What makes a good facelift?

If you are thinking about a facelift, it can be bewildering and overwhelming when you start researching your options. You will hear terms such as SMAS, short scar, long scar, full facelift, composite facelift, deep plane, mini-facelift, MACS lifts and many more. To be honest, even plastic surgeons do not universally agree on the terms used when it comes to facelifts, so how anyone else is meant to make head or tail of the options is beyond me!


Fundamentally I think there are a few key questions to ask yourself (and your plastic surgeon) to help define what technique would be best suited to you.


The neck

If your neck is a concern, and you are keen to have it lifted and tightened, then there is good evidence to achieve a long term and stable result, a full scar facelift is required. This means that the scars for the facelift extend behind the ear into the hairline. This is because there has to be somewhere for the excess neck skin to go, once the deeper tissues have been lifted and tightened. If the scars do not extend that far, then there will inevitably be early recurrence of the neck laxity, which can be very disappointing.

facelift scars

The jowls

If your main concern is your jowls, and you do not have any laxity on your neck, then you may be suitable for a short scar facelift. The short scar means that the scar runs in front of the ear and around the side burns, but does not extend behind the ear to any significance. What is done to the deeper tissue is a separate issue. There is no automatic correlation with the scar length to the technique used in the deeper tissues. However, the manipulation of the deeper tissue is the key to the outcome of the operation.



This stands for the superficial musculo-aponeurotic system, which is the soft tissue skeleton of the face, including the muscles of facial expression, and the platysma muscle in the neck (that may cause bands in the neck). The key to any modern facelift to producing a natural result is to tighten the SMAS. This can be done by lifting and repositioning it (SMAS flaps); by tightening it (SMAS plication); by removing some of it and re-stitching it (SMASectomy) or by using stitches to draw it up (SMAS imbrication). The best SMAS technique should be decided depending on your facial features


Looking at before and after pictures

The immediate (up to 4-weeks) results of the facelift are partly due to the skin tightening, and the true results of the facelift can only truly be analysed after at least 6-months following surgery. Therefore do not be fooled by anyone showing pictures 1 or 2 weeks after surgery, as this may have no bearing on the final result. Furthermore, the post-operative swelling will make any result look better, as it fills out residual wrinkles and lines temporarily! The results you are shown should be at least 6-months after surgery, so you can really appreciate the longer term effects that are achievable.


I hope this helps bring some clarity the facelift decision-making process. For more information, please see the page on facelifts and associated PDF on facelifts.

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