With advances in modern healthcare and improvements in lifestyle we are living longer and leading more active lifestyles into older age. Many develop new relationships and partnerships in later life or may desire to maintain a youthful appearance for professional or social reasons.

We expect our outward appearance to reflect these improvements in our health, fitness and the active lifestyles we lead. The increasing use of social media and Zoom/online video conferencing with Working From Home has strongly driven the desire to improve facial aesthetics also.

Facial rejuvenation surgery techniques have also become significantly more advanced and refined over time and now produce more comprehensive rejuvenation results in a natural way, and allow patients to achieve these aims in a safe manner.

A facelift is a very powerful technique used to comprehensively rejuvenate the face and neck regions, correcting the signs of ageing, taking the patient’s appearance back to where they were 10-15 years previously whilst maintaining a natural look.




The ideal youthful face has full convex cheeks with good volume, a slim lower face and a well-defined jawline and neck angle, together with good skin tone.

With ageing, the facial tissues lose tone and elasticity as collagen and elastin are lost. This is accelerated by smoking, overexposure to the sun, lifestyle factors such a stress and loss of sleep, environmental and genetic factors. The face also loses volume as fat is lost, the skin thins and there is loss of skeletal volume also.

Together these changes produce wrinkling and sagging of the facial tissues. loss of volume and fullness in the cheeks and upper face, cheek descent, formation of folds between the nose and mouth, and the appearance of jowls on the jawline with loss of jawline definition.

These changes involve not only the skin and superficial tissues but also the deeper facial tissues, including the SMAS tissue layer between the skin and the deeper lying muscles of facial expression.

The brow can also descend causing a tired or angry look and heaviness around the eyes. The neck is also increasingly affected with age, presenting as loose skin and excess fat obscuring a taut and defined neckline. There may be marked longitudinal bands down the neck in some older patients.


For patients in their 30s, and many in their early 40s, anti-wrinkle injections and facial fillers can produce significant correction and effective rejuvenation. However for those patients in their early to mid 40s onwards, and some younger patients, non-surgical treatments alone will not produce a complete correction and a surgical approach is required to produce a complete correction and full rejuvenation, if this is what the patient wants.

Younger patients (those in their 40s, occasionally later 30s and a few in their early 50s are usually best suited to a short scar or mini facelift. They may have noticed their mid-face/cheeks starting to drop with a loss of cheek volume, contour and projection, the appearance of tear troughs or shadowing under the lower eyelids, naso-labial folds, and the formation of jowls with some loss of jawline definition. However these patients generally have good neck contours so don’t require a necklift although some may benefit from liposuction to the neck with a short scar facelift.

Older patients (normally from the 50s upwards) usually benefit from a full facelift (face-necklift) as their necks have started to slacken and descend also, losing neck definition, plus they tend to have further loss of jawline and lower face definition also. They will also frequently combine a full face-necklift with additional procedures eg eyelid blepharoplasty, facial fat grafting and a browlift.


The commonest form of facelift involves resuspension of the SMAS tissue layer (the superficial muscular aponeurotic system), a fibrous-fatty layer of tissue in the face below the skin and above the muscles of facial expression, which tends to lose tone and sag with age. This type of facelift is commonly called a SMAS facelift or deep plane facelift depending on the method of resuspension used.

Once the skin has been elevated, the tissues in this deeper SMAS layer are lifted, repositioned and reshaped. The overlying skin is then redraped, and the excess skin trimmed. This restores the facial tissues back to their position when the patient was 10-15 years younger and produces a more ideal, youthful facial shape. This is commonly combined with some liposuction to the lower face and neck also to slim the lower face and neck and enhance facial definition.

The skin is then sutured without tension so that a natural, refreshed look is produced without signs of surgery.

A head dressing and drains are placed in each side of the face at the end of the procedure which are removed the following morning after the procedure prior to discharge.

In relatively younger patients (late 30s and 40s usually) as discussed above, where most of the correction is required in the face and cheeks only, a short-scar type technique is usually used in which the cheek and facial tissues are lifted only.

In older patients (usually 50s and above), or patients who have experienced significant changes in their weight, significant correction to the neck region is also usually needed and the deeper neck tissues (SMAS and Platysma layer) are lifted and recontoured also in addition to the facial deep plane SMAS tissues. Liposuction in the neck is commonly used with the neck surgery and a significant amount of spare neck skin is usually removed.

Skin incisions are normally hidden in the hairline and placed discreetly in the skin creases around the margin of the ear. These usually fade quickly and settle well over time.

In younger patients suitable for a short-scar type technique the incisions are placed in the temple hairline and in the creases on the front of the ear alone.

In relatively older patients requiring a full facelift (face-necklift) the incisions are extended into the creases around the back of the ears and into the adjacent hairline behind in addition.

In patients with a slimmer face, as in many younger patients, a SMAS plication facelift is commonly used. This lifts and resuspends this deeper SMAS tissue layer without removing volume.

In patients with a heavier face a SMASectomy facelift may be used which removes a strip of SMAS tissue at the same time as lifting and resuspending this tissue layer. This slims the face, as well as lifting it, in those patients who may have gained a significant amount of weight in the face over time, which helps to define the new contours further.

In some patients the SMAS tissue layer may be more widely released to obtain an effective resuspension which is often termed a deep plane facelift.

The surgery is usually performed under a general anaesthetic with a stay overnight, although in some less complex cases it can be performed as a day case. A dressing is applied and drains are used to allow any fluid to drain out, and both are removed the following morning prior to discharge. A compression garment is worn for 2 weeks day and night and 4 weeks subsequently at night only to minimise swelling. Sutures are removed at day 5-7 usually.

Patients should allow 2 weeks away from work and social activities after facelift surgery alone. Where a facelift is performed in combination with other procedures such as eyelid surgery or fat transfer a 3 week recovery period is usually required.

There is little discomfort or pain after facelift surgery and simple analgesics at most are required after discharge during the recovery period.

Patients should take things very quietly for the first 3 weeks after facelift surgery to keep the blood pressure stable and minimise the risk of bleeding. They should avoid all exercise, heavy lifting, house work and sexual activity during this period

Facelift techniques are frequently used in combination with other facial rejuvenation procedures such as upper and lower eyelid blepharoplasty, a browlift, facial fat transfer and additional neck procedures, such as a platysmaplasty, to achieve a full, harmonious rejuvenation of the face and neck regions. A detailed pre-operative discussion and assessment is performed in clinic to advise which particular combination of techniques is best suited to the patient to achieve the optimal aesthetic outcome.

These procedures are either performed in combination in one stage or in a series of procedures depending on the requirements of each patient.

The face loses volume with ageing as subcutaneous fat is lost, the skin thins and there is also loss of skeletal volume. Fat grafting is often used to replace this lost volume, enhancing facial contours further in addition to the facelift, and softening the facial appearance. The stem cells contained in the fat rejuvenate the overlying skin also, thickening the dermis giving a healthy glow to the skin in addition.

Fat is harvested from the abdomen usually through very small incisions, transferred into small syringes to inject into the face. The fat is injected around the face depending on patient requirements eg into the temples, brows, cheeks, nasolabial area, lips and jawline.

For patients with very heavy necks, particularly where there is significant amounts of deep fat between or below the neck muscles, a platysmaplasty allows for this deeper fat to be removed, the muscles tightened from the front and the neck slimmed and defined additionally beyond that achieved by a face-necklift alone. Liposuction will only remove more superficial fat and the additional platysmaplasty surgery frequently produces significantly improved neck definition in this group of patients.

Additionally in older patients where the deeper platysma muscle layer is very lax, a platysmaplasty allows this to be tightened from the front in addition to being lifted from the sides to obtain optimal neck contours and improved durability of results.

If a good, well executed technique is used, including a lift of the deep SMAS tissue layer, and the skin is closed without tension, then a natural result will be produced. This is dependent on the planning, artistic vision, technical skill and experience of the surgeon.

Although the principles and techniques used for both female and male facelifts are the same, there are some differences in facial contour and emphasis in the type of results that are usually desired between female and male patients. The surgical technique will be adapted to match these differences.

Female patients generally prefer fuller, more convex cheeks in contrast with a slimmer lower face, and in many cases desire a more arched brow with some canthal tilt in the appearance of the eyes.

Male patients prefer a well-defined, strong jawline with less emphasis on the fullness of the cheeks and a more horizontal brow in most cases. However specific requirements and emphasis may vary between patients.

At consultation there is a detailed discussion of the patient’s concerns and requirements for facial rejuvenation surgery, together with any history of previous facial treatments or surgery, their vision, and any other previous surgery or medical conditions.

A detailed assessment of the face and neck is made and a series of photographs are taken. Through discussion with the patient a recommended plan or range of options for treatment is discussed.

The patient is usually seen over several consultations to discuss the different aspects of the procedure and finalise the treatment plan ahead of surgery taking place.

Smoking, vaping and all nicotine products must be avoided for at least 4-6 weeks before and a month after surgery to maintain adequate blood supply to the facial tissues for safe healing. Non-steroidal anti-inflammatory drugs should also be avoided for 2 weeks before and 3 weeks after surgery as these significantly increase the risk of bleeding. Arnica can be used for a week before and 2 weeks after surgery to minimise swelling.

Skin peels and other surface skin treatments should be avoided for at least 6 weeks before and after surgery.

The results of a facelift should last 10-15 years and longevity will depend on the technique used and skill of the surgeon together with the patient’s genetics and lifestyle factors.

Avoiding smoking, excessive sun exposure, stress and sleep loss, combined with good genetics, diet and lifestyle will ensure the results last the maximum length of time.

It is possible for the facelift to be repeated as a patient gets older to ensure optimal facial aesthetics are maintained.

An additional benefit of facelift surgery is that the facial tissues tend to age at a slower rate after facelift surgery due to the fibrous tissue laid down after the procedure which provide additional support to the face.

Combining a facelift with additional facial procedures such as fat transfer results in a more comprehensive correction that is likely to be more durable over time.

This depends on a patient’s genetics, lifestyle, profession and their preference and views regarding surgery. Different patients will have varying views or requirements as to whether to start facial rejuvenation surgery at a younger, middle or older age. Some may prefer to maintain optimal facial aesthetics from a young age and will start with a simpler procedure (eg a short scar facelift) once anti-wrinkle injections and facial fillers stop being able to provide a full correction – usually in their early 40s or late 30s. Others may prefer to wait until they are older in their later 40s, 50s, 60s or even later to start surgery and will more often require a full face-necklift in these cases.

Those patients who start with a short scar facelift at a relatively younger age may often go on to a full face-necklift at an older age, e.g. their mid 50s to maintain optimal facial aesthetics.

Starting facial rejuvenation surgery younger has the advantage that less is required to produce a full correction, the tissues have stronger tone to maintain the results longer and the patient is younger and fitter for surgery. Following initial surgery the face tends to age slower as the scar and fibrous tissue laid down in the face subsequently strengthens the support to the superficial facial tissues.

A revision facelift will usually be a full facelift (face-necklift) and will utilise incisions around the margins of the ears which are likely to be already present from previous surgery. If they have not been optimally placed previously their position will be adjusted for optimal aesthetics. The deep plane SMAS tissue layer is again lifted, and this may be a more comprehensive resuspension if the patient has had a less comprehensive lift previously to ensure the facial tissues are resuspended and reshaped into the optimal shape.

Additional facial surgery is commonly performed such as further adjustment to the eyelids and fat transfer, as more facial volume is lost in older patients.







  • ANAESTHETIC: General
  • DURATION: 2-5 hours
  • HOSPITAL STAY: Daycase or 1 night
  • POST-OP: Sutures out at 5-7 days, compression garment for 14 days day and night, then at night only for the following 4 weeks


“If you are a person who values their looks and has very definite views on how they want to age then I cannot recommend Mr Paul Tulley highly enough.

Many years ago I had breast implants and for a time they were wonderful. However, they became encapsulated and needed to be removed. At that time I found a cosmetic surgeon to do the operation and afterwards was astonished at the amount of pain and extensive bruising I experienced. I could barely function for days.

Years later, at the age of 56, my breasts had again encapsulated. I decided that instead of having the implants replaced, I would have the implants removed and my breasts uplifted with the possibility of having fat grafts afterwards if there was little to no volume. I was mentally prepared for days of pain and incapacity.

Having done research on the internet, I decided on Mr Paul Tulley. To use an old adage ‘measure twice, cut once’; Mr Paul Tulley takes this to the nth degree. Not only did he measure but he rechecked and re-measured over and over again before he eventually made his pen marks ready for surgery. There was nothing blasé about the way he prepared for my surgery. I found his attention to detail incredibly reassuring.

After my surgery not only were my breasts symmetrical but they were pert and more youthful than I had ever dared to imagine. There was barely any bruising at all and I had absolutely no pain! I was amazed! Six weeks later the scars are healed and almost barely visible.

To say I am thrilled by Mr Paul Tulley’s hard work and expertise would be the understatement of the century. He is definitely a surgeon I trust to make you look the best you are able.

“I had a deep plane face and neck lift plus upper eyelid surgery on 9th July 2022. Mr Tulley is an absolute genius, I am so thrilled with the results and my husband who looks at me more than I do is even happier I have never had so many compliments from him. This is a surgery that requires your commitment to take the right amount of time to really heal and recover in order to get the best results.

I am now at the 4 week stage. I still have healing to do not that anyone can tell but my results will improve even further.

All the along the way I have had great communication from Beckie and Mr Tulley who took great care of me in surgery. At the age of 59 I feel ready for my 60th and the years beyond. There’s no stopping me fully embracing life with my new confidence.”

“I’m so grateful to you for making me look younger! You’re the best. I appreciate all your help.”

“I’m so so pleased with my facelift and eyelid surgery… it’s so natural! If I need another in 15 years or so, I’ll definitely come back to see you again!”

“Thank you so much for my new face!”