Facelift checklist | Dr. Walter Zamarian Jr.

At a glance: what should you organize before and after a facelift?

Before surgery: tests and a surgical risk assessment, a medication review with stop dates, no smoking and help for the first few days. Afterward: follow-up visits, removal of the net and stitches, and a gradual return to activities. I routinely use the timelines below; the plan you receive at your consultation comes first, and no treatment should be stopped on your own.

Tests: a surgical risk assessment with an ECG for every patient, valid for 3 months.
Smoking: stop at least 2 weeks before and 2 weeks after; ideally 4 and 4.
Medications: aspirin 14 days before, GLP-1 receptor agonists 3 weeks, oral or vaginal estrogen and injectable testosterone 4 weeks, always agreed with the prescriber.
Day of surgery: nothing by mouth for 8 hours, including water; arrive at the hospital 2 hours early.
Recovery: net removed around day 2; stitches at 7, 10 and 14 days; no driving for 10 days.
Activity: light exercise at 1 month and everything at 2 months; follow-up for 1 year.

My deep plane facelift guide explains the operation and how I build the plan. This checklist helps you organize each stage; if you’re coming from abroad, the travel side is covered in the guide for international patients.

At your assessment: mention anything that could change the plan

Bring a list of your medical conditions, allergies, previous surgery and facial treatments, plus every medication and supplement with its dose and frequency. Include what you take only occasionally and what you might not think of as medicine, such as herbal products and compounded formulas. The ASPS includes a medical evaluation, medication adjustments and stopping smoking in facelift preparation [1].

I ask every patient for preoperative blood work and a surgical risk assessment with an ECG. Results are valid for 3 months and can be sent ahead on my team’s WhatsApp. The preoperative tests page explains this stage.

Weeks ahead: smoking and medications

These are the timelines I routinely use for a facelift. They’re meant to help you plan with my team and with the doctor who prescribed each treatment; they’re not an instruction to stop anything after reading this article.

Cigarettes, vaping and other nicotine products: stop at least 2 weeks before and don’t resume until 2 weeks after; ideally 4 weeks before and 4 after. The ASA advises quitting as early as possible and discussing it with your anesthesiologist [2].
4 weeks before: oral or vaginal estrogen, injectable testosterone and isotretinoin. Transdermal hormones can be continued.
1 month before: topical acids and tretinoin, restarted 1 month after surgery.
3 weeks before: GLP-1 receptor agonists, such as semaglutide and tirzepatide. According to anesthesia societies, most patients can keep taking them, with an individual decision [3]; stopping them 3 weeks before is my own practice, so agree on it with your prescriber, especially if you have diabetes.
2 weeks before: aspirin (14 days), tricyclic antidepressants, omega-3, arnica, ginkgo, cascara sagrada and horse chestnut.
5 days before: no alcohol at all, and no large amounts of garlic.
3 days before: last hair coloring; stay hydrated with water, coconut water or a sports drink.

Anticoagulants have their own instructions: when prescribed, the first injection is at 7 p.m. the evening before, about 12 hours before surgery, and you bring the next one with you to the hospital. Don’t change any timing without talking to my team. The pre-surgical preparation page brings these steps together.

Before the week of surgery: arrange your support

Who takes you to the hospital, picks you up at discharge and helps you get to follow-up visits.
Who helps around the house in the first days. A companion isn’t required; my team can recommend a driver and a companion or caregiver, hired separately.
Clothes that open at the front and a quiet place to rest.
Work and commitments with room to change.

If you’re coming from out of town, arrive in Londrina 2 days before surgery: the day before, I see you in person and take photographs. After surgery, plan to stay 12 to 14 days.

On the day of surgery

Have nothing by mouth for 8 hours, including water, and take the prescribed anti-anxiety medication at the agreed time. Arrive at the hospital 2 hours early. If you take blood pressure or thyroid medication, take it when you arrive at the hospital, with about a small coffee cup of water. Don’t shorten or extend the fast on your own.

For a facelift, I use total intravenous anesthesia (TIVA) with propofol and remifentanil, managed by the anesthesiologist. Surgery takes place at Hospital do Coração Bela Suíça, and discharge is usually the next morning, after I’ve seen you.

The first two weeks

I use the hemostatic net in all my facelifts, without drains; it’s removed at the clinic around day 2. The surgical stitches come out in stages, usually at 7, 10 and 14 days. For pain, I usually prescribe acetaminophen and ketorolac, with a rescue medication for stronger pain; take only what you’ve been prescribed.

Sleep on your back for 1 month.
No driving for 10 days.
Makeup from day 7; hair coloring from 3 weeks.
No massage, lymphatic drainage or products on the incisions until I clear them.

Describe any change to my team: when it started, whether it’s getting worse and whether one side differs from the other. The article on pain after a facelift helps with that description.

Warning signs that can’t wait

Shortness of breath or chest pain needs emergency care wherever you are; don’t wait for a WhatsApp reply. Rapid swelling on one side of the face, severe pain, bleeding that won’t stop, fever or a marked change in skin color also need immediate assessment: let my team know and, if you can’t be seen quickly, go to an emergency room.

The weeks and months that follow

Light exercise at 1 month; everything, including contact sports, at 2 months.
Sun: avoid it for 3 months; from 3 to 6 months, only early morning or late afternoon with SPF 30 to 40; no restriction after 6 months.
Follow-up visits with me at 7 and 14 days, 1, 2 and 6 months and 1 year, in person or online, included in the cost of surgery.

Time off work depends on what your job involves and how you’re recovering. Swelling and scars keep changing for months, and I don’t judge the result from an early photo. During follow-up, Isanna and I provide 24-hour support on WhatsApp. The post-surgical recovery page covers this stage in detail.

Questions

Does this checklist replace the instructions from my consultation?

No. It helps you see what needs to be organized; the instructions for your case come first.

Can I stop a medication early on my own to get ahead?

No. Tell us about every medication and agree on each change with my team and your prescriber.

Is removing the net the same as removing all the stitches?

No. The net comes off around day 2; the surgical stitches come out in stages, usually at 7, 10 and 14 days.

Do I need a companion?

It isn’t required. If you need help, my team can recommend a driver and a companion or caregiver, hired separately.

Bring your open questions to the consultation

If you’d like to plan these steps for your case, write to us on WhatsApp: Bruna, my AI assistant, handles the first contact and then puts you in touch with Isanna to arrange a consultation with me.

References

American Society of Plastic Surgeons. Facelift Preparation.
American Society of Anesthesiologists. Smoking and Anesthesia – Before & After Surgery.
American Society of Anesthesiologists. New Multi-Society GLP-1 Clinical Practice Guidance Released. 2024.