Facial Aesthetic

Face and Neck Lift

A facelift and neck lift are surgical procedures designed to rejuvenate the lower face and neck by lifting and repositioning deeper tissues, tightening loose skin, and restoring a more defined jawline and neck contour. These procedures address sagging in the cheeks, jowls, and neck, banding of the neck muscles, and excess skin. Modern facelifts focus on moving the deeper supporting layers of the face rather than simply tightening the skin. This creates a natural, long-lasting result without a stretched or overly pulled appearance of the skin, more common in older techniques.

Indications

As we age, the face undergoes predictable structural changes involving the skin, soft tissues, and deeper support layers. The skin gradually loses elasticity and thickness, leading to fine lines, wrinkles, and areas of laxity. Facial fat pads diminish in volume and descend with gravity, creating hollowness beneath the eyes, flattening of the cheeks, and the development of jowls. Supporting ligaments weaken, allowing the mid-face to descend and the jawline to lose definition. In the neck, the skin and underlying platysma muscle can loosen, resulting in skin redundancy, banding, or a heavier neck profile.

Some of these changes also occur after significant weight loss and are increasingly seen in people taking semaglutides such as Ozempic™ and Wegovy™.

Non-surgical treatments such as fillers, skin tightening devices, and injectables may provide good results in early facial ageing. However, as deeper facial tissues descend and skin loses elasticity, these treatments may no longer lift or reposition underlying structures effectively. When volume replacement or skin-tightening procedures no longer provide meaningful improvement or create an unnatural appearance, a facelift becomes a more appropriate and predictable option.

The specific concerns a facelift and neck lift address include:

Sagging of the mid-face or cheeks: The deeper facial tissues descend, causing loss of youthful cheek lift and heaviness in the lower face. A facelift repositions these layers to restore natural contour.
‍Jowls or loss of jawline definition: Soft tissue descent along the jawline creates jowls, which a facelift lifts and tightens for a more defined jawline.‍
Deepning of nasolabial folds: As the mid-face descends, creases between the nose and mouth become pronounced. A facelift softens these folds by lifting underlying tissues.‍
Loose or excess skin of the lower face: When skin laxity is significant, non-surgical treatments cannot tighten it effectively. A facelift removes excess skin and redrapes it naturally‍
Neck laxity (loose skin): A neck lift improves loose skin, muscle banding, and restores the chin-neck angle for a smoother contour.
‍Platysmal bands: Vertical neck bands caused by platysma separation can be tightened during a neck lift.‍
Excess fat under the chin or around the neck: Submental or neck liposuction is often combined with a neck lift to improve definition.

Types of Facelifts

While many facelift techniques exist, Dr Phua typically uses either a deep plane facelift or a high SMAS facelift, selecting the approach that best suits each patient's facial anatomy and aesthetic goals. The incisions for both techniques are generally similar.

Deep Plane Facelift

Lifts and repositions the deeper supporting tissue of the face (SMAS) beneath the cheek fat pads. This releases retaining ligaments and moves the mid-face and jowl region as a single unit. Effective for restoring cheek volume, softening nasolabial folds, defining the jawline, and creating a smooth neck–jaw transition. Results are natural and long-lasting.

High SMAS Facelift

Lifts the SMAS layer more laterally and vertically without full deep-plane dissection. Improves the cheek and jowl area and may be combined with a neck lift when neeed. Preferred when mid-face lifting is less extensive.

Neck Lift

Focuses specifically on improving neck contour by tightening loose skin, addressing platysmal banding, and removing excess fat. Often combined with submental liposuction and platysma tightening to restore a smoother, more defined neck profile.

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Ancillary Procedures

Facelifts and neck lifts can be performed alone or combined with other facial procedures:

Structural fat grafting: Uses fat harvested from the abdomen or thigh to restore volume in cheeks, temples, jawline, lips, or peri-orbital region. Complements the lifting effect.
‍Temporal lift or brow lift: Lifts the outer eyebrow and improves heaviness around the upper eyelid and temple region. Can be combined with a facelift.
‍Chin augmentation or genioplasty: Enhances chin projection to improve facial proportions and sharpen the jawline, especially when combined with a neck lift.

Other procedures that may be performed simultaneously include blepharoplasty, rhinoplasty, and lip lift.

What to Expect

First Few Days

Swelling, tightness, and bruising are normal, particularly around the cheeks, neck, and ears. You may feel fullness, numbness, or mild pressure. Swelling and bruising can be pronounced in the first few days. Ice packs can help reduce swelling and provide comfort. Small drains may be used and typically removed the day after surgery. Most patients can shower after the first dressing change. Sleeping with the head elevated on pillows helps reduce swelling. A supportive garment for the chin is usually worn for the first one to two weeks.

First Week

After the initial few days, swelling, bruising, and tightness begin to settle. You may still experience fullness or firmness around the cheeks, jawline, and neck. Bruising changes colour and starts fading. The supportive garment should continue to be worn. Minor asymmetry and numbness around the ears, cheeks, or neck are normal. Stitches are typically removed five to seven days post-op. Most people can resume light activities at home and short outings but should avoid heavy lifting or exercise.

Weeks Two to Three

Bruising generally fades and swelling continues to improve. Mild tightness, firmness, or lumpiness may persist along the jawline and neck. Many patients feel comfortable returning to work and social activities by the end of week two. Light exercise can resume, but strenuous activity should be avoided. Makeup may be applied once incisions are well healed, usually around the two-week mark.

After Four Weeks

Most swelling has settled, and the face and neck begin to feel more natural. Scars hidden around the ears and hairline continue to mature and fade over several months. Numbness around the neck and ear may persist for weeks to months. Strenuous exercise, heavy lifting, and sports can generally resume after six weeks. Final results are typically seen around three to six months as swelling resolves and tissues relax into position.

Potential Risks

Possible complications include bleeding or hematoma, infection, delayed wound healing, numbness or altered sensation (usually temporary), asymmetry, thickened or visible scarring, hairline changes or local hair loss, and temporary facial movement weakness due to swelling. Rarely, facial nerve injury may occur, which can affect part of the face temporarily or, in very rare cases, permanently. Other risks include persistent swelling, contour irregularities, skin discolouration, prolonged bruising, and the potential need for revision surgery.

Smoking or vaping significantly increases the risk of complications and should be avoided for at least six weeks before and after surgery.

If you have any queries about facelift surgery or would like to arrange a consultation, please contact us at Terrace Plastic Surgery.

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Note that for facelift procedures in Brisbane, Dr Phua follows AHPRA requirements that include a minimum of two consultations, a cooling-off period before offering surgery, and screening for dysmorphic body disorder.

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