Inside the Operating Room

    Your Facelift Procedure: A Step-by-Step Guide

    Ever wondered what *exactly* happens during your facelift surgery after you drift off to sleep? We're pulling back the curtain on the entire procedure as performed by Prof. Dr. Cengiz Volkan Demirtaş in our JCI-accredited Istanbul hospital. This is the complete, unfiltered guide for our 1,200+ US patients, from the first surgical marking to the final, delicate suture.

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    Prof. Dr. Cengiz Volkan Demirtaş
    JCI-Accredited Hospital
    1,200+ US Patients
    Board-Certified Anesthesia Team
    Facelift procedure step by step performed by Prof. Dr. Demirtaş in Istanbul JCI hospital
    12 Steps
    From markings to closing sutures

    Facelift Procedure — Quick Snapshot

    Total OR Time
    4 to 5.5 hours, depending on technique
    Anesthesia Type
    General Anesthesia (TIVA - Total Intravenous Anesthesia)
    Incision Design
    Hidden within the hairline and natural ear creases
    SMAS Technique
    Deep Plane Release or SMAS Plication (Patient-specific)
    Typical Blood Loss
    Minimal, typically less than 100cc
    Hospital Stay
    **1-2 Nights** in a private JCI-accredited hospital suite
    First Post-Op Walk
    Within 4-6 hours of returning to your room
    Drain Removal
    Typically within 24 to 48 hours post-procedure

    Demystifying the Facelift: What Really Happens Behind the OR Doors

    Prof. Dr. Demirtaş's facelift procedure is a meticulous, multi-hour surgery under general anesthesia performed in a JCI-accredited hospital. It involves precise incisions, lifting and repositioning the deep facial tissues (SMAS), removing excess skin, and closing with fine sutures. Every step is designed for a natural, long-lasting result with maximum safety protocols in place for our international patients from the US.

    For many patients traveling from the United States to Istanbul for a facelift, the greatest source of anxiety isn't the flight or the recovery—it's the unknown of the operating room itself. What happens during those hours? Who is in the room? How are safety standards maintained so far from home? At Plastic Surgery Istanbul, we believe transparency is the cornerstone of trust. That's why we've created this exhaustive guide to Dr. Cengiz Volkan Demirtaş's specific surgical protocol. We want you to feel as confident and informed about the procedure as you are about the stunning, natural results you'll achieve.

    This is not a generic overview. This is the precise, step-by-step process that over 1,200 of our American patients have undergone. It details the techniques, safety measures, and meticulous attention to detail that define a procedure with Prof. Dr. Demirtaş. Our entire process is built around the unique needs of a traveling patient. From the board-certified anesthesiologist dedicated solely to you, to the advanced monitoring technology that's standard in our Class A operating rooms, every element is designed to meet or exceed the standards you'd expect from a top-tier US hospital, but at a fraction of the cost.

    As you read through these steps, picture yourself in the hands of a team that specializes in creating beautiful, harmonious results for an international clientele. Prof. Dr. Demirtaş's approach is not just about lifting the skin; it's about artistically repositioning the foundational structures of the face for a result that is refreshed and rejuvenated, never 'pulled' or 'done.' Let's walk you through the entire journey, from the moment you meet the doctor on your surgery day to the final stitch that sets you on the path to a more confident you.

    Inside the OR

    The 12-Step Facelift Procedure Inside Our OR

    The following 12 steps represent the exact surgical workflow of Prof. Dr. Cengiz Volkan Demirtaş. This methodical and practiced sequence ensures efficiency, safety, and consistency, delivering the world-class results our US patients expect. The timings are approximate and can vary based on individual anatomy and the specific surgical plan.

    1
    Approx. 20 minutes

    Pre-Operative Markings & Final Consultation

    This crucial first step happens before any anesthesia is administered. You will be awake, comfortable, and sitting upright in the pre-op area. Prof. Dr. Demirtaş will meet with you to review your goals one last time. Using a sterile surgical marker, he will draw detailed guidelines directly on your face and neck. These markings map out the precise incision lines, the vectors of lift for the underlying tissues, and areas requiring specific contouring. This step must be done while you are upright, as gravity affects facial tissues. It's a collaborative moment that ensures the surgical plan is perfectly aligned with your desired outcome.

    What you feel: You will feel the gentle touch of a surgical marker and the reassurance of discussing the final plan with Dr. Demirtaş.
    2
    Approx. 10-15 minutes

    Anesthesia Induction

    You will be escorted into our state-of-the-art, Class A operating room and made comfortable on the surgical table. Your dedicated, board-certified MD Anesthesiologist will introduce themselves and connect you to advanced monitoring equipment (ECG, blood pressure, pulse oximetry, BIS monitor). An IV line will be placed, and the anesthesiologist will begin administering medication. We use Total Intravenous Anesthesia (TIVA), a modern technique that provides a smooth induction and emergence with less post-operative nausea. You will gently drift off to sleep within moments, feeling calm and secure.

    What you feel: You are now completely asleep under general anesthesia and will feel, hear, and remember nothing of the procedure.
    3
    Approx. 10 minutes

    Sterile Preparation & Draping

    Once you are fully asleep, the surgical team begins the sterile preparation. Your face, neck, and the surrounding areas are meticulously cleansed with an antiseptic solution like Betadine or Chlorhexidine to eliminate bacteria and create a sterile field. The team then places sterile drapes over your body and head, leaving only the surgical area exposed. A special breathing tube is secured by the anesthesiologist. This step is a critical protocol in our JCI-accredited hospital to prevent any risk of infection and maintain the highest standards of surgical safety for every patient.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    4
    Approx. 20 minutes

    The Initial Incision

    The surgery officially begins. Following the pre-operative markings with scalpel-like precision, Prof. Dr. Demirtaş makes the initial incisions. The goal is camouflage. The incision typically starts within the hairline of the temple, extends downward along the natural crease in front of the ear (or inside the tragus), curves around the earlobe, and continues into the crease behind the ear before disappearing into the lower scalp hairline. This meticulous placement is fundamental to achieving a scar that will be virtually undetectable once healed. For neck lifting, a small, separate incision may be made discreetly under the chin.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    5
    Approx. 45 minutes

    Skin Flap Elevation

    With the incisions made, the next step is to elevate the skin. Dr. Demirtaş carefully separates the skin and a thin layer of subcutaneous fat from the underlying structural tissue, known as the SMAS (Superficial Musculoaponeurotic System). This is a delicate process performed with specialized instruments to preserve the vital blood vessels and nerves within the skin flap. Creating this flap provides the necessary access to the deeper facial structures that are responsible for sagging. The extent of the elevation is determined by your specific needs, ensuring a comprehensive yet safe rejuvenation.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    6
    Approx. 30 minutes

    SMAS Identification & Dissection

    This is the heart of a modern facelift. The SMAS is a fibrous network of tissue that covers the deeper facial muscles and is a primary cause of jowling and mid-face sagging. Unlike older, 'skin-only' facelifts, Dr. Demirtaş's technique focuses entirely on this layer. He meticulously identifies and dissects the SMAS layer, preparing it to be lifted and repositioned. This approach is what creates a truly natural and long-lasting result, as it addresses the foundational cause of facial aging rather than just pulling the skin tight. His extensive anatomical knowledge is paramount during this critical phase.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    7
    Approx. 60 minutes

    Deep Plane Release & SMAS Repositioning

    For a Deep Plane Facelift, Dr. Demirtaş works beneath the SMAS layer to release key facial retaining ligaments, such as the zygomatic and masseteric ligaments. By releasing these tethers, the entire mid-face, jowl, and neck complex can be lifted as a single unit, without tension. The SMAS is then elevated in a more vertical direction, restoring youthful volume to the cheeks and defining the jawline. It's then anchored into its new, higher position with internal sutures. In SMAS plication, the layer is folded and sutured. This step re-establishes the 'scaffolding' of the face, providing the dramatic, yet natural, structural improvement.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    8
    Approx. 40 minutes

    Neck Rejuvenation (Platysmaplasty)

    A youthful face requires a harmonious neck. Through the small incision under the chin, Dr. Demirtaş addresses the neck muscles (platysma). He may remove excess submental fat, and then he will tighten the platysma bands, which cause vertical banding or 'turkey neck.' The separated muscle edges are sutured back together in the midline, creating a sharper, more defined neckline and jaw angle. This step is often performed in conjunction with the lateral SMAS lift to ensure a seamless and comprehensive rejuvenation from the cheeks down to the collarbone. It is a critical component for a balanced and complete result.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    9
    Ongoing throughout procedure

    Meticulous Hemostasis

    While not a sequential step, hemostasis (the control of bleeding) is a continuous and critical process. Throughout the entire surgery, Prof. Dr. Demirtaş uses a technique called electrocautery to seal tiny blood vessels as he works. This meticulous attention to hemostasis is vital. It significantly reduces post-operative bruising and swelling, minimizes the risk of hematoma (a collection of blood under the skin), and contributes to a faster, more comfortable recovery for our patients. This is a hallmark of a careful and experienced surgeon and is standard practice in every one of our procedures.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    10
    Approx. 30 minutes

    Skin Redraping & Excision

    With the underlying facial structure beautifully repositioned, the elevated skin flap is now gently redraped. The key here is zero tension. The skin is not pulled tight; it is simply laid back over the new facial contours. The excess skin that has become apparent due to the deep tissue lift is then precisely trimmed away along the incision lines. This tension-free closure is what prevents a 'wind-tunnel' or 'overdone' look and is absolutely essential for creating fine, inconspicuous scars. Dr. Demirtaş's artistic eye ensures the perfect amount of skin is removed for a smooth, natural finish.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    11
    Approx. 5 minutes

    Surgical Drain Placement

    Before the final closure, one or two very fine, soft surgical drains are placed beneath the skin flaps, typically exiting from the scalp area behind the ears. These drains are a crucial safety measure. They work by gentle suction to remove any small amount of fluid or blood that may accumulate in the first 24-48 hours post-surgery. By preventing fluid buildup, drains dramatically reduce the risk of hematoma and seroma, decrease swelling, and promote faster healing. They are a standard part of our protocol to ensure the safest possible recovery for our US patients.

    What you feel: You are fully asleep under general anesthesia and feel nothing.
    12
    Approx. 45 minutes

    Multilayer Suture Closure

    The final step is the meticulous closure of the incisions. This is performed in multiple layers. First, deep, dissolvable sutures are used to support the underlying tissues and take all the tension off the skin. Then, the skin itself is closed with extremely fine, non-dissolvable sutures, placed with the precision of a watchmaker. For incisions along the hairline, Dr. Demirtaş often uses a trichophytic closure, allowing hair to grow directly through the scar line for ultimate concealment. A light dressing and a supportive facial garment are applied, and the procedure is complete. You are then ready to be gently awakened.

    What you feel: You are fully asleep under general anesthesia and feel nothing.

    Surgical Techniques Inside the Procedure

    Deep Plane Release

    This is the most advanced facelift technique, performed by Prof. Dr. Demirtaş for suitable candidates. It involves working underneath the SMAS muscle layer to release foundational ligaments. This allows for a tension-free, vertical lift of the entire cheek, jowl, and neck complex as a single unit. The result is exceptionally natural, powerful, and long-lasting, as it repositions the actual source of facial sagging, not just the skin.

    SMAS Plication

    In an SMAS plication facelift, the SMAS layer is not lifted as a flap but is instead folded upon itself and secured with strong internal sutures. This effectively tightens and lifts the underlying facial structure, correcting jowls and defining the jawline. It is a highly effective and slightly less invasive technique than a deep plane lift, offering excellent, durable results for patients with specific anatomical needs. Dr. Demirtaş chooses the technique best suited to your unique facial structure.

    Platysmaplasty (Neck Lift)

    Essential for comprehensive facial rejuvenation, a platysmaplasty targets the neck. Through a small incision under the chin, the platysma muscles, which cause vertical bands, are tightened and sutured together in the midline. This procedure, often combined with liposuction to remove excess fat, re-establishes a sharp, youthful contour between the jawline and neck. It is the gold standard for correcting a 'turkey neck' and creating a defined profile.

    Pre-Tragal Incision

    The placement of the incision is critical for an invisible result. The pre-tragal incision runs along the natural crease where the ear meets the cheek. Prof. Dr. Demirtaş masterfully places this incision so it heals as a fine line, perfectly camouflaged in the natural shadow. This technique avoids any distortion of the ear's anatomy and is a key element in making the signs of surgery imperceptible to others, a concern for many of our US patients.

    Trichophytic Hairline Closure

    To hide the upper portion of the facelift scar, Dr. Demirtaş employs a trichophytic (hair-bearing) closure technique. The incision is made at a specific angle along the temporal hairline, allowing hair follicles to grow directly through the healing scar line. This advanced technique ensures that once healed, the scar is completely concealed by your own hair, making it virtually impossible to detect even with your hair pulled back. It's a detail that makes a world of difference.

    Anesthesia: What Happens While You Sleep

    For our patients from the US, the quality and safety of anesthesia are paramount. At our JCI-accredited hospital, every facelift is performed under the direct, one-on-one care of a board-certified MD Anesthesiologist. We utilize Total Intravenous Anesthesia (TIVA), a modern protocol that uses a computer-controlled infusion of propofol and remifentanil. This avoids anesthetic gases, leading to a smoother wake-up, reduced post-operative nausea, and a faster initial recovery. Your safety and comfort while you're asleep is our highest priority.

    0-10 min

    Induction

    This is the process of gently going to sleep. After you are connected to all safety monitors, your anesthesiologist administers medication through your IV. You'll feel a sense of calm and relaxation as you drift off into a deep, controlled sleep within about 30-60 seconds. Our team is right there with you, ensuring you are safe and comfortable.

    10 min - 4+ hours

    Maintenance

    Throughout the entire surgical procedure, your anesthesiologist remains by your side, continuously monitoring your vital signs and adjusting the TIVA infusion second-by-second. Using advanced tools like the BIS monitor, they ensure you remain at the perfect depth of anesthesia—completely unaware and pain-free, but never deeper than necessary. This constant vigilance is the core of our anesthetic safety protocol.

    Final 15-20 min of surgery

    Emergence

    As Dr. Demirtaş is placing the final sutures, your anesthesiologist begins to lighten the level of anesthesia. The TIVA medications are cleared from your system very quickly, allowing for a smooth and gentle return to consciousness. This process is carefully controlled to be as pleasant and comfortable as possible, minimizing disorientation.

    1-2 hours post-op

    Recovery Room (PACU)

    You will wake up in the Post-Anesthesia Care Unit (PACU), a specialized recovery area. A dedicated recovery nurse will be right there with you, monitoring your vital signs as you fully awaken. You may feel drowsy, but you will be comfortable. Once you are stable, awake, and comfortable, you will be transferred to your private hospital suite to continue your recovery.

    6 Safety Layers Built Into Every Procedure

    When you travel from the US for surgery, you deserve absolute confidence in your safety. Our JCI-accredited hospital is equipped with technology and protocols that meet and often exceed global standards. Prof. Dr. Demirtaş's procedures include multiple, redundant layers of safety monitoring for your complete peace of mind.

    Continuous ECG Monitoring

    Your heart's rhythm and rate are monitored continuously from the moment you enter the OR until you are discharged from the recovery room. This allows the anesthesia team to detect and respond to any subtle changes instantly, ensuring your cardiovascular system remains stable throughout.

    Pulse Oximetry

    A small clip on your finger continuously measures the oxygen saturation in your blood. This is a critical safety parameter that ensures your lungs and circulatory system are functioning perfectly while you are under anesthesia, providing your body with the oxygen it needs.

    BIS Depth of Anesthesia Monitor

    The Bispectral Index (BIS) monitor uses a sensor on your forehead to measure your brain's electrical activity. This gives your anesthesiologist a real-time, objective measure of your consciousness level, ensuring you are at the precise, optimal depth of sleep—deep enough to be unaware, but not unnecessarily deep.

    DVT Prophylaxis (Compression Devices)

    To prevent deep vein thrombosis (blood clots), sequential compression devices (SCDs) are placed on your legs before surgery begins. These cuffs gently inflate and deflate throughout the procedure, promoting continuous blood flow and significantly reducing the risk of clots, a crucial measure for longer surgeries.

    Bair Hugger™ Patient Warming

    Maintaining a stable core body temperature is vital for patient safety and optimal healing. We use a forced-air warming system (the Bair Hugger™) to keep you warm and comfortable throughout the surgery. This reduces bleeding, lowers infection risk, and speeds up your metabolism of anesthetic drugs.

    Class A Sterile Operating Room

    Our surgeries are performed in a Class A (ISO 5) operating room within a JCI-accredited facility. This means the room utilizes positive pressure and HEPA filtration systems that perform over 20 air changes per hour, creating an ultra-clean environment that virtually eliminates airborne contaminants and minimizes infection risk.

    Our OR Protocol vs. a Standard US Facelift

    While the core surgical principles of a facelift are universal, the operational protocols, standards of care, and overall patient experience can differ significantly. We have tailored our process to provide a level of service and safety that gives our American patients complete confidence. Here’s a comparison of what is *standard* in our all-inclusive package versus what can be variable or cost extra in the US.

    OR Factor
    Our Istanbul OR
    Standard US OR
    Anesthesiologist
    A dedicated, **Board-Certified MD Anesthesiologist** is assigned exclusively to you for the entire duration of your surgery and recovery.
    Care may be provided by a CRNA (Certified Registered Nurse Anesthetist) under the supervision of an MD who may be overseeing multiple operating rooms simultaneously.
    Hospital Stay
    A **guaranteed 1-2 night stay** in a private room at our JCI-accredited hospital is included. This allows for 24/7 professional medical monitoring during the critical initial recovery phase.
    Facelifts are commonly performed in outpatient surgery centers. Patients are often sent home or to a hotel the same day. An overnight hospital stay, if available, is a significant additional cost.
    Advanced Monitoring
    Comprehensive safety monitoring including **BIS (depth of anesthesia) monitoring**, DVT compression devices, and patient warming systems are standard for every facelift procedure.
    The level of monitoring can vary. Advanced tools like BIS monitors are not always standard in all private surgery centers and may be considered an optional extra.
    Surgeon's Focus
    Prof. Dr. Demirtaş limits his schedule to **1-2 major cosmetic surgeries per day**. This ensures he is fully focused, fresh, and never rushed during your procedure.
    It is common for high-volume US surgeons to schedule 3, 4, or even more cosmetic procedures in a single day, potentially leading to surgeon fatigue and less personal attention.
    All-Inclusive Pricing
    One transparent, **all-inclusive price** covers the surgeon, anesthesia, all hospital and OR fees, post-op care, medications, and your hospital stay. There are no hidden costs.
    Pricing is typically a-la-carte. You will receive separate bills from the surgeon, the anesthesiologist, the surgery facility, and for any necessary post-operative care or hospital stay.
    Post-Op Environment
    You recover in a hospital environment with immediate access to doctors, nurses, and emergency facilities if needed. Dr. Demirtaş will personally check on you during your stay.
    Recovery typically happens at home or in a hotel, relying on a friend or family member for care. Access to immediate, professional medical help can be more limited.
    Total OR Time Allotment
    A generous time slot of **4 to 5.5 hours** is reserved for your surgery, allowing Dr. Demirtaş to perform every step with meticulous, unhurried precision.
    Operating rooms are booked in blocks, and there can be pressure to finish within the allotted time to accommodate a busy schedule, which can compromise the final, nuanced steps of the procedure.

    What This Step-by-Step Procedure Costs

    At Plastic Surgery Istanbul, we provide a single, transparent, all-inclusive price for our US patients. This price covers every aspect of the detailed procedure described above, with no hidden fees or surprise charges. Compared to the average cost of **$25,000+** for a surgeon's fee alone in the United States, our packages offer exceptional value without compromising on the quality of the surgeon, the hospital, or the safety protocols.

    Mini Facelift

    $5,500
    OR Time: 2.5 - 3 hours
    • Targets jowls and neck laxity
    • Prof. Dr. Demirtaş's Surgeon Fee
    • Board-Certified Anesthesiologist Fee
    • All JCI-Accredited Hospital & OR Fees
    • 1 Night Private Hospital Stay
    • All Pre-op Testing & Medications
    • VIP Airport & Clinic Transfers
    • Dedicated US Patient Host

    SMAS Facelift

    $6,800
    OR Time: 4 - 4.5 hours
    • Full SMAS Plication for jowls & mid-face
    • Includes Platysmaplasty (Neck Lift)
    • Prof. Dr. Demirtaş's Surgeon Fee
    • Board-Certified Anesthesiologist Fee
    • All JCI-Accredited Hospital & OR Fees
    • 2 Nights Private Hospital Stay
    • All Pre-op Testing & Medications
    • VIP Airport & Clinic Transfers
    • Dedicated US Patient Host

    Deep Plane Facelift

    $8,500
    OR Time: 5 - 5.5 hours
    • Most advanced technique for comprehensive rejuvenation
    • Includes Platysmaplasty (Neck Lift)
    • Prof. Dr. Demirtaş's Surgeon Fee
    • Board-Certified Anesthesiologist Fee
    • All JCI-Accredited Hospital & OR Fees
    • 2 Nights Private Hospital Stay
    • All Pre-op Testing & Medications
    • VIP Airport & Clinic Transfers
    • Dedicated US Patient Host

    Your OR Day: An Hour-By-Hour Itinerary

    To help you feel prepared and at ease, here is a typical timeline for your facelift surgery day with us. From the moment you arrive at our modern, JCI-accredited hospital, our team is there to guide you every step of the way, ensuring a smooth, comfortable, and stress-free experience.

    06:30 AM
    Hospital Check-In & Admission
    Your personal host will meet you at your hotel and accompany you to the hospital. You'll be checked into your private room, where you can settle in. The nursing staff will complete your admission paperwork and take your vital signs.
    07:00 AM
    Final Consultation & Markings
    Prof. Dr. Demirtaş will visit you in your room for the final pre-operative consultation. This is when he will perform the detailed surgical markings on your face and neck, as described in Step 1 of the procedure.
    07:30 AM
    Meet Your Anesthesiologist
    Your board-certified MD Anesthesiologist will come to your room to introduce themselves. They will review your medical history, explain the anesthesia process, and answer any questions you may have, ensuring you feel completely comfortable and informed.
    08:00 AM
    Transfer to the Operating Room
    The surgical team will escort you from your room to the pre-operative area and then into the operating room. Our team's warm and professional demeanor will help you feel calm as you are prepared for the procedure to begin.
    12:30 PM (Approx.)
    Procedure Complete & Move to Recovery
    After approximately 4.5 hours, your facelift is complete. You will be moved to the Post-Anesthesia Care Unit (PACU), where a specialized nurse will monitor you closely as you gently wake up from anesthesia.
    02:00 PM
    Return to Your Private Hospital Suite
    Once you are fully awake and stable, you will be transferred back to the comfort of your private room. A nurse will be dedicated to your care, monitoring your progress and ensuring you are comfortable.
    05:00 PM
    First Meal & Assisted Walk
    You'll be offered a light meal and liquids. A nurse will help you get out of bed for your first short, assisted walk. This is important for circulation and helps kick-start your recovery process.
    09:00 PM
    Evening Check-up & Rest
    The nursing staff will perform regular checks throughout the evening, managing your comfort with prescribed medication. Prof. Dr. Demirtaş may also visit to check on your progress before you settle in for a restful night of recovery.

    Frequently Asked Questions

    The actual 'skin-to-skin' surgical time for a facelift with Prof. Dr. Demirtaş is typically between 4 and 5.5 hours. A comprehensive SMAS or Deep Plane facelift is a meticulous, artistic procedure that cannot be rushed. This duration allows for precise dissection, careful repositioning of deep tissues, perfect hemostasis to minimize bruising, and tension-free closure for minimal scarring. The total time you'll be away from your room, including anesthesia induction and recovery room time, is usually around 6 to 7 hours. We allocate ample time for every case to ensure perfection.

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    Reserve Your OR Date in Istanbul

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