Facelift & Necklift


Introduction to Facelift Surgery (Rhytidectomy)

A facelift is one of the most rewarding and impactful procedures in facial rejuvenation. Common patient goals in facelift surgery include tightening the neckline, reducing “jowl” formation along the jawline, restoring volume to the cheeks, and imparting a refreshed and well rested appearance to the face.  As is discussed below, there are many variations to the facelift procedure, but overall, these share common principles of safely repositioning the soft tissue of the face.

Dr. Pepper’s Philosophy of Facelift Surgery

Dr. Pepper’s philosophy of performing Facelift Surgery is a balance of two priorities: safety and efficacy.  As the Director of Stanford Facial Nerve Center, he is deeply knowledgeable about the anatomy of the facial nerve.  This nerve resides underneath the plane of dissection during a facelift surgery.  Several times per year, Dr. Pepper is called into consultation from colleagues around the country regarding injury to the facial nerve.  Although no surgeon can provide a 100% guarantee of a complication-free surgery, Dr. Pepper is uniquely knowledgeable about facial nerve anatomy and avoidance of potential complications of its injury.  On the other hand, facelift surgery should be effective.  The most effective techniques involve manipulation of the SMAS (superficial musculoaponeurotic system).  Dr. Pepper published this technique with his mentor, Dr. Shan Baker, who is now retired (1).  This facelift technique leads to excellent and durable results, as demonstrated by the patient below shown 1 year and then more than 5 years after SMAS lift by Dr. Pepper using a short scar approach. 


After 6 months

After 5 years


After 6 months

After 5 years


After 6 months

After 5 years

What Are the Incisions of a Routine Facelift?

In a facelift, the incisions are hidden around the ear and within the hairline.  The skin is then elevated and used to access the SMAS (superficial musculoaponeurotic system) and the platysma muscle.  This deeper layer is the key to effective and durable elevation of the facial anatomy.  The incisions used for a full facelift are shown below.

What if I Want a Necklift, Moreso Than a Facelift?

In general, a facelift is the most effective means of achieving a good necklift.  In most cases they are identical procedures.  There are two important exceptions, however.  First, some younger patients have congenital excessive fat underneath the chin.  This is treated with a submental liposuction, which is a minimal liposuction procedure performed through a small incision just under the chin.  The second situation where treatment of the neck may call for a procedure other than a facelift is in the male patient with a significant amount of redundant skin in the neck and under the chin.  This is typically treated with a submentoplasty, which involves excision of the excess skin underneath the chin.  The differences between these procedures are straightforward for a board-certified surgeon who specializes in facial surgery to guide you through.

What if I Would Like a Shorter Incision?

Limited incision facelifts are still quite effective, when used in the right patient.  In general, there may be slightly less impact on the neck, as the incisions that extend behind the ear are employed in order to tighten the neck and remove excess skin.  The incisions of a “short scar facelift” or “minilift” are shown below. 

Why Not do a “Skin-only” Facelift?

“Skin only” facelifts are simple to perform and involve minimal downtime.  However, they typically are less satisfactory for patients due to their short lifespan and limited effect on the appearance of the face.  This is partly due to the nature of skin.  When skin is used as the means of tightening the face, the skin responds by relaxing significantly after around 6 months after the procedure.  Facelifts that reposition the tissue layer deeper to the skin, called and SMAS (superficial musculoaponeurotic system) have a much longer duration.  A typical effective SMAS lift will last approximately 10 years, much longer than a “skin-only” facelift which may lose impact after less than a year in some cases.

What Can I Expect After a Facelift in Terms of Recovery?

Patients are asked to limit their activity in the first several weeks after facelift and to ice the face to limit bruising.  Pain should be well controlled with prescribed medication.  Most patients are comfortable working from home the second week after surgery, but this depends on the patient and the extent of surgery.  Patients typically return to work one to two weeks after a facelift, but this can vary depending on occupation and other factors.  Patients are seen 1 day, then 1 week after surgery for assessment by Dr. Pepper and suture removal.

How Painful is a Facelift?

Although everyone is different, a facelift is typically NOT a painful procedure.  It certainly creates a “tight” sensation, but patients typically report little pain after a facelift.

What Are Other Procedures That Can be Included With a Facelift?

Natural complementary procedures to a facelift include: fat transfer, laser resurfacing or chemical peel to smooth skin wrinkles, blepharoplasty (eyelid tightening), and brow lift surgery.

If you would like a consult for facelift or facial rejuvenation, please call us at (650) 736-3223 (FACE).  


1. Pepper, Jon-Paul, and Shan R. Baker. 2011. “SMAS Flap Rhytidectomy.” Archives of Facial Plastic Surgery 13 (2): 108. https://doi.org/10.1001/archfacial.2011.11.


Schedule a Consultation

(650) 736-FACE (3223)

Jon-Paul Pepper, MD
Associate Professor of Otolaryngology — Head & Neck Surgery


Dr. Pepper is a double-board certified surgeon who specializes in aesthetic and reconstructive surgery of the face, in particular surgery for the treatment of facial paralysis. He is the Director of the Stanford Facial Nerve Center since 2017. He has broad expertise in facial plastic and reconstructive surgery, including facial reanimation surgery, facelift surgery, rhinoplasty, and the reconstruction of the face after skin cancer resection. Dr. Pepper performed his undergraduate studies at Brown University, majoring in Neuroscience. He completed a one-year research fellowship at the National Institutes of Health in preparation for a career in academic medicine. He was awarded his M.D. at the University of California, Irvine, graduating with highest honors and Alpha Omega Alpha designation in 2007. He went to the University of Michigan for residency training in Otolaryngology – Head & Neck Surgery in 2012. He then completed fellowship training in Facial Plastic & Reconstructive Surgery in 2013, also at the University of Michigan. Dr. Pepper was honored to receive the highest board score in the nation on the American Board of Facial Plastic & Reconstructive Surgery examination in 2013. For this accomplishment, he was given the Jack R. Anderson Award for Scholastic Achievement. He also directs the scientific work of the Stanford Facial Nerve Center and his NIH-funded research explores regenerative strategies to improve nerve regeneration after injury.