There are a number of different facelift variants which vary in technique and cost. It can be seen as a three-stage procedure:

1. S-lift: With an s-lift, only the skin of the cheek is lifted via an s-shaped incision (also referred to as a mini-lift). The underlying supporting tissue is not lifted.
2. MACS lift: With a MACS lift (Minimal Access Cranial Suspension lift), the skin of the cheeks is lifted together with the underlying supporting tissue (SMAS) via the same incision. This variant does not make any difference to the skin of the neck.
3. Face-neck lift: With a face-neck lift, an elongated incision is made behind the ear, which is used to lift the skin of the cheeks, the underlying supporting tissue (SMAS) as well as the skin of the neck.

The combined face-neck lift is the most extensive facelift and also gives the most satisfactory results. As with a MACS lift, the plastic surgeon makes an incision from the temples downwards in front of the ear.

The incision then runs under the earlobe and ends in the hairline behind the ear. It is then possible to also tighten the tissue of the neck. A face-neck lift therefore improves the appearance of the face as well as the area below the jawline. A face-neck lift delivers the most satisfactory results. Deep creases in your face and neck can be eliminated with a combined face and neck lift. It is also possible to carry out an eyelid correction procedure at the same time as a face-neck lift.

A face-neck lift is always performed under general anaesthetic and always includes an overnight stay at the clinic. In most cases, you are free to go home again the next morning.

Plastic surgeon

The consultation is always held with the plastic surgeon who will be carrying out your procedure.
During this consultation, you can discuss what bothers you the most about your face and what you would like to have changed. The plastic surgeon will take down your medical history and examine your face. They will then suggest the most suitable surgical technique for you and discuss it with you. In front of a mirror, you will be shown what this procedure entails and what you can expect in terms of end results.
The plastic surgeon will explain to you the results you can expect from an s-lift, MACS lift and face-neck lift. The recovery period and pros and cons of the procedures will also be explained. You will then be in a position to make a well-informed decision. After this, the plastic surgeon will show you before and after photos of a face-neck lift procedure.

Possible complications and risks are then discussed with you and an indication of the costs involved. The aim of the consultation is to inform you as clearly and fully as possible.

Consultants

Following on from your first consultation with your plastic surgeon, you will have an appointment with your consultant. The aim of this appointment is to tell you about the general aspects to be arranged with respect to your face-neck lift. 

You are expected to arrive at the Boerhaave clinic half an hour before your face-neck lift. 

A face-neck lift usually involves staying at the clinic for 24 hours. You will therefore be free to go home again the day after your operation. The operation is carried out under general anaesthetic.
Before the procedure, the plastic surgeon carefully marks out what they are going to do. The general anaesthetic is then administered.
With a face-neck lift, the plastic surgeon makes an incision from the temple in the hairline downwards around the ear. The incision then ends in the hairline slightly further back behind the ear, so that your neck can be lifted. Once the skin has been separated from the layer of connective tissue between the skin and muscles (MACS), the plastic surgeon returns this connective tissue to its original position. They then shorten the connective tissue by pleating it or folding it in half, and stitch it to the underlying layers. This creates more volume around your jawline. The top layer of skin is then pulled back in the same direction. The skin is then attached using absorbable stitches at the location of the incision.
Once the excess skin tissue has been removed, the skin is stitched up again around and behind the ear using absorbable stitches. This skin is placed under tension, because skin has been removed. Because of this tension on the skin and stitches, there is a risk that the scars may not heal very nicely. Your plastic surgeon therefore uses Tisseel, a skin glue. This glue is applied to the underlying tissue before stitching up the incision, so that there is less tension placed on the stitches. As a result, the scar heals much more nicely. But the Tisseel glue does more than that. It is also used to achieve effective haemostasis, in other words tiny burst blood vessels are sealed, so there is less chance of post-operative bleeding. The airtight layer of glue also reduces the generation of tissue fluid (oedema), which in turn aids recovery and speeds up the end results. As a result, very few patients nowadays need a drain or pressure bandage after a MACS lift (drains are small plastic tubes that are often left in after an operation, to allow excess fluid exuding from the wound to drain away). You are free to go home a few hours after your treatment (accompanied by another adult) wearing just a headband.

Because deeper layers of tissue are also lifted in a face-neck lift, it is a much longer-lasting solution than an s-lift. Your neck is also lifted, as the procedure goes further and deeper to reduce the sagging in your neck region. Whereas with the MACS lift and s-lift, the neck region is not included.

Face-neck lifts are performed under general anaesthetic, so you stay the night at the clinic after the treatment. After the operation, you will be taken to the recovery room, where your blood pressure, heart rate and other vital signs will be monitored. You will stay there for about half an hour, after which you will rest in a bed in the day care department for a further 3 to 4 hours.

After a facelift with an overnight stay

The morning after the facelift, the head bandage is replaced with an elastic headband. If you so wish, your hair will then be washed with special antiseptic shampoo by the nursing staff. The area will then be carefully dried with a hair dryer. It is best to avoid washing the treated area for the next week. If you feel well and the nursing staff give their approval for you to leave, you are free to go home, accompanied by another adult.

Post-procedure pain

You may feel mild pain and pulling after your facelift. You are bound to feel a pulling sensation, because the skin and tissue are slightly under tension. There may also be sensitivity around the ears. This is normal and will disappear after a couple of days.

Recovery

As with every surgical procedure, the body takes time to recover. The treated area will initially be bruised, sore and swollen. The scars may also be reddish in colour and raised immediately after the facelift. You shouldn’t worry about this, as it is your body’s natural reaction. Swelling and bruising will usually be worse in the first 3 days after the procedure, and will then gradually start to disappear.

Your skin will feel hard for a couple of weeks. This is because the layers of tissue are adhering together and scars are forming. The skin may sometimes be quite sensitive. This is a normal reaction to the procedure and will gradually disappear. The stitches will dissolve and swelling and bruising will gradually subside.

Scar cream

At your first check-up, you will be given a scar care cream to take home with you. Once the wound has closed and the scabs have disappeared, you can start applying the scar cream. If you apply this cream to the closed wound twice a day, you increase the chance of the wound healing nicely.

Your face will look strange to you for a number of weeks after your face-neck lift. Once the swelling and bruising subside, you will have more of an idea of your new youthful appearance. Because the healing process takes a while, you will have to wait a couple of weeks before you really start seeing the “new you”. Small changes may continue to take place in the months following your face-neck lift. Most patients are pleased with the results, especially if their expectations are realistic.

Scars

The scars from a face-neck lift are mainly hidden in the hairline, with only a small section passing in front of the ear. The plastic surgeon will do everything they can to ensure that the scars are virtually invisible. The scars will initially be red and swollen, but this will start to fade after a couple of weeks. It is useful to know that a scar takes 1 to 1½ years to completely calm down. Take care to keep the scars out of the sun, and treat them carefully. The clinic will give you a special scar care cream to take home with you.

It is important you are aware that every surgical intervention can entail risks and complications. Plastic surgery procedures are in principle carried out on healthy people, so the risks and chances of complications are low. We make sure any risks are reduced to an absolute minimum, by providing plenty of information, taking a thorough medical history (noting your case history, including medication, any problems experienced in previous operations, allergies, etc.) and applying our professional procedures.

A face-neck lift is a very common procedure. In experienced hands, the risk of complications is very low. A face-neck lift entails the same risks as any other operation. You can help reduce certain risks by carefully reading through the instructions you are given prior to your facelift.

Possible complications of a face-neck lift may be:

• Haematoma (blood clot under the skin which has to be removed)
• Adverse reaction to the sedation
• Haemorrhaging
• Infection
• Change in sensitivity
• Permanent scars
• Damage to underlying structures
• Unsatisfactory aesthetic result.

Smoking

Patients who smoke or use tobacco or nicotine products (such as nicotine patches and chewing gum) at the time of their surgery have a greater risk of complications, such as skin loss and impaired wound healing. People who are exposed to passive smoking may also have an increased risk of complications such as these. What’s more, smoking may have a negative effect on the anaesthesia, which may in turn lead to an increased risk of bleeding. People who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of such complications. It is important not to smoke for at least 2 weeks prior to the operation and to keep this up for the entire recovery process.