What the research shows
Satisfaction is high and lasts. Patients of one surgeon, surveyed more than a decade after surgery, mostly still rated their improvement very good, fewer than at one year, and about a third were disappointed in some detail (Friel 2010). On the FACE-Q, a validated patient questionnaire, patients rated their decision to have surgery highest and the area under the chin lowest (Sinno 2015). Scores rose by three months and held at one year (Berger 2019).
Patients look several years younger. Outside raters judged patients clearly younger after surgery, and the change was largest when eyelid and forehead surgery were added to the face and neck lift (Chauhan 2012). Patients rate their own change higher than face-reading software does: about seven years younger by their own estimate, about four by the software (Zhang 2021). Lifts that moved the deeper SMAS layer took off more apparent age than skin-only lifts (Gibstein 2021).
Most complications are minor. In a national database of patients of board-certified plastic surgeons, about 1 in 20 had an adverse event, most often a blood collection (hematoma) or an infection. Men, smokers, obese patients, long operations, combined procedures, general anesthesia and office-based surgery carried more risk (Chopan 2020). For deep plane lifts, temporary facial nerve weakness occurred in about 1 in 100, and no permanent nerve injury was reported (Koroma 2026).
Results last about a decade. Patients who returned for a second lift did so after about 9 to 12 years on average, after SMAS and deep plane lifts alike (Sundine 2010, Beale 2013, Levin 2026). An early return was most often from poor skin elasticity, as in heavily sun-damaged skin (Sundine 2010). The jawline held longer than the fold beside the mouth, which came back after early success (Hamra 2002).
Where surgeons disagree
- Deep plane or SMAS. Pooled reviews find both safe with high satisfaction. One reported higher satisfaction and more complications with deep plane (Khoury 2025); another found similar hematoma and nerve injury rates and only one direct comparison (Vayalapra 2025). A prospective comparison and a small randomized trial found no difference in results (Neel 2026, Baptista 2026). Surveyed facial plastic surgeons linked deep plane lifts with more temporary nerve injury and not with longer results (Pak 2026).
- Age at the first lift. Patients 53 or younger went longer before a second lift (Levin 2026), and patients under 50 reported higher satisfaction, so some surgeons favor earlier lifts (Liu 2012). Others point to face shape: fuller faces did better and fuller necks relapsed more (Rohrich 2016).
What is new
- Experience lowers risk. In one surgeon's deep plane lifts, the complication rate in the last group of cases was half that of the first group (Çelik 2026).
- Face-reading software now measures apparent age after surgery and agrees moderately with human raters (Baptista 2026).
- Tranexamic acid, a drug that slows bleeding, lowered minor hematoma and drain output without adding complications (Alenazi 2024).
What is still unknown
- How good the long-term evidence is: a review of American facelift research found most studies of moderate to low quality and validated questionnaires rarely used (Hornick 2026).
- Which technique lasts longest: no head-to-head comparison has followed patients for years (Vayalapra 2025).
Key papers
- Friel 2010: surveyed patients more than a decade after their facelifts; most remained satisfied.
- Klassen 2014: built the FACE-Q facelift scales that patients now use to rate their results.
- Sinno 2015: first FACE-Q facelift study; the area under the chin scored lowest.
- Chopan 2020: national complication rate and the risk factors a patient can change.
- Sundine 2010: about twelve years between a first and second SMAS lift.
- Hamra 2002: the jawline holds longer than the fold beside the mouth.
- Koroma 2026: pooled deep plane complications, with no permanent nerve injury.
- Levin 2026: thirty years of deep plane lifts; younger patients went longer before a revision.
- Hornick 2026: graded American facelift outcome research; most studies scored moderate to low.