressure or diabetes increases the risk of a collection of blood under the skin (haematoma) and of poor healing; both should be well controlled before surgery.1
Smoking and nicotine. Stop all nicotine, including vapes, patches, gum and snus, at least three to six weeks before surgery and for three to six weeks afterwards. Nicotine narrows small blood vessels and raises the risk of wound problems and skin loss; if you relapse, tell us, because postponing is safer.10
The operation
A facelift usually takes three to six hours and is done under general anaesthesia or under sedation with local anaesthetic.1 The incision runs in or along the hairline at the temple, follows the natural contour in front of the ear, passes around the earlobe and ends behind the ear; a small incision under the chin is added when the neck muscle needs tightening.1
After the deep plane release and lift, the SMAS is secured with sutures and the skin is trimmed and closed without tension.3 A soft dressing and sometimes a small drain behind the ear are used; drains are usually removed the next day.3
Recovery and risks
| Time | What is typical |
|---|---|
| First 24 hours | Dressing worn continuously, head raised; drain and dressing usually removed on day one3 |
| Days 1–4 | Discomfort is greatest and usually lasts three to four days; cold compresses help3 |
| About 1 week | Stitches removed and wounds checked; head kept raised during the first week3,1 |
| 2 weeks | No strenuous activity; bruising is visible for at least two weeks3,4 |
| 2–4 weeks | Most people feel ready for work and social life4 |
| 6 weeks | Facial stiffness usually gone; hair colouring allowed again4,1 |
| 6–9 months | Final result visible4 |
Risks. A haematoma (blood collecting under the skin) is the most common complication and usually appears within the first 24 hours; it occurs in under 2% of cases overall and is about twice as common in men. Careful blood-pressure control after surgery lowers the risk.1,3 Numbness around the ear is common and usually improves over weeks to months. Weakness of facial movement occurs in under 1% of deep plane facelifts and is almost always temporary.3 Other risks include visible scars, hair loss near the incisions, a change in earlobe shape, asymmetry, infection and healing problems, which are more likely in smokers.4,1
Travelling to Istanbul for a facelift
Many patients travel from other cities or countries. A clear plan makes the trip calmer and safer:
- Online consultation first: most international patients start with an online consultation. Send your concern, your medical history, your medicines and a few clear photos through the channel the practice arranges, before you book flights.
- Arrive at least one day before surgery: the anaesthesia assessment and the final examination take place before the day of the operation.
- Hospital stay: usually one night; a second night is optional and decided according to your comfort and the surgeon’s assessment.
- Time in Istanbul: plan about seven days after surgery. This covers the drain and dressing change and the one-week wound check, when stitches are removed.3
- Follow-up: reviews are planned at 1 month, 3 months, 6 months and 1 year. They can be done online if you live abroad; you will know whom to contact for urgent questions after you return home.
Dr. Atmış and facial surgery
Op. Dr. Esin Özlem Atmış is an ENT and facial surgeon in Istanbul. She completed her specialist training in otorhinolaryngology at Ankara University Faculty of Medicine in 2014 and is a member of the Turkish Facial Plastic Surgery Association. She is one of the congress presidents of Face Bosphorus 3 (Istanbul, April 2026), a meeting on facial anatomy and medical practice. At Face Bosphorus 2025 she gave an opening talk and chaired sessions on the upper face and periorbital region, biostimulators and whole-face assessment; she was a listed speaker at Face Minima 2025, and at the 4th Congress of European ORL-HNS in Barcelona (2017) she chaired sessions that included facial anatomy. Details are on her scientific activities page.
In facelift surgery she uses the deep plane approach and plans the face and neck together, often alongside the eyes and brows, because a change in one area alters how the others look. Her congress work on the upper face and on whole-face assessment reflects this view.
Her approach starts with understanding the concern before discussing an operation: what has changed, how it affects you, and which structures are actually responsible. The aim is a proportionate plan that keeps your expression and character, which sometimes means a smaller procedure, a different order of treatment, or no surgery. Besides Turkish, she speaks English and Italian.
Frequently asked questions
How long does a facelift last?
Results last for many years, but they do not stop the face from ageing. A facelift resets position; ageing continues from there.1
Will I look “pulled”?
A pulled look mostly comes from tension on the skin. In deep plane surgery the deeper layer carries the lift and the skin is closed without tension.3 The plan also aims to keep your own features.
Can a neck lift be done without a facelift?
Sometimes, when the problem is mainly in the neck. A neck lift treats the jawline and neck; descent of the cheeks needs a facelift.2,1
Can fillers, threads or devices replace a facelift?
They can help skin quality or volume, but they cannot reposition descended tissue in the same way. Non-surgical treatments do not achieve the results of a neck lift.2
I take blood thinners. Can I have a facelift?
Often yes, if the doctor who prescribes them agrees to a safe pause.5 People whose blood cannot clot normally are not candidates.1
Is a facelift different for men?
The principles are the same, but men have about twice the risk of haematoma.3 Beard-bearing skin and the hairline also affect where the incisions are placed.
Clinical references
- Mayo Clinic. Face-lift.
- American Society of Plastic Surgeons. Neck lift.
- Hohman MH, Raggio BS, Patel BC. Deep Plane Facelift. StatPearls, NCBI Bookshelf (updated 2026).
- NHS (UK). Facelift.
- Perioperative management of antithrombotic medications: guidelines from the American College of Chest Physicians (summary in Am Fam Physician, 2023).
- Pandkhahi A, Zare N, Karimi AM, et al. Comparison of deep SMAS lift and MACS in facelift: a meta-analysis. Medicina (Kaunas). 2026;62(1):112.
- Mayo Clinic. Blepharoplasty.
- American Society of Anesthesiologists. Herbal and dietary supplements and anesthesia (patient leaflet).
- American Society of Anesthesiologists. Multi-society guidance on GLP-1 receptor agonists before elective surgery (2024).
- American Society of Plastic Surgeons. How nicotine sabotages plastic surgery.
This page is general information, not a personal diagnosis or treatment recommendation. Medicines must never be stopped without the advice of the doctor who prescribed them. Seek urgent medical care for heavy bleeding, rapidly increasing swelling, breathing difficulty, chest pain or sudden vision changes after surgery.
Start with a careful, honest consultation.
A consultation is not a commitment to surgery. It is where your concern, your anatomy and your health are looked at together.