A face lift is done when the following changes appear along with increasing age

• Sagging or wrinkled skin
• Folds and fat deposits appearing around the neck
• Deep flexion creases between the nose and mouth
• The jaw line grows jowly and slack

• Candidates without medical conditions such as lung problems and heart disease.
• Candidates whose face and neck have begun to sag, but whose skin still has some elasticity along with strong and well-defined bone structure.
• Candidates in their forties to sixties, though a facelift can also be done successfully on candidates in their seventies or eighties.
• Candidates who are physically healthy, psychologically healthy and have realistic expectations from the procedure
• Candidates who seek improvement rather than perfection

Though complications occur in very rare cases, they may include

• Formation of a haematoma characterized by pain or swelling affecting one side of the face but not the other, in which case the patient may have to return to have the stitches reopened to find the source of the bleeding.
• Temporary injury to the nerves that control facial muscles affecting the patient's ability to raise an eyebrow, distort his smile, or with limited feeling in his earlobe.  These injuries repair by themselves in 2-6 months.
• Infection
• Reactions to the anaesthesia
• Poor healing of the skin, mostly seen in smokers.

• During the initial consultation, a thorough discussion on the expectations of the patient is understood
• The surgeon will evaluate the face, including the skin and underlying bone
• The surgeon shall perform a medical evaluation to rule out factors that may affect the procedure such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars.
• Photographs are taken for further comparison after procedure.
• The doctor discusses and advises on options of anaesthesia, surgery, type of facilities and cost with the patient.
• The patient must inform the doctor of any previous injury or surgery, allergies, infections, smoking habits, recreational drugs and medications being taken.
• The doctor provides guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications
• Steroid injections may be given before the surgery to reduce swelling
• Vitamins may be prescribed to promote healing
• The patients are advised to let the hair grow out before surgery, in order to hide the scars while they heal.
• The patient must arrange for transportation and assistance to leave for home after the surgery.

• The patient is given either a local or general anaesthesia before the surgery. If local anaesthesia is to be given, the patient is given a sedative to relax through an intravenous line after which the local anaesthesia is injected to numb the area.
• Incisions are made above the hairline at the temples, behind the earlobe to the lower scalp and the skin is separated from the muscle and fat below. 
• Fat is trimmed or suctioned from around the neck to improve the contour.
• The underlying muscle and membrane is tightened, the skin pulled back and excess skin removed.
• Incisions are closed and metal clips or sutures may be used for the purpose on the scalp. 
• A small tube may be placed under the skin behind the ear to drain any blood that may get collected in the region.
• The head may be bandaged to minimize bruising and swelling.

The operation takes one to three hours to complete.

The surgery is mostly done as an outpatient procedure.

• A pressure bandage is applied to the face to reduce the risk of haematoma.
• Numbness of the skin is experienced which may disappear in a few weeks or months.
• There may be no significant discomfort after the procedure.  Any severe discomfort may be relieved by medications prescribed by the surgeon.
• The patient may spend a few hours resting in a recovery room to ensure no bleeding has occurred after which he returns home.
• The drainage tube is removed 1-2 days after surgery.
• The patient is advised to remain reclining for the next 24 hours, consuming a liquid diet, and avoiding any movements that require the neck to flex.
• Ice packs for the first few days must be used to reduce swelling and lower the risk of haematoma.
• Antibiotics prescribed must be taken for five days when the first stitches come out. The remaining stitches are removed seven to ten days later.
• The face may be pale and bruised which will return to normalcy in a few weeks time.
• Most of the stitches will be removed after about five days

• The patient must limit activities for the first week
• The patients may return to work within two weeks of the procedure.
• The patient must be gentle with the face and hair, since the skin will be both tender and numb
• The patient must follow the specific guidelines regarding resuming the normal activities such as
• Avoid strenuous activity for at least two weeks
• Avoid alcohol, steam baths, and saunas for several months
• Get plenty of rest and allow the body to spend its energy on healing

Some scars may remain from the facelift, usually hidden by the hair or in the natural creases of the face and ears, which will fade within time and become scarcely visible.

Haematoma - a collection of blood under the skin that must be removed by the surgeon