The Facelift Procedure: What Happens on the Day, Step by Step
Key takeaways
- A facelift takes roughly 2 to 3 hours, or 4 to 6 hours if a neck lift is combined, under a general anaesthetic or local anaesthetic with sedation.
- The incisions sit at the temples above the hairline, in front of the ear, under the earlobe and behind the ear, with an extra under-chin incision if the neck is being treated.
- The surgeon lifts and repositions the deeper SMAS layer and then re-drapes the skin, rather than simply pulling the skin tight.
- Some people go home the same day (day-case) and others stay overnight; the NHS describes an overnight stay, while many private and US facelifts are day-case.
- The day itself is short compared with the recovery, and the face you see straight afterwards is heavily swollen, not the final result.
By Paula Winters | Medically reviewed by Mr Alexander Frost, FRCS (Plast)
Published June 6, 2026 · 5 min read
A facelift takes roughly 2 to 3 hours and follows the same broad shape whoever performs it: you are given a general anaesthetic or a local anaesthetic with sedation, incisions are made around the ear and hairline, the deeper SMAS layer is lifted and repositioned, the skin is re-draped and closed, and you go home the same day or stay one night. A combined face and neck lift takes longer, about 4 to 6 hours1.
The day was the part I was most frightened of and, oddly, the part I remember least. I wanted someone to walk me through it hour by hour beforehand, in plain words, so I stopped bracing for a horror film and understood it was a long, methodical piece of work. This is that walk-through. For the bigger picture of what a facelift is and does, start with the pillar guide to the facelift, and for the anaesthetic choice specifically, see facelift anaesthesia.
How long does the procedure take?
A facelift on its own takes roughly 2 to 3 hours; a combined face and neck lift can take about 4 to 6 hours. The time depends on the technique, how much tissue is being repositioned, and whether anything else is being done on the same day1.
That range surprised me, because I had imagined something quick. It is not quick. The surgeon is working carefully in a small space full of nerves and blood vessels, and the deeper, more thorough techniques take longer than a limited short-scar lift. If you are weighing up how much work you actually need, the range of options is set out in types of facelift, and the two most-compared approaches in SMAS versus deep-plane.
What anaesthetic is used?
A facelift is done under either a general anaesthetic, where you are fully asleep, or a local anaesthetic with sedation, where the area is numbed and you are relaxed but not fully unconscious. Which one is chosen depends on the extent of the surgery, your health, and the judgement of the surgeon and anaesthetist1.
Mine was under general anaesthetic, and the last thing I remember is a nurse holding my hand and telling me she liked my socks. The next thing I knew it was over. That gap of nothing, hours long, was strange to reckon with afterwards. The trade-offs between the two options, and why one might be recommended over the other, are laid out in facelift anaesthesia.
Where are the incisions?
The incisions run at the temples above the hairline, down in front of the ear, curving under the earlobe and up behind the ear into the hairline, with a small extra incision under the chin if the neck is being treated. They are deliberately placed in the natural creases and the hairline so the healed scars are difficult to spot1.
This was the detail that reassured me most. I had pictured a scar across my cheek; the reality is a line that hugs the contour of the ear where the skin naturally folds. Cleveland Clinic describes the same pattern of incisions tucked around the ear and into the hair2. How the scars settle over time, and how to look after them, is covered in facelift scars.
What does the surgeon do once the incisions are made?
Once the incisions are open, the surgeon lifts the skin, repositions the deeper SMAS (superficial musculoaponeurotic system) layer, removes any excess skin, and closes the incisions. Lifting and securing the SMAS rather than just pulling the skin tight is what produces a natural result instead of a wind-blown, over-pulled look34.
In practice the SMAS can be folded and stitched, partly removed, or, in a deep-plane lift, moved together with the fat and skin as one unit. Large reviews have not shown any single technique to be clearly better than the others, so the choice comes down to your face and your surgeon’s judgement5. If a neck lift is included, the platysma muscle bands in the neck are tightened through that under-chin incision; that overlap is explained in neck lift.
Are drains and dressings used?
Drains are sometimes placed briefly to stop blood and fluid collecting under the skin, and the face is then wrapped in a supportive dressing before you wake or come round. Not every surgeon uses drains, and when they are used they usually come out within a day or two1.
I woke up with a soft dressing snug around my head and under my chin, which I had not expected and which made me feel oddly cocooned. The point of both the drain and the dressing is the same: to keep pressure on and reduce the chance of a collection of blood, a haematoma, which is the most common complication of a facelift at roughly 1 to 7% and much more common in men and smokers5. The full account of what can go wrong is in facelift risks and complications.
Do you go home the same day or stay overnight?
Some people go home the same day as a day-case and others stay one night; the NHS describes an overnight stay, while many private and US facelifts are done as day-case procedures. It varies with the extent of the surgery, the anaesthetic used, and the facility’s policy1.
I stayed one night, and I was glad of it, because that first evening I felt woozy, tight and a little tearful, and having a nurse a button-press away mattered more than I had admitted it would. Whether you stay or go, you must have a responsible adult to take you home and stay with you afterwards; you cannot drive yourself. The reasons a general anaesthetic in particular tends to push towards an overnight stay are set out in facelift anaesthesia.
What happens straight after?
Straight after a facelift your face is swollen and tightly dressed, and the face in the mirror is not the face you will keep. Visible bruising and swelling last around 2 weeks, and the deeper swelling settles and the scars mature over about 6 to 9 months1.
No one quite prepared me for how alien I looked at first, and it helps enormously to know in advance that the swollen, unfamiliar early reveal is normal and temporary. I have written about that first look honestly in the first time I saw my face after a facelift. For the practical timeline from that first day onward, follow facelift recovery week by week, and for the raw version of those first two weeks, my facelift recovery.
References
- Facelift (rhytidectomy), NHS. ↩
- Facelift (Rhytidectomy), Cleveland Clinic. ↩
- InService Insights: Facelift anatomy, techniques and complications, American Society of Plastic Surgeons. ↩
- Facelift, American Society of Plastic Surgeons. ↩
- A Systematic Review and Comparative Analysis of Rhytidectomy, PMC (systematic review). ↩
Common questions
How long does a facelift take?
A facelift takes roughly 2 to 3 hours. If a neck lift is combined with it, a face and neck lift together can take about 4 to 6 hours. The exact time depends on the technique, how much is being done and whether other procedures are added on the same day.
Are you awake during a facelift?
It depends on the anaesthetic. A facelift is done either under a general anaesthetic, where you are fully asleep, or under a local anaesthetic with sedation, where the area is numbed and you are relaxed and drowsy but not fully unconscious. Which one is used depends on the extent of surgery, your health and the surgeon's and anaesthetist's judgement.
Where are facelift incisions made?
The incisions sit at the temples above the hairline, in front of the ear, curving under the earlobe and behind the ear into the hairline. If the neck is being treated, there is often a small extra incision under the chin. They are placed in the natural creases and hairline so that the healed scars are hard to see.
Do you stay in hospital after a facelift?
Not always. Some people go home the same day as a day-case, and others stay one night. The NHS describes an overnight stay, while many private and US facelifts are done as day-case procedures. It varies with the extent of the surgery, the anaesthetic used and the facility's policy.
What does the surgeon actually do during a facelift?
After the incisions, the surgeon lifts the skin, then repositions the deeper SMAS layer beneath it by folding, tightening or moving it, releases tissue where needed, removes any excess skin and closes the incisions. Drains are sometimes placed briefly and the face is dressed. The point is to reposition the deep layer, not just pull the skin.
Does a facelift hurt during the procedure?
You should not feel pain during the procedure itself, because you are either fully asleep under a general anaesthetic or numbed and sedated. Afterwards there is tightness, swelling and some discomfort rather than severe pain for most people, managed with ordinary pain relief. Sharp or worsening pain on one side should always be reported, as it can be an early sign of a haematoma.
Written by Paula Winters. Medically reviewed by Mr Alexander Frost, FRCS (Plast).
Our guides are written from personal experience and reviewed by a qualified clinician for accuracy. Read our editorial policy.