Medical Encyclopaedia › Facelift (short definition)
In brief: A facelift (rhytidectomy) is an operation in which sagging skin and the underlying tissue in the lower face and often also the neck are lifted and tightened. It can improve sagging cheeks, jowls along the jawline and lax neck skin, but it does not stop ageing and hardly changes the skin surface itself.
How does a facelift work?
Over the years, the skin loses elasticity, fat pads in the face shift downwards and partly shrink, and the supporting structures of the tissue also loosen. In the skin-only lift that used to be common, only the skin was tightened, which often looked mask-like and did not last long. Today, the deeper connective tissue and muscle layer (SMAS) is usually treated as well: it is gathered, folded or lifted as a separate layer. In the deep-plane technique, dissection is carried out beneath this layer in order to reposition cheek tissue as a unit. Smaller variants such as the mini-lift use shorter incisions but also have more limited effects. Which technique is suitable depends on the findings and the surgeon’s experience; none is clearly superior for all cases.
The operation
The procedure is performed under general anaesthesia or local anaesthesia with sedation and usually takes several hours. The incision typically runs from the temple in the hairline along the front of the ear, around the earlobe and behind the ear into the hairline. For the neck, a small incision under the chin is often added (neck lift). The facelift is often combined with eyelid surgery, fat transfer or liposuction of the neck. Excess skin is removed with little tension; drains and a compression bandage may be needed for a short time.
Healing and course
Swelling, bruising and a feeling of tightness or numbness in the cheeks and ears are normal in the first weeks. Many people feel presentable again after about two to three weeks; however, residual swelling and sensory disturbances can last several months. The scars are red at first and usually fade within a year. Keeping the head raised, cooling and avoiding heavy physical exertion in the first weeks support healing. The tissue continues to age afterwards; although many effects remain visible for years, there is no guarantee of a particular durability.
Risks and limits
- Secondary bleeding and haematoma: the most common early complication, especially with high blood pressure; larger haematomas must be relieved surgically.
- circulatory disorders of the skin up to wound-healing problems, much more common in smokers
- injury to branches of the facial nerve with weakness of facial expression, usually temporary, rarely permanent
- numbness, especially at the ear
- conspicuous, widened scars, an altered hairline or distorted earlobes
- asymmetries or an unnaturally tight appearance
- general surgical risks such as infection, thrombosis and anaesthetic risks
A facelift hardly improves fine lines, pigment spots and skin texture; peels or laser treatments are more suitable for this.
Alternatives
Depending on the findings, fillers, botulinum toxin, thread lifts or energy-based procedures such as ultrasound or radiofrequency treatments may be considered. They are less invasive but have a much smaller and temporary effect and their own risks. In pronounced tissue laxity, they do not replace surgery.
Costs and important to know
An aesthetic facelift is paid for privately; German health insurers do not cover the costs, and for follow-up treatment of complications they can require insured persons to share the costs under Section 52 SGB V. Important are a surgeon with specialist qualification in plastic and aesthetic surgery or a comparable qualification, a detailed consultation, sufficient time to reflect and realistic expectations. Smoking should be avoided for several weeks before and after the procedure; anticoagulants and high blood pressure must be discussed beforehand. If there are very great concerns about appearance despite minor changes, a psychological assessment is advisable.
Related terms in the encyclopaedia
Neck lift, Blepharoplasty, Thread lift, Skin ageing, Haematoma, Facial nerve, Facial palsy, Filler, Body dysmorphic disorder
Sources
- Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC): Patienteninformationen zur Gesichtsstraffung
- American Society of Plastic Surgeons (ASPS): Facelift – Patient Information
- Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC): Patienteninformationen
- Bundesärztekammer: (Muster-)Weiterbildungsordnung – Facharzt für Plastische, Rekonstruktive und Ästhetische Chirurgie
Note: This article is for general information and does not replace advice, diagnosis or treatment from a doctor, dentist or pharmacist. Last updated: October 2026.