Facelift: what it corrects and what it leaves exactly as it was

There is one question worth asking before any other, and it decides whether a facelift is what you need: has the thing that bothers you dropped, or has it changed in quality?

A facelift repositions the tissues that have descended over the years — the cheek, the jawline, the neck — and removes the skin left over once they are back in place. That is what it does, and it does it very well. It does nothing else.

What a facelift leaves exactly as it was

• Pigmentation. That is colour, and it is treated by other means.
• Skin texture and pores.
• Fine lines around the lips and the eyes. Those are not there because something has fallen.
• Tone and radiance.

If what you see in the mirror is mostly that, a facelift will give you back your jawline and the same skin you had. It is major surgery to solve something that was not the problem, and it is the commonest reason for leaving a well-performed operation disappointed.

A facelift changes where the tissues are. It does not change what they are made of.

That does not mean you have to choose: the two are often combined, and sometimes the sensible order is to treat the quality of the skin first and decide about surgery afterwards.

It is not about stretching skin

The real work is in a deep layer called the SMAS, which is what holds up the cheek and the neck. Repositioning it is what restores the jawline without leaving the skin under tension.

That is why it matters so much: if only the skin were pulled, the result would be a tight face that slackens within months. That stretched look everybody fears is not "a facelift"; it is a facelift done badly, done on the wrong plane.

Two things that can postpone the date

These are not general health advice: in this particular operation they are the two factors that raise the risk most.

Smoking. A facelift raises thin, long skin flaps that depend on a microcirculation nicotine narrows. It is the operation where smoking does most harm.

Uncontrolled high blood pressure. It multiplies the risk of a haematoma, which is the characteristic complication of this procedure and the one that can mean going back to theatre within hours.

If either is present, the right thing is to sort it out and operate afterwards.

The real calendar

• First 48 hours. Dressings, considerable swelling and a feeling of tightness and numbness rather than pain. This is the period of closest watch for a haematoma.
• Week 1. Drains and some stitches out. Bruising is at its worst between the third and fifth day. The face is not recognisable yet.
• Weeks 2 to 3. Back to social life with make-up and to office work. Uneven swelling and numb patches in front of the ears persist: normal and temporary.
• Months 1 to 3. The swelling clearly settles and the jawline appears.
• 6 to 12 months. Result settled, scars mature, sensation back to normal.

You need to allow two to three weeks out of circulation. Anyone who does not have them would do well to wait until they do.

What is not promised

You are not promised a different face. You get your own back a few years, and anyone looking to resemble someone else will be dissatisfied with any result.

Nor does it stop ageing: the skin carries on and the tissues descend again. A good facelift lasts years, not forever.