The Condition
Facial ageing is driven by volume loss, skin laxity, descent of fat compartments and weakening of facial ligaments. Jowling, deepening nasolabial folds, marionette lines, neck banding (platysmal bands) and submental fat accumulation are characteristic findings. Non-surgical treatments have limited effect on these structural changes; facelift surgery remains the gold standard for durable correction.
Surgical Technique Options
There is no single "facelift" operation — the right technique depends on the pattern and severity of facial ageing, the degree of skin laxity, and the patient's goals. Mr Naparus selects from several established approaches below, and often combines techniques for a bespoke result.
Deep Plane facelift: Widely regarded as the current gold-standard technique for more advanced ageing of the jawline, mid-face and neck. Rather than tightening and pulling the skin — the hallmark of the traditional facelift, which on its own is now rarely indicated — the deep plane approach releases the facial ligaments that tether descended tissue in place, and redrapes the underlying fat compartments of the mid-face, jowl and neck back into a more youthful position. Because the lift is carried by the deeper tissues rather than the skin, it avoids the tight, "operated" appearance associated with older skin-only techniques, and tends to produce a more natural, durable result.
SMAS (Superficial Musculo-Aponeurotic System) facelift: Addresses the deep structural layer of the face, not just the skin. The SMAS is elevated, repositioned and secured, redistributing descended facial fat and lifting jowls. Provides long-lasting, natural results with no skin tension.
SMASectomy facelift: A more limited variation of the SMAS lift in which a strip of SMAS is excised and the edges brought together, rather than raising and repositioning a full flap. Suited to patients with mild-to-moderate jowling, combining a natural result with a comparatively shorter recovery.
Extended SMAS facelift: Extends the SMAS dissection further to restore fullness to the cheekbone area in addition to the jowls and neck. Useful where mid-face volume loss is a significant feature of ageing, though swelling can take somewhat longer to settle than with a standard SMAS or SMASectomy approach.
Short-scar facelift: An abbreviated incision for patients with more limited skin excess who are only beginning to show early signs of ageing, addressing the lower face — nasolabial folds, jowls and jawline — through a shorter, less conspicuous scar.
MACS (Minimal Access Cranial Suspension) lift: Purse-string sutures placed through a shorter incision, suspending the SMAS. Suited to patients with moderate laxity requiring less extensive surgery. Shorter operating time and recovery.
Isolated neck lift / platysmaplasty: For patients who wish to address the neck without visible facial incisions, the neck can be treated on its own through a well-hidden incision under the chin, working on both the skin and the deeper structures beneath the platysma muscle. Facelifts are frequently combined with this neck work where both the face and neck show signs of ageing, using the same submental approach for the neck component. Artiss fibrin sealant (the Auersvald Hemostatic Net technique) may be used to reduce haematoma risk and eliminate the need for a drain — most procedures are performed drainless.
Incisions are placed discreetly within the hairline and natural skin creases around the ear, and — where neck work is performed — hidden beneath the chin. These scars typically settle and fade quickly, and are rarely noticeable once healed.
Secondary (Revision) Facelift
Revision surgery after a previous facelift presents particular challenges and is approached differently from a first-time procedure. The most common reasons for early facelift failure are inadequate treatment of the deeper supporting structures at the original surgery, traction deformities from over-tightened skin, and a lack of durable deep-tissue support. Where a patient has developed visible facial distortion following a previous facelift, Mr Naparus generally recommends waiting at least a year before considering revision surgery, to allow tissues to settle and swelling to fully resolve before further surgery is planned.
Indications & Contraindications
Indications: Jowling and lower face laxity; deepened nasolabial folds and marionette lines; neck laxity and banding; submental fat and skin excess; patients in generally good health with realistic expectations.
Contraindications: Active smoking (nicotine cessation of at least 6 weeks mandatory); significant uncontrolled medical conditions; unrealistic expectations; very thin skin with minimal subcutaneous fat (relative). Anticoagulant medications must be managed pre-operatively.
The Procedure
Face and neck lift surgery is performed under general anaesthesia as an overnight stay procedure at Chelsea & Westminster Hospital Private Care. Thorough preparation beforehand includes a review of your general health, allergies, current medication and anaesthetic history; the specific combination of techniques used is then determined by an assessment of your individual facial changes together with your own goals and expectations. Incisions are placed in concealed locations — in the hairline, around the ear and behind the ear. Operating time is typically 3–5 hours depending on technique. Mr Naparus uses Artiss fibrin sealant where appropriate to seal tissue planes, significantly reducing haematoma risk and allowing drainless surgery in most cases (Auersvald Hemostatic Net technique). This improves comfort and recovery.
Aims & Expected Outcomes
A refreshed, natural appearance — not an operated one. Lifting of jowls and jaw definition. Smoothing of nasolabial folds and marionette lines. Improved neck contour and definition. Results typically last 8–12 years, though this is not a permanent procedure. The goal is always subtlety and naturalness; Mr Naparus does not aim for an overdone or "pulled" result.
Risks & Complications
All surgery carries risk; these are discussed fully at your consultation.
Haematoma
Historically the most common problem in the first few hours after facelift surgery: 2–8% overall, higher in men and hypertensive patients. Artiss sealant (Auersvald Hemostatic Net technique) substantially reduces this risk. Most managed by aspiration; occasionally requires prompt return to theatre.
Facial Nerve Injury
Temporary weakness in ~1%; permanent weakness rare (<0.5%). Mr Naparus has a thorough understanding of facial nerve anatomy.
Skin Necrosis
0.5–1% in non-smokers; significantly higher in smokers — a key reason for mandatory cessation. Usually affects skin edges behind ear.
Infection
<1%. Prophylactic antibiotics given perioperatively.
Alopecia (Hair Loss)
Temporary hair shedding near incisions; permanent alopecia uncommon. Careful incision placement minimises this risk.
Asymmetry
Minor asymmetry expected; pre-existing asymmetry documented. Significant asymmetry requiring revision uncommon.
Scarring
Scars are concealed; most become imperceptible within 6–12 months. Hypertrophic scarring uncommon.
Earlobe Distortion
Altered earlobe position ("pixie ear") can occur; meticulous closure technique minimises this risk.
Aftercare & Recovery
- Overnight stay at hospital following surgery
- Head elevation for 48 hours to reduce swelling
- Shower and wash hair gently after 48 hours
- Sutures removed in stages: face at 5–7 days, hairline at 10–14 days
- Bruising and swelling: substantially resolved by 2–3 weeks; final result at 3–6 months
- Return to office work: typically 2–3 weeks
- Exercise: light activity at 2–3 weeks; strenuous exercise at 6 weeks
- Swimming/sauna: once wounds healed, typically 2–3 weeks
- Contact sports: 6 weeks minimum
- Avoid direct sun exposure to scars for 6 months; use SPF50+
Alcohol impairs platelet function and increases bleeding risk, interferes with anaesthetic agents requiring higher doses, impairs wound healing by reducing collagen synthesis and immune function, and increases infection risk. Abstain completely for at least two weeks before and two weeks after surgery.
Nicotine causes vasoconstriction, dramatically increasing risk of wound breakdown, skin necrosis, poor scarring and infection. This includes cigarettes, vaping, patches and gum. Mr Naparus requires patients to be nicotine-free for a minimum of six weeks before and six weeks after surgery. In procedures such as facelift, active smoking is an absolute contraindication.
GLP-1 agonists slow gastric emptying and carry aspiration risk under general anaesthesia. Stop weekly injections at least one week before surgery; daily formulations 24 hours before. Declare all GLP-1 medications at pre-assessment.
Absorbable sutures (Vicryl Rapide, Monocryl) dissolve over days to weeks. Non-absorbable sutures (Prolene, nylon) are removed at 5–7 days on the face or 10–14 days elsewhere. You will be clearly advised which has been used.
Micropore tape: applied along scars to reduce tension; used for several weeks post-healing. Silicone tape/sheets: reduce scar thickness and redness; commenced 2–4 weeks postoperatively. Prineo: mesh/glue system for longer incisions; removed at 7–14 days. Non-adherent dressings used in early healing phase.
Related Patient Guides
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- Neck Liposuction
- Fat Grafting to the Neck & Jawline
- Manual Lymphatic Drainage (MLD)
- Preparing for Surgery
- Pain Management After Surgery
- Scar Management
- All Patient Guides