Facelift (meloplasty)

Facelift surgery

A ‘facelift’ (also known as meloplasty or rhytidectomy) is a type of cosmetic surgery that tightens and removes sagging skin on the face and neck. Facial muscles may be surgically tightened to change their tone. Excess fat may also be removed or repositioned as part of the surgery.

Facelift surgery can reduce jowls and smooth the jawline. Most people find that they look younger after facelift surgery. The scars of the procedure will be permanent, although they are generally hidden – usually by your hair.

A suture facelift (thread lift) can tighten or smooth out the skin around the eyes, cheeks or chin. This treatment will leave no obvious scars but will not dramatically alter your facial shape.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, consider other alternatives first. Talking to a counsellor or psychologist may help you overcome your concerns about your appearance. Alternatively, non-surgical treatments such as a chemical skin peel, dermabrasion or skin resurfacing may be considered.

Changes to laws that affect cosmetic procedures

In 2018, amendments were made to the Health Services Act 1988 to regulate all surgery, including cosmetic surgery. The changes specified that:

• all surgery must be carried out in a registered private hospital or day procedure centre
• liposuction and anaesthesia, including intravenous sedation and anything more than a low dose of local anaesthetic, must be carried out in a registered private hospital or day procedure centre.

This means that it is now illegal in Victoria for:

• any surgery (including cosmetic surgery) to be performed in facilities that are not registered with the Victorian Department of Health
• anaesthetic (other than low doses of local anaesthetic) to be administered in an unregistered facility.

How do I know if a facility or health service establishment is registered?

To find out if a facility is registered, you can:

• visit the Department of Health's Private hospitals page and expand the ‘contact details for private hospitals’ link
• email the Department’s Private Hospitals Unit privatehospitals@health.vic.gov.au
• ask to see the facility’s certificate of registration (this is usually on display in an obvious place where consumers can see it easily).

You can also contact the unit to report suspected illegal activity or for further queries regarding liposuction, cosmetic surgery or anaesthesia in Victoria.

Things to consider before deciding to have facelift surgery

Before you choose to have a facelift, some important issues to keep in mind include:

• While a facelift should make you look younger, it will not raise sagging eyebrows, remove deep frown lines in the forehead, change your upper or lower eyelids, or get rid of wrinkles around the mouth.
• Suture facelift, or thread lifting, is best suited to younger and middle-aged patients whose tissues have sagged with time or sun damage. It is not recommended for people with very thin or dry skin. Your medical practitioner will need to assess your individual suitability for this type of treatment.
• The results of a facelift usually last between 5 and 12 years.
• The normal ageing process will still continue after surgery.
• Think about the financial cost. Cosmetic surgery rarely qualifies for rebates from Medicare or private health insurance companies. For more information:
• Ask your medical practitioner about any out-of-pocket costs you can expect, and if you will be eligible for a rebate.
• Visit PrivateHealth.gov.au for more information on private health insurance.
• Smokers are at increased risk of complications. To decrease the risk of these complications, and for your general health and wellbeing, try to quit smoking before having surgery.
• Consider asking another medical practitioner for a second opinion. It is important to have as much information as possible, before deciding to have otoplasty.

Finding a qualified medical practitioner

Ask your GP for advice on a reputable medical practitioner or hospital where facelift surgery is performed.

At your first consultation, ask the medical practitioner about their training and experience.

This procedure should be done by a medical practitioner who is specially trained to perform facelift surgery and has a lot of experience in carrying out this type of surgery. Ask to see the medical practitioner’s certificates that show them to be qualified to perform this specialised surgery.

All doctors practising in Victoria must be registered with the Medical Board of Australia (the Board). Find out if your medical practitioner is registered with the Board by searching on the AHPRA website.

Your current medical status and facelift surgery

If you are considering having facelift surgery, you need to discuss your current medical status with your medical practitioner. This includes discussing:

• Your physical health – including your past medical history, such as diseases, illnesses, surgeries, immunisations and current physical status, which will include your diet and exercise regime. This would be a good time for the medical practitioner to check your blood pressure, temperature, heart rate/rhythm, oxygen saturation and respiratory rate.
• Your mental health – any mental illnesses or issues and their treatments.
• Medications you are currently on, including vitamins and supplements.
• Past reactions to medications.
• Any allergies you have.
• As a result of this discussion, your medical practitioner will be able to assess the risks and possible complications of the surgery for you. They will also be able to tell you what preparations you will need to make to ensure your recovery from surgery is as smooth as possible.

Facelift – what happens during surgery

All surgery, including otoplasty, must be performed within licensed and accredited facilities. A registered anaesthetist must be present to treat you for any adverse reaction you may have to the anaesthetic. You can check if your anaesthetist is registered by searching on the AHPRA website.

Facelift surgery is usually performed under a general anaesthetic. The length of the operation will depend on the type and extent of the surgery but could take anywhere from two to four hours.

The three main types of facelift include:

• Traditional facelift surgery – the medical practitioner makes an incision (cut) in the hairline from the temple, around and behind the ear, and back into the hairline. The skin is lifted away from the underlying tissues. Muscles are tightened and fat is removed. The medical practitioner pulls the skin up and back towards the scalp, removes any excess then stitches or staples the skin into its new position.
• Limited incision facelift – the medical practitioner makes smaller incisions at the temples and around the ears.
• Neck lift – the medical practitioner makes an incision in front of the ear and back into the hairline. The skin of the jaw and neck is lifted and tightened.

Immediately after facelift surgery

After facelift surgery, you may expect:

• a drainage tube in the wound to help prevent fluid build-up
• bruising and swelling
• to be given antibiotics to prevent infection
• possible numbness
• pain and discomfort
• dressings or bandages on your face
• a compression garment to help minimise swelling.

Potential complications of facelift surgery

All surgery carries some degree of risk. Some of the possible complications of facelift surgery include:

• heavy bleeding from the surgical site
• infection – which might requirement treatment with antibiotics, or further surgery in some cases
• allergic reaction to sutures, dressings or antiseptic solutions
• the formation of a large blood clot (haematoma) beneath the incision site, which may require drainage
• pain, bruising and swelling around the operated site(s)
• keloids and hypertrophic scars – raised, thickened scars that may form over the healed incisions. These may be itchy, annoying and unsightly but are not a threat to health
• slow healing, often associated with smoking or diabetes
• separation of wound edges
• short-term nausea following general anaesthesia
• hair loss around the scars
• loss of skin due to impaired blood supply – this may require a skin graft
• numbness around the surgical sites – this is temporary in most cases
• deformity of the earlobe
• slight difference in appearance between left and right side of the face
• nerve damage, which can cause temporary or permanent paralysis of part or all of the affected facial muscles
• further surgery may be required to treat complications.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. Speak to your medical practitioner for more information.

Self-care after facelift surgery

Your medical practitioner will provide you with post-operative care instructions, including:

• how to care for your surgical site(s) after surgery
• medications to apply topically (directly to the face) or take orally to aid healing and reduce the risk of infection
• specific instructions to look for at the surgical site(s) or in your general health
• when to follow up with your medical practitioner.

Long-term outlook after a facelift

Scars are an inevitable part of any invasive surgery. Your medical practitioner will try to minimise scarring and keep your scars as inconspicuous as possible by making the incisions in easily hidden sites. This way, scars will be along natural skin lines and creases. Scars may fade with time and become barely noticeable. If you are prone to scarring, let your medical practitioner know.

After traditional or limited-incision facelift surgery and neck lift surgery, the swelling may take months to subside. Scarring will be permanent but should fade over time. Be patient – improvements to scars may take around a year.

Remember, facelift surgery does not change your fundamental appearance and cannot stop the ageing process. Although the results are permanent, your skin will continue to age. A healthy lifestyle and minimising your daily exposure to sunlight will help maintain the results of your facelift surgery.

Suture facelift

An alternative form of facelift that is often done using local anaesthetic is a suture facelift (thread lift). The medical practitioner inserts fine threads under the skin through very thin tubes (cannulae) – no cuts are made in the skin.

These threads are made of a non-absorbable medical polypropylene fibre (Prolene®), which has been used safely in surgery for many years. Once the threads have been positioned through the tiny puncture sites, the threads are then gently tightened and secured to the facial tissue and skin.

Immediately after suture facelift

After a suture facelift, some pain may be experienced, but the discomfort usually settles within 24 hours. Some people experience more severe pain after the procedure. There may be slight swelling and bruising for four to 10 days.

Potential complications of suture facelift

Some of the possible additional complications of a suture facelift include:

• thread movement – this may lead to the thread extruding, breaking or losing its hold on the skin
• puckered skin
• discomfort, if the threads are felt under the skin
• skin irregularities or a loss of facial symmetry
• infection (this is rare).

More extensive surgery may be required if removal is necessary because of infection, discomfort or an unsightly appearance.

Self-care after suture facelift

Your medical practitioner will provide you with post-procedural care instructions.

Long-term outlook after suture facelift

The results of a suture facelift usually last for one to three years.

Alternatives to facelifts

Alternatives to facelift surgery can include:

• talking to a counsellor or psychologist may help you overcome your concerns about your appearance
• dermal fillers
• injections of botulinum toxin Type A (such as Botox®) into wrinkles
• laser resurfacing
• facial implants
• light therapy
• a new beauty regimen that includes experimenting with different face creams that work for you – there are always new technologies developing beauty products with new ingredients that focus on aspects of ageing
• beauty therapy devices, such as derma rollers.

Where to get help

• Your GP (doctor)
• A dermatologist
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• A second opinion from another medical practitioner specially trained and experienced in performing cosmetic surgery
• Your psychologist, councillor or psychiatrist
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Private Hospitals Unit, Department of Health Email privatehospitals@health.vic.gov.au
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495