Facelift in Zurich

A facelift repositions descended soft tissues in the lower third of the face and neck and tightens the excess skin this creates. It sharpens the jawline, treats jowls and improves the neck contour.

It does not change skin quality, pigmentation or fine surface wrinkles, ageing itself, bone structure, or the upper and lower eyelids or brow position — these regions require their own procedures, which can be combined.

The procedure may be appropriate when descended soft tissues are the main concern, rather than volume loss or skin quality alone; when the jawline has become less defined, jowls are visible or the neck contour has changed.

Reasons against surgery include relevant accompanying illnesses, smoking with an increased wound-healing risk, a wish to change the skin surface rather than the contour, and expectations that surgery cannot meet.

Jawline

The clear separation between face and neck is lost as soft tissues descend.

Jowls

Tissue gathers in front of and behind the edge of the jaw, bounded by fibrous ligaments.

Midface

Volume flattens at the top and shifts downwards, creating shadows and a longer-looking eyelid region.

Neck

Fat distribution, platysma bands and excess skin together determine the contour.

A skin-only lift pulls at the surface without moving the descended structures. Its effect is therefore limited and can look unnatural if the pull is too strong. The real work takes place in the deeper tissue layer, which is repositioned and secured; the skin is then redraped with little tension.

The direction of repositioning is decisive. Tissue has originally descended downwards and inwards — so it must be returned accordingly. A predominantly backward pull does tighten, but can create contours that do not match the original anatomy.

SMAS techniques

The superficial musculoaponeurotic layer is tightened, folded or partially removed and re-secured. An established approach with many variants.

Deep-plane techniques

Dissection takes place beneath this layer; skin and the deeper layer are moved together and the retaining ligaments are released.

Further variants

These include MACS and short-scar procedures and combined approaches; they differ in the extent of dissection, incision placement and fixation.

Why no technique is generally superior

The procedures address the same anatomy in different ways. Which approach suits depends on the findings, tissue quality, previous surgery and objectives. Describing one technique as generally superior does not reflect the current discussion in the specialist literature.

Facelift or mini facelift

Shorter variants with limited dissection can be suitable for mild findings. They achieve less when the neck and midface are clearly involved — then too small a procedure is the most common cause of disappointment.

Facelift or fillers and energy-based treatments

Fillers add volume but do not reposition descended tissue. Energy-based treatments act mainly on the skin and superficial tightening. They are alternatives for mild findings and useful additions, but no substitute for marked laxity.

Combination with a neck lift

The neck and lower face form a unit. If only the face is treated, the neck contour often remains the most noticeable sign. Treating the neck is therefore often part of the procedure.

Planning the brows and eyelids

A facelift does not change the eye region. When brow position or the eyelids determine the expression, they are planned separately and treated at the same time or in stages, depending on the situation.

Fat transfer as an addition

Your own fat can replace lost volume, particularly in the midface. The survival rate of transferred fat varies individually; the remaining volume cannot be predicted exactly.

The incisions typically run in front of and behind the ear, partly within the hairline and, depending on the findings, under the chin. They follow natural contours and are largely concealed.

Scars remain permanently visible, although usually inconspicuous. Their course and maturation depend on skin type, tension and wound healing; the final assessment is only possible after about a year.

The procedure is usually performed under general anaesthesia, in selected cases under sedation with local anaesthesia. The duration depends on the extent and any combinations.

The first few days are marked by swelling, bruising and a feeling of tightness; cooling and an elevated head position are part of this. Sutures and dressings are removed as directed by your doctor.

After about two to three weeks, most patients are socially presentable again. Sport and greater exertion follow in stages over several weeks. Numbness, particularly around the ears, usually subsides over months. The result settles over six to twelve months.

Possible risks include postoperative bleeding and haematoma, infection, wound healing problems — particularly with smoking — conspicuous scarring, sensory disturbances, temporary and rarely permanent weakness of facial nerve branches, changes in ear shape, asymmetries, and a result that requires revision surgery.

Limitations: skin quality, bone structure and previous surgery determine what can be achieved. A facelift neither replaces volume nor substitutes skin treatment, and it does not stop ageing.

The tissue continues to age after the procedure, starting from its new position. Some patients choose a further lift or smaller corrections to individual regions years later.

Revisions are possible in cases of asymmetric healing, scar problems or remaining findings. The timing depends on completed healing.

The medical consultation for surgical procedures costs CHF 250. Following the examination, you will receive an individual cost breakdown for the recommended procedure. This should clearly state which services are included.

• Dr. med. Michael W. Payne

  Specialist in Plastic, Reconstructive and Aesthetic Surgery

• Facial surgery — overview
• Brow lift
• Upper eyelid lift
• Lower eyelid lift
• Neck lift
• Facelift or neck lift — decision guide
• Facelift or filler — decision guide

The initial consultation is about clarification, not selling. It does not necessarily end with a surgery date — often it brings the realisation that a different approach, or no procedure at all, is the right choice.

The consultation process

1. 01

   Discussion

   We listen to your concerns, medical history, expectations and what you would like to change about your appearance.

2. 02

   Examination

   A careful clinical examination and assessment of your underlying anatomy.

3. 03

   Options

   Possible procedures, alternatives, limitations and risks — explained clearly and without time pressure.

4. 04

   Time to reflect

   You decide in your own time. Any outstanding questions can be addressed in a further consultation.