Facelift by age

How the face ages

• Facial fat sits in separate compartments, and each changes on its own with age; the face does not sag as one mass (PMID 17519724).
• The bones of the face recede in predictable places: the upper jaw beside the nose, parts of the eye socket rim, and the jaw in front of the jowl (PMID 22580543). The facial angles shrink between young adulthood and the 60s, more in women (PMID 19966653), and the jaw loses height, with women losing more bone at the chin (PMID 40264908).
• The distance from the skin to the SMAS shrinks with age (PMID 30882511). In a study of Chinese women, soft-tissue aging sped up around 35 and bone aging around 40 (PMID 41247912).

Where the evidence came from

• In 1985 Lewis asked whether facelifts should be done before 40. His youngest patients had the most loose skin removed, were satisfied and had few complications, and he saw no reason to defer surgery on age alone (PMID 3993464).
• In 2004 Becker compared patients aged 75 and older with patients aged 45 to 61 and found similar complications when health status was matched (PMID 15381577).
• In 2011 and again in 2026, one surgeon's series found that age itself, including age over 75, was not linked to complications (PMID 21617479, PMID 42045665).
• In 2026 two revision studies measured how long patients waited before a second facelift by their age at the first (PMID 41749415, PMID 42741888).

Under 50

• Facelifts are done before 40 when the skin is loose, often from heredity (PMID 3993464). In a large Chinese series the average patient age was about 40 (PMID 33651016).
• In a long-term satisfaction survey, patients under 50 reported greater satisfaction and longer-lasting improvement than older patients (PMID 22186515). The survey reached a minority of patients and may carry recall bias (PMID 20224460).
• Lifting direction differs by age: younger faces were lifted at a more upright angle than faces over 70 (PMID 22942107).

50s and 60s

• This is the most common age group, with ages 61 to 70 the single largest decade (PMID 30194721).
• Major complications occur in about 1 in 55 facelifts; the risk factors were male sex and the type of facility for hematoma, and overweight and combined procedures for infection (PMID 26578747).
• In the plastic surgery outcomes database, adverse events followed about 1 in 20 facelifts, more often with male sex, obesity, smoking, longer operations, combined procedures, general anesthesia and office-based surgery (PMID 32459769).
• One series found more complications and hematomas over 55 (PMID 22446820); another found no link between age and complications (PMID 32309087).

65 and older

• Carefully selected patients 65 and older had complication rates close to younger patients: major complications about 3 in 100 against 2 in 100, and minor complications about 6 in 100 in both groups, with no deaths (PMID 21617479).
• Older patients more often had other health conditions and a previous facelift (PMID 21617479). Among second-facelift patients, about 3 in 4 over 60 had at least one medical condition, against about 1 in 3 at 60 or younger (PMID 19332009).
• Across insured cosmetic patients 65 and older, overall complications were not higher than in younger patients; hematoma and infection were the most common (PMID 25911627).

75 and older

• Healthy patients aged 75 and older had minor complications at the same rate as patients aged 45 to 61 and no major complications. The authors advise counseling on health status, not age, and limit surgery to patients without serious systemic disease (PMID 15381577).
• In a ten-year series, major complications were rare (about 1 in 250) and minor ones about 1 in 13, and age was not associated with either, including over 75 (PMID 42045665).
• Patients 80 and older had a complication rate of about 1 in 45, not significantly different from younger patients (PMID 25911627).

Results and how long they last

• Observers judge patients about five years younger after facial rejuvenation surgery, with no difference by patient age (PMID 21514913, PMID 29040425, PMID 28448667). A facelift alone accounted for about 4.6 years; laser resurfacing added about 2.5, and eyelid surgery and an endoscopic forehead lift about 2 each (PMID 21514913).
• Patients see a bigger change than observers or face-age software do (PMID 34181603, PMID 39085528). People who looked older than their age before surgery moved back toward their true age (PMID 39085528).
• In a randomized trial of women aged 45 to 65, deep-plane, high SMAS and plication facelifts lowered perceived age by a similar amount (PMID 41061760).
• Younger at the first lift, longer to the second: after deep-plane facelifts, patients who were 53 or younger at the first lift returned after about 12 years, and older patients after about 9 (PMID 41749415). In another series, the second facelift came about 11 years after the first, sooner in patients who were older at the first (PMID 42741888).
• Nearly all patients rated their result very good or better at one year, and about two in three at about 12 years (PMID 20224460).

How surgeons adjust by age

• More skin was removed in patients under 40 than in older groups (PMID 3993464).
• In a small comparison by decade, SMAS plication scored higher in patients in their 50s and 60s, and deep plane slightly higher at 70 to 80 (PMID 14732637).
• Second facelifts were shorter operations and more often used SMAS plication (PMID 42741888).
• Local anesthesia was linked to fewer blood clots and steadier blood pressure than general anesthesia (PMID 42034464).
• Blood thinners: stopping anticoagulants 48 to 72 hours before a facelift has been advised, without a consensus (PMID 40461841).

Recovery

• About 1 in 28 facelift patients returned to a hospital or surgery center within 30 days, most often for a hematoma (PMID 30194721).
• Blood clot risk rose with operations longer than five hours, and both clots in one series followed combined procedures (PMID 22446820).

With other procedures

• Combined procedures raised major complications to up to about 1 in 27, against about 1 in 65 for a facelift alone (PMID 26578747). Patients had an average of two to three procedures, most often eyelid surgery (PMID 32459769).
• More facelift patients now report concern about volume loss, and fat grafting with facelift has become more common (PMID 38302713).

Questions to ask a surgeon

• Is my health, more than my age, a reason to wait or not to operate? (PMID 15381577)
• Do I need volume as well as a lift? (PMID 38302713)
• What other procedures would you combine, and does that raise my risk? (PMID 26578747)
• How long should I expect the result to last at my age? (PMID 41749415)
• How should my blood thinners be handled? (PMID 40461841)

Open questions

• An upper age limit: the 2011 series asked whether one exists beyond 65 (PMID 21617479); the 2026 update found none through 75 and older with strict screening, in one surgeon's practice (PMID 42045665).
• Early "maintenance" facelift: proposed for patients under 50 (PMID 22186515); the survey behind it has a low response rate and possible recall bias (PMID 20224460).
• Durability is measured by the time to a second facelift, a proxy for how long the result lasts (PMID 41749415, PMID 42741888).
• Measuring results: face-age software was modest on front views and inaccurate on profile views (PMID 42775335).
• Blood thinner management for older facelift patients has no agreed standard (PMID 40461841).

Terms

• Apparent age: the age observers assign from a photograph (PMID 29040425).
• Chronological age: age in years, as opposed to how old a face looks (PMID 39085528).
• ASA class: the anesthesia society's health grade, 1 for healthy and higher numbers for more disease (PMID 15381577).
• Octogenarian: in the CosmetAssure analysis, a patient aged 80 or older (PMID 25911627).
• Secondary facelift: a second facelift after an earlier one (PMID 42741888).
• Major complication: unplanned admission, reoperation or persistent nerve injury; minor complications are managed as an outpatient (PMID 42045665).
• Fat compartments: separate pockets of facial fat divided by thin walls (PMID 17519724).
• Bone resorption: loss of facial bone volume with age (PMID 22580543).
• Angle of lift (vector): the direction the lifted tissue is pulled, measured from horizontal (PMID 22942107).
• Deep vein thrombosis (DVT): a blood clot in a leg vein (PMID 22446820).

Papers