The patient's face should be elevated to determine which areas are most wrinkled, sagging and unattractive. The procedure may then include a forehead lift, cheek lift or neck lift. Any excess fat in the neck can be removed at the same time, by either suction or scissors. The level of dissection may be as deep as the facial bones. The surgeon must have a complete knowledge of the branches of the facial nerves because inadvertent section would result in paralysis of the part supplied by this nerve.

While the surgery can be accomplished under local anesthesia with adequate preoperative sedation, some surgeons prefer to use supplemental intravenous or inhalation anesthesia as well. If that is the case, there should be an anesthesiologist or certified nurse anesthetist in charge of the patient.

If the forehead lift is to be included, the incision extends across the top of the head from ear to ear in the shape of a crown; hence, the procedure's other name, coronal lift. Some surgeons prefer to make the incision just below the hairline, especially in a very high forehead, because this part of the forehead is raised during the operation. Many people have deep frown lines between the eyebrows. For this reason, the muscles between the eyebrows are cut and a portion removed. The coronal lift is designed to accomplish four things: elevation of the eyebrows, removal of deep wrinkle lines across the forehead, improvement of crow's feet and removal of deep creases between the eyebrows.

The incisions vary according to each surgeon's preference. Some think that they get a better or longer lasting correction of the sag if the tissue overlying the parotid (mumps gland) and adjacent muscles is elevated and firmly sutured there, the excess being cut away or sutured behind the ear.

On completion of the surgery, some surgeons insert drains under the skin, which are attached to a gentle suction reservoir. Blood and serum are removed, leaving less bruising and less postoperative swelling. Some surgeons do not apply any dressings, while others use an around-the-head occlusive dressing.

Postoperatively there is some pain, especially in the muscles at the sides of the neck. It should be treated with some form of light narcotic. Each surgeon has a particular timetable for suture and bandage removal. The patient should plan on three weeks for recovery to the point of no bruising or swelling.

Of all the possible postoperative complications, the most common one is the formation of a hematoma (a swelling containing blood). This is most likely to occur in individuals who have untreated hypertension or uncorrected blood clotting factors and those who are taking aspirin who smoke. A large hematoma may lead to loss of tissue and infection. Smaller hematomas result in the development of heavier scar tissue, which may appear as a dimple or a lump that can take up to six months to soften. Other complications involve injury to nerves and changes in pigmentation. Loss of skin sensitivity may occur but gradually diminishes.