Facelift FAQ

Facelift surgery addresses the structural changes of facial ageing — descended soft tissues, jowling along the jawline, laxity of the neck, and loss of jawline definition. Effective techniques work at the level of the SMAS and deeper retaining ligaments, not the skin alone. Approaches that rely primarily on skin tension produce less durable results because the underlying structural cause of the descent has not been addressed.

Facelift surgery does not address skin quality, pigmentation, fine surface lines, or periorbital changes — these require separate assessment and treatment.

The SMAS — superficial musculo-aponeurotic system — is a continuous layer of fibromuscular tissue that lies beneath the skin and subcutaneous fat of the face and neck. When the SMAS descends with age, the overlying skin descends with it, producing jowling, deepened nasolabial folds, and loss of jawline definition.

Facelift techniques that address the SMAS directly — rather than relying on skin tension alone — produce more durable and more natural-appearing results, because the structural layer causing the visible change has been repositioned.

The deep plane facelift is a technique in which the surgeon works beneath the SMAS layer, releasing the retaining ligaments of the face to allow the facial soft tissues to be elevated and repositioned as a single composite unit of skin and SMAS together. First described by Sam Hamra in 1990, it achieves a more thorough correction of midface descent and jowling than SMAS-level techniques and produces results that appear natural rather than stretched.

Dr Roth performs the deep plane facelift as his primary facelift technique. He has trained in this approach through formal fellowship training, dedicated surgical observerships, cadaveric dissection laboratories, and ongoing participation in national and international surgical conferences.

A mini facelift is a more limited facelift performed through a shorter incision, most appropriately applied to patients with early, modest jowling and good skin quality. It does not treat the neck, does not significantly reposition the midface, and is not appropriate for patients with more advanced facial descent.

A substantial proportion of patients who present requesting a mini facelift have anatomy that it will not meaningfully address. Whether a mini facelift is the right choice is one of the central questions at consultation and depends entirely on the examination findings.

A facelift addresses the midface, lower face, and jawline — repositioning the SMAS and skin of the cheeks, restoring the jawline, and improving jowling. A neck lift addresses the neck — the platysma muscle, submental fat, and cervical skin laxity. In practice the two are very frequently performed together, as the neck and lower face form a continuum. The incisions for facelift and neck lift are in similar locations, so the combined procedure involves little additional recovery compared with either alone.

Neck lift surgery addresses the structural changes of the ageing neck including:

• Redundant or crepey cervical skin — sometimes described as “turkey neck”
• Platysmal banding — the vertical bands visible in the midline of the neck
• Submental fat accumulation — excess fat beneath the chin
• Loss of a defined cervicomental angle
• Jowling that extends from the lower face into the upper neck

Injectables have limited efficacy for structural neck changes and are generally not an adequate substitute for surgery once meaningful structural laxity is present.

The vertical platysmal advancement technique — also known as the vertical neck lift — is an extended deep plane facelift approach that elevates the skin and SMAS-platysma complex as a single composite unit and repositions it vertically. It was popularised by surgeons including Dr Andrew Jacono and Dr Neil Gordon in the United States, and is Dr Roth’s primary neck lift approach.

It does not routinely require midline platysmal surgery (platysmaplasty) in the majority of cases, as the vertical repositioning of the SMAS-platysma complex provides sufficient correction of platysmal prominence.

The deep neck lift addresses structures beneath the platysma muscle — specifically the digastric muscles and the submandibular glands — which can contribute to persistent submental fullness and neck contour that conventional neck lift surgery does not reach. It is not required in all patients but is relevant in a subset identified at consultation. Dr Roth has incorporated deep neck volume reduction techniques informed by the work of Dr Francisco Gómez Bravo of Madrid.

Yes, an isolated neck lift is appropriate for a specific group of patients — typically those who have significant neck laxity but in whom the face itself does not yet show sufficient descent to warrant facelift surgery. This presentation is less common than the combined presentation, but it does occur — particularly in younger patients with anatomically prominent necks or in patients who have experienced significant weight change.

Suitable candidates are adults in good general health who have identifiable, structural facial or neck descent — jowling, platysmal banding, cervical skin laxity — that is causing genuine concern and that cannot be adequately addressed by non-surgical means.

There is no fixed upper age limit for facelift surgery. Fitness for general anaesthesia is the relevant medical threshold, not chronological age. Conditions that may affect suitability include significant cardiovascular disease, blood-thinning medications, active smoking, or uncontrolled diabetes. All of these are discussed at consultation.

A minimum of two consultations is required before any facelift or neck lift proceeds. This is both a standard of care and a requirement under the Medical Board of Australia’s guidelines for cosmetic surgery. There is no obligation to proceed at either appointment.

Yes. Common combinations include: facelift with neck lift; facelift with blepharoplasty; facelift with brow lift; facelift with fat grafting; and facelift with lip lift. Combining procedures can reduce the total number of general anaesthetics required. However, longer anaesthetic times carry their own risks, and not all combinations are appropriate for all patients. The suitability of combining procedures is discussed at consultation.

Yes. Facelift and neck lift surgery is performed under general anaesthesia at an accredited private hospital. Dr Roth performs facelift surgery at North Shore Private Hospital, Castlecrag Private Hospital, and Wyvern Private Hospital in Sydney.

A deep plane facelift with neck lift typically takes between four and six hours. The operative time depends on the anatomical complexity, the extent of neck work required, and whether additional procedures are performed. More limited procedures such as a mini facelift are shorter, typically two to three hours.

Facelift incisions are designed to be concealed within the natural contours of the ear and hairline. They typically begin in the temporal hairline, continue along the crease in front of the ear, curve around the earlobe, and extend behind the ear into the posterior hairline. A small additional incision under the chin may be used for submental work. Scars from facelift surgery are generally not visible in everyday social settings once healed, but scar quality varies between individuals.

The initial visible recovery — when bruising and swelling are socially significant — is typically two to three weeks for a deep plane facelift. Drains, where used, are removed within the first one to two days. Sutures are removed at approximately one week. Most patients feel socially presentable by three to four weeks. The final result continues to improve over six to twelve months.

For desk-based or remote work, most patients return between two and three weeks after surgery. Work in public-facing roles or physically demanding occupations typically requires three to four weeks or more. Each patient recovers at a different rate and individual variation should be anticipated.

Facelift surgery does not halt the ageing process — the face continues to age from whatever improved baseline surgery establishes. However, the structural improvement achieved by a deep plane facelift tends to be more durable than that of more superficial techniques. Clinical experience suggests results remain evident at ten years and beyond in many patients. Durability is influenced by genetics, sun exposure, smoking history, and significant post-operative weight change.

Yes, significantly. Smoking is associated with impaired wound healing, increased risk of skin necrosis over flaps with compromised blood supply, prolonged swelling, and higher infection risk. The risk of serious skin healing complications is substantially elevated in active smokers. Smoking cessation is required for a minimum of four to six weeks before surgery and an equivalent period afterwards. This is a clinical requirement.

For a deep plane facelift with neck lift in Sydney, the total cost — comprising surgeon’s fee, anaesthetist’s fee, and hospital facility fee — typically ranges from approximately $25,000 to $40,000 or more, depending on the complexity and the hospital. A detailed fee estimate is provided following consultation once the nature of the surgery has been assessed.

Facelift surgery for purely cosmetic purposes does not attract a Medicare rebate. Medicare does not provide rebates for cosmetic procedures where the primary indication is aesthetic improvement. In rare cases involving reconstructive components, specific Medicare item numbers may apply — this is discussed at consultation where relevant.

For purely cosmetic facelift surgery, private health insurance does not cover the hospital facility fee as no Medicare item number applies. Patients are advised to confirm their level of cover with their fund prior to surgery and to check applicable waiting periods.

Facelift risks include haematoma (the most common early complication, occurring in approximately 1–3% of cases), facial nerve injury (temporary weakness is not uncommon; permanent injury is rare), skin flap necrosis (more common in smokers), visible scarring, hair loss near incision sites, asymmetry, prolonged numbness, and unsatisfactory cosmetic result. All cosmetic surgery involves risks and individual results vary. A full discussion of risks is provided at consultation.

Full information is available on the facelift and neck lift risks page.

ENT surgeons with dedicated facial plastic surgery fellowship training are fully qualified to perform facelift and neck lift surgery. The anatomy of the face and neck — including the facial nerve, the parotid gland, the SMAS, and the platysma — is core surgical anatomy for head and neck surgeons.

The International Board Certification in Facial Plastic and Reconstructive Surgery (IBCFPRS), which Dr Roth holds, requires documented operative experience, a peer-reviewed surgical audit, and success in the international board examination regardless of parent specialty. The AAFPS — the principal professional body for facial plastic surgery in Australia — includes both ENT surgeons and plastic surgeons among its fellows.

Dr Roth consults from Suite 4205, Level 2, 834 Pittwater Road, Dee Why NSW 2099, on Sydney’s Northern Beaches. He performs facelift and neck lift surgery at North Shore Private Hospital, Castlecrag Private Hospital, and Wyvern Private Hospital. The practice telephone number is (02) 9982 3439.

To arrange a consultation, contact the practice by telephone on (02) 9982 3439 or submit an enquiry via the contact page. A GP referral is recommended and enables a Medicare rebate on the consultation fee.