What Happens During a Facelift? Anaesthesia, Duration, Incisions and Surgery Day Step by Step

For many people considering a facelift, the biggest unknown is the day of surgery itself: Will I be asleep? How many hours does it take? Where are the incisions? How will I feel when I wake up? Knowing the answers in advance reduces anxiety and makes preparation easier.

This guide walks through a facelift step by step, from the morning of surgery to the end of the first day. Details vary with the technique, the extent of surgery and any combined procedures.

The morning of surgery

Usually you will not eat after midnight; water and approved medicines are often allowed. You may be asked to wash your face and hair with an antibacterial soap on the morning of surgery.² At the hospital you meet the anaesthetist, final checks are done, and the surgeon marks the incision lines and the directions in which tissues will be moved, usually while you sit or stand.

Preparation in the weeks before surgery is covered in how to prepare for a facelift.

Anaesthesia

A facelift is usually done under general anaesthesia; sometimes local anaesthesia with sedation is used.¹ The choice depends on the extent of surgery, any combined procedures and your health. Even under general anaesthesia, local anaesthetic is usually injected along the incision lines to reduce bleeding and pain.

The operation step by step

1. Incision: incisions are planned so the scars are hidden along the hairline and the natural folds around the ear.² If the neck is also treated, a small incision under the chin may be added.³
2. Lifting the skin: the skin is separated from the supporting tissues beneath, up to a planned limit.
3. Repositioning the deeper tissues: in modern techniques the main work is done in the SMAS, the layer that supports the face. In SMAS techniques the layer is folded, stitched or partly removed; in a deep plane facelift the surgeon works beneath the SMAS, releases the retaining ligaments and moves skin and SMAS together.⁴ The difference is explained in deep plane vs SMAS facelift.
4. The neck: if needed, fat under the chin is reduced and the platysma muscle is tightened.³
5. Removing excess skin and closing: once the deeper tissues are fixed in their new position, excess skin is removed. In the deep plane technique, sutures are placed at the fascial level and the skin is closed without tension.⁴
6. Drain and dressing: a small drain may be placed behind one or both ears, and the face is wrapped in a bandage.²

How long does it take?

The NHS states that a facelift usually takes 2 to 3 hours; Mayo Clinic gives 3 to 6 hours, and longer when other cosmetic procedures are done at the same time.^1,2 Additional procedures such as a neck lift, eyelid surgery or brow lift lengthen the operation. Because combined procedures can also increase the major complication rate, the scope is weighed for each patient.⁵ Combining a facelift with eyelid surgery is discussed in facelift and eyelid surgery together.

Waking up and the first night

After surgery, pain, swelling, bruising, numbness and fluid from the drain are normal.² Most people stay one night in hospital.¹ In the first days you will be asked to rest with your head raised, take painkillers as instructed and use cool packs.²

The first 24 hours are when haematoma, the most common facelift complication, most often develops. If you have severe pain on one side of the face, shortness of breath, chest pain or an irregular heartbeat during this time, the team must be told immediately.²

The following days

Recovery week by week is covered in facelift recovery week by week.

Frequently asked questions