A facelift is usually performed under general anesthesia, but may also be performed under intravenous sedation.  The incisions are performed in the hair of the temple, around the ear and on the back of the ear and then into the hair behind the ear.  There will often be an incision under the chin to remove excess fat from under the chin and tighten the muscles creating the neck bands.  All incisions are strategically placed allowing them to be maximally camouflaged.  A portion of the skin is elevated and then the underlying muscles and connective tissue are elevated and repositioned, resulting in maximal suspension of the underlying structures and reducing tension on the skin.  This reduction of skin tension helps to avoid widened scars or noticeable scars.  Excess skin is trimmed and the incisions are meticulously repaired.