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Face lifting (facelift): Options for face lift

Options for face lifting

Each year, approximately 400,000 people worldwide undergo facelift rejuvenation [1]. Facelifts have been performed in Germany and the United States for over one hundred years [2] [3]. The techniques are constantly being refined. Today’s techniques are characterized by natural and lasting results and very inconspicuous scars. Techniques are divided, among others, according to the depth of the layer in which the tissue is loosened and tightened. Since English is the dominant language of science, the techniques have English names. The following techniques are distinguished:

  • The Mini Facelift
  • The SMAS Plication
  • The SMAS Ectomy
  • The extended SMAS facelift
  • The Midface Lift
  • The MACS Lift
Incision guides of the SMAS Plication, SMAS Ectomy and the extended SMAS Facelift. Incision behind the tragus.

Face lift facts

OP duration 4-6h
AnaesthesiaGeneral anaesthesia / Twilight sleep / Fast recovery surgery
Hospital stay Outpatient
Costs to the price calculator
Aftercare 6 weeks
Thread Traction Self-dissolving threads
Socially acceptable after 2 weeks
Supplements or alternatives Wrinkle treatment with own fat / skinbooster / microneedling

How is a face lift performed?

Step 1: Preparation

After the personal consultation, our patients are already familiar with the surgical procedure and the pre- and post-operative preparations. A certain amount of residual nervousness on the day of the operation is nevertheless quite normal. Dr. Santos Stahl and the anesthesiologist welcome you to the clinic and once again check that the surgery can take place under the best conditions.

Step 2: The surgery

After you are changed, you will be given an antibiotic. You will then be taken to our operating room, which is equipped with the latest medical technology. Now the entire operations team verifies that all precautions have been taken for your safety. The anesthesiologist will administer a sleeping medication and monitor your well-being throughout the procedure. The surgeon prepares the surgical field and injects the surgical area with a tumescent solution. The surgeon and assistant work with optical magnification to operate as precisely and finely as possible. According to the surgical plan, excess fatty tissue is first suctioned out or autologous fat treatment is performed. Subsequently, the skin soft tissue mantle and the underlying connective tissue framework are loosened. After tightening the supporting structure of the face and neck, the excess skin is removed and finely sutured. If necessary, a microneedling treatment is performed at the end of the surgery. Finally, a sterile wound dressing and compression mask are applied. You will then be continuously monitored in the relaxation room while you rest.

Step 3: After the procedure

Before you leave the clinic, you will be given the cell phone number of your surgeon, who will be available for you at all times. You will also receive a report on the treatment, the recommended precautions and the dates of follow-up examinations.

How facelift methods differ for face lifting

In the following sections, we would like to give you a rough idea of how the techniques of lifting procedures differ. The figures are estimates, as there is no exact scientific data on this. The following distinctions are possible:

  • Recovery time: Recovery time covers many different areas. When can I eat and drink after facelift surgery? When can I take a shower? When can I do sports? When can I go back to work? How long does the swelling last? When is scar healing complete? Our guideline values refer to the earliest time at which you can perform your daily activities.
  • The duration of effect: How long does the result last? The changes after a face lift are usually permanent. Nevertheless, no operation in the world can stop time. As a rough guide, it refers to the length of time during which you will look noticeably younger. How long the results last for your more youthful appearance also depends on individual lifestyle habits (cigarette smoking, sunbathing, sleeping habits, daily skin care).
  • The surgery duration: Every surgical procedure involves many procedures that must be scheduled: Entering the operating room, administration of sleeping medication by the anesthesiologist, gentle positioning of the patient, injecting a local anesthetic (numbing solution), dressing the wound, post-surgery monitoring, and talking with the plastic surgeon after surgery. To simplify matters, we will give you the duration from the time of the skin incision to the fine suturing of the wound as a rough indication of time.
  • The efficiency factor: By how many years will I look younger? With the help of artificial intelligence, algorithms (FacePlusPlus, Amazon, Microsoft, IBM) can estimate a person’s age based on a facial photo. Research shows that the age determination of the algorithms is relatively reliable [4]. The effect can also be determined on the basis of the perceived age of the persons concerned. Because the patient’s judgment is ultimately critical, we quantify the tapering effect as a range of algorithm and patient evaluation.

Mini facelift

The mini-facelift is a superficial facelift (subcutaneous face lift). Superficial face lift is the oldest surgical technique of face lift. This technique involves loosening the layer of tissue just below the skin. During superficial facelift, the skin can be loosened to different degrees. Exposure of the superficial tissue layer may be limited to the skin to be removed or may include the cheek area. Below is a brief overview with key data on the Minilift:

  • Recovery time: 5 to 7 days.
  • Operation time: 2 to 3 hours.
  • Duration of action: 4 to 5 years.
  • Effectiveness of mini-lifting: 4 to 5 years younger.
  • Special feature: If a higher degree of effectiveness is sought with the mini-lift, there is a risk of an unnatural result, a visible scar, and distortion of the pinna or earlobe.

SMAS Plication

Like the skin of the face, the connective tissue loses elasticity with age. Between the skin and the parotid gland there is a layer of connective tissue called the superficial musculoaponeurotic system (abbreviation SMAS) [5]. Techniques have been developed that tighten not only the skin, but also the underlying connective tissue framework. A plication refers to a suturing technique in which the layers of tissue are superimposed. The technique of SMAS plication was first described in the early seventies [6]. First, the layer between the skin and the connective tissue is loosened widely. Subsequently, the connective tissue layer is tightened by plicature. In the process, the tissue is shifted toward the cheekbone.

  • Recovery time: 1 to 2 weeks.
  • Operation time: 4 to 6 hours.
  • Efficiency: 4 to 7 years younger.
  • Duration of action: 8 to 10 years.
  • Special feature: the displacement of the connective tissue layer emphasizes the contours of the cheekbones.

SMAS Ectomy

This technique involves the removal of excess connective tissue in the area of the parotid gland. The surgical technique is therefore referred to in English as lateral SMAS ectomy. First, the connective tissue above the parotid gland is exposed. A strip of sagging connective tissue, about two centimeters in width, is removed. The connective tissue layer is closed again with a suture. Removal of excess connective tissue is preferable to a shirring suture (SMAS Plication) for plump facial contours.

  • Recovery time: 1 to 2 weeks.
  • Operation time: 4 to 6 hours.
  • Efficiency: 4 to 7 years younger.
  • Duration of action: 8 to 10 years.
  • Special feature: the removal of excess connective tissue results in balanced contours for a round face shape.

Extended SMAS Lift

Unlike all other facelift techniques, an extended SMAS lift (also called a superextended facelift) involves moving the SMAS layer (SMAS connective tissue). The technique of tissue shifting, also called flapplasty (in English flap), is used in many areas of aesthetic plastic surgery and in manifold variations. To bring the connective tissue below the cheek to the desired position, the tissue must be loosened. Unlike other techniques, SMAS flapplasty involves loosening the layers in two planes: between the skin and the SMAS, and between the SMAS and the parotid gland. In order to achieve harmonious facial contours, the connective tissue is moved towards the temples during the SMAS facelift. The wide solution of the tissue gives a lower facial area a youthful chin-jaw line (in English Jawline) and softens deep nasolabial folds.

  • Recovery time: 1 to 2 weeks.
  • Operation time: 6 to 8 hours. The loosening of the connective tissue must be performed with microsurgical precision.
  • Efficiency: 4 to 7 years younger.
  • Duration of action: 10 years or longer.
  • Special features: The SMAS-Lift technique is particularly effective for correcting sagging cheeks. The results are natural. The facial skin settles over the tightened connective tissue without any visible tension. The fat pads of the cheeks are brought to the position they were in when they were younger by SMAS lifting. The operation can be well combined with a neck lift. In this case, it is also called a face-neck lift.

Midface Lift

The midface lift is a facelift technique that involves a deep release of the tissue below the periosteum. The technique is therefore also called deep plane facelift, composite and subperiosteal face lifting in English. The effect of this technique is limited to the area below the eyes, also called midface. The midface lift is performed through a small incision on the lower eyelid, as in the lower eyelid lift. The zygomatic muscles and upper lip elevator are detached from the zygomatic bone and maxilla. To protect a cutaneous nerve exiting the maxilla, the use of a special camera system (endoscope) is recommended.

  • Recovery time: 1 to 2 weeks.
  • Operation time: 4 to 6 hours.
  • Efficiency: 4 to 7 years younger.
  • Duration of action: 8 to 10 years.
  • Special features: The effect is limited to the region below the eyes. The scar on the lower eyelid is very inconspicuous. The results are natural as the cheek fat pads are returned to their original position. The jaw contours and the contour of the neck cannot be improved by this technique.


MACS stands for “minimal access cranial suspension” and is a facelift surgical technique first described in 2002 [7]. MACS lift is a surgical technique in which the layer between the skin and connective tissue SMAS is loosened. The connective tissue is tightened by a loop-shaped suture technique.

  • Recovery time: 1 to 2 weeks.
  • Operation time: 4 to 6 hours.
  • Efficiency: 4 to 7 years younger.
  • Duration of action: 8 to 10 years.
  • Special features: The scar is quite short. With a round face shape, the impression of fullness can be enhanced.

Schematic representation of important structures in facelift surgery

1. zone of autologous fat treatment
2. incision for a facelift
3. superficial temporal vessels (vasa temporalis superficialia) 4. elevation in front of the auditory canal (tragus)
5. ligaments between skin and bone (ligamentum zygomaticus)
6. parotid gland (parotid gland) 7. submandibular gland (submandibular gland)
8. cutaneous nerve (auricular nerve magnus)
9. muscular nerve to the mouth (Rami buccales nervi facialis)
10. incision guidance for a neck lift

During a facelift, the sagging skin is removed and the supporting apparatus is tightened. For this purpose, a fine layer of connective tissue (superficial musculoaponeurotic system) is exposed. Sagging ligaments are cut and the deep connective tissue layer is tightened. After the connective tissue has been tightened and, if necessary, lost volume has been replaced, the excess sagging skin is removed. The green zones can be injected with tissue fillers (autologous fat or hyaluronic acid) to beautify the contours.

Other facial nerves in the image: muscle nerve of the forehead (ramus frontalis nervus facialis), muscle nerve to the upper lip (rami zygomatici nervi facialis), muscle nerve of the lower lip and chin (ramus marginalis mandibulae), cutaneous nerve (nervus auricularis magnus).

Other ligaments in the image: ligaments between skin and bone (ligamentum mandibulare), ligaments between muscle and skin (ligamentum massentericum)

Facelift without general anesthesia

The goal of any anesthesia is to provide anesthesia or freedom from pain during treatment. Preventing pain in a variety of ways achieves the greatest possible comfort. By combining different procedures, the drugs can be administered in lower concentrations. As a result, side effects occur less frequently and patients recover more quickly. Thanks to modern anesthesia procedures and optimal cooperation of the anesthesiologist with the surgeon, we can offer a face lift without general anesthesia. The benefits of this particular form of local anesthesia (tumescent anesthesia) and twilight sleep have been widely supported scientifically [8] [9] [10] [11].

Facelift with stitches

During a PDO thread treatment, sunken fat pads of the face are lifted. The contours of the cheeks are beautified. However, PDO threads are not suitable for the treatment of sagging skin. PDO threads do not cause tightening. PDO threads rather shift the skin, like the fabric of a hood or waistband along a cord. PDO thread lifting is reserved for patients who have good skin elasticity. PDO thread lifting is not suitable for the treatment of skin and connective tissue changes that occur after the age of 45. In these cases, the skin and supporting tissue should each be treated in a targeted and differentiated manner. A SMAS facelift is an effective treatment with long-lasting effects. PDO sutures are not an alternative to a facelift.

Advantages and disadvantages of a face lift

The traces of time can be read more clearly in some faces than in others. Those who feel younger want to bring body and soul back into harmony. The decision to have a face lift is a very personal one. Modern aesthetic surgery offers many options that have become increasingly gentle and effective over the decades. Non-surgical treatments include microneedling, treatment with the patient’s own blood and injections. The following comparison of facelift and conservative procedures should be taken as a rough guide.

Facelift Conservative methods
Effectiveness Rejuvenation by 4 to 7 years Help increase skin tone Increase skin thickness Reduce pigmentation spots
The duration of action Depending on technology up to over 10 years Months to a few years
Risks 2% hematoma, 1% inflammation, 0.1% nerve injury [12]. 0.004% inflammation [13]
Downtime 7 to 14 days None
Treatment duration 4 to 6 hours 30 – 45 minutes
Visibility of the result After 2 – 3 weeks After 6 to 12 weeks – treatments at intervals of 4 weeks should be repeated at least 3 times

Face lift for man

Facelift techniques are basically similar for men and women. However, the technical subtleties must meet male-specific characteristics. Men have an accentuated lower jaw, wider chin and flatter round cheeks. The skin is thicker and more perfused than in women. The cut must take into account the whiskers and short haircut.

Face lifting with the laser

A laser can be used to perform a surface treatment of the skin. CO2 laser treatment stimulates collagen production and is a useful adjunct to facelift surgery [14]. Many studies show that microneedling is comparably good at improving skin pigment spots and increasing skin tone [15]. Especially in darker skin types, laser treatment can cause darkening of the skin (postinflammatory hyperpigmentation). We prefer microneedling treatment to laser treatment because microneedling has fewer side effects and the recovery time is shorter [16] [17]. In addition, microneedling treatment is more sustainable. The effect of microneedling treatment can be enhanced by simultaneous treatment with the patient’s own blood. Nevertheless, neither the laser nor microneedling replaces a facelift.

What should be considered after a face lift?


Ohne eine gewissenhafte Nachsorge kann auch eine perfekt geglückte Operation nicht zu einem optimalen Ergebnis führen. Beachten Sie bitte die folgenden Empfehlungen:

  • You will be offered four on-site or video consultation appointments during the first two weeks to monitor wound healing.
  • Use cooling elements or so-called migraine glasses for a maximum of 15 minutes every two to three hours during the first three days. Do not place the face mask directly on the skin, as extreme cold can cause skin damage. Always make sure to place a compress on the surgical area before applying the cooling elements. These should only be chilled, but not frozen.
  • Lying down and sleeping with a slightly upper body (about 30 degrees) for the first five days is beneficial for decongestion and wound healing.
  • Minor pain may begin when the anesthesia wears off, usually one to two hours after the procedure. Just in case, you will be prescribed medications to take before surgery to prevent pain from occurring in the first place.
  • If you suffer from high blood pressure, your blood pressure should be measured every two to three hours for the first five days. If the first (systolic) reading of your blood pressure rises above 140 mm Hg, you should take a medication to lower your blood pressure.
  • If an increased bleeding tendency can be noted, small drainage tubes are temporarily inserted behind the ear. Drains are usually removed after only 24 hours.
  • Finest skin threads are removed after about ten days.
  • Already on the first day after the surgical procedure you can shower as usual. Make sure that no soap residue remains and always dry the face with a fresh towel. During the first week, we recommend applying a wound disinfection spray (Octenisept®) after showering.
  • To help reduce swelling, a previously fitted compression mask may be worn during the first week. In the second week, the compression mask only needs to be worn at night.
  • From the third week you can support scar healing. Apply a grease cream with as few additives as possible to the scars. Massage the cream two to three times a day for about five minutes. Protect your skin and the scars with a sunscreen.
  • Bending, lifting heavy loads, heavy physical work and sports activities should be avoided for three weeks, possibly longer if swelling persists. Of course, strong UV radiation (sunbathing or solarium) should also be avoided for a certain period of healing.

Face lift without surgery

As patients naturally first inform themselves about alternatives to surgical face lifting, they initially come across a large number of dubious advertising promises on the Internet. Dietary supplements, cosmetic products and alternative practitioners are not subject to the strict requirements of the Heilmittelwerbegesetz (German Drug Advertising Act) or the Berufsordnung für Ärzte (Professional Code of Conduct for Physicians). It is therefore not surprising that laudatory advertisements for tightening the facial skin with various devices, creams or even facial gymnastics are widely distributed online. Advertising ultrasound machines, EMS facial muscle training (electrical muscle stimulation), radio waves or plasma pens for facial tightening is misleading. Currently, there is no high-quality scientific study that demonstrates a rejuvenating effect of these procedures.

Only minimally invasive aesthetic procedures such as injections with fillers and muscle relaxants can be an alternative, but they provide a temporary result and thus have to be repeated several times. In addition, they are only effective when the signs of aging are less pronounced (less deep wrinkles and sagging skin to a lesser extent). You can find more information on this in our category on minimally invasive treatments.

Before and after pictures of a face lift

In the run-up to a facelift, patients want to get an idea of the possible outcome of the facelift. Before and after photos of cosmetic surgery may not be published on the Internet. At CenterPlast, however, you have the option of viewing corresponding images of the entire face during the non-binding consultation appointment. In this process, the lifting images are carefully selected according to certain criteria for comparability. The before and after photos were of course taken in accordance with data protection regulations. Individuals receiving treatment gave consent to do so in order to help educate other patients. Feel free to ask us about the possibility of viewing the before and after pictures during your individual consultation appointment.

Frequently asked questions

Which method of face lifting is the best?

Unfortunately, there is no blanket universal answer to this question, as each patient has unique conditions. Comparison of different techniques in identical twins also failed to answer the question [18]. The method with the lowest complication rates, a significantly rejuvenating and a long-lasting result is the best in our eyes. The selection of the appropriate method depends on the individual skin elasticity, face shape, contour of the lower jaw and neck. The method may also differ depending on the patient’s wishes and expectations. After examining and discussing your goals, we will recommend a treatment plan.

The author

Unsere Fachärzte für Plastische Chirurgie Saarbrücken
Dr. Adelana Santos Stahl

“Our goal is to provide the best, most discreet and precise treatment based on our extensive expertise in plastic surgery. „

Dr. Adelana Santos Stahl is distinguished by a unique international perspective with a feminine view of plastic surgery. Her personalized and detailed approach is key to the beautiful and natural results she achieves. Having trained in Brazil, one of the largest and most well-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best. She completed her medical studies and her training as a specialist for plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the medical state examination. Two years later, in 2011 she received the German and in 2012 the EU specialist recognition (EBOPRAS) for plastic surgery. From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris. A VDÄPC Fellowship (continuing fellowship for graduate students) in Switzerland, France and the USA has further enriched her professional experience. Dr. Santos Stahl is active in several prestigious professional societies. Besides the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP. She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.


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