All surgical procedures come with a risk of complications, and facelifts are no different. Luckily facelifting has become a standard, reliable procedure so complications do not occur frequently. If you are thinking of getting a facelift, you should be aware of the kinds of complications that may arise, how often they occur and how best to avoid them. So what types of complications can occur?

Hematoma (collection of blood)

By far and away the most common complication after facelifting is a collection of blood causing a lump in the cheek or neck. This almost always happens during the first 12 hours after surgery. The lump would eventually resolve but would take months so the treatment is to return to the operating room, open part of the incision, milk out the blood, and reclose the wound. It amounts to an inconvenience more than anything and occurs in approximately 3% of women. It is slightly more common in men, perhaps related to higher blood pressure. Hematomas are more common in patients with high blood pressure and/or those who take anticoagulant medications (aspirin, Eliquis, etc.).

Skin slough (Delayed healing)

A facelift involves lifting up the skin, manipulating the deeper tissues, and then pulling the skin tighter. In rare cases (far less than 1%), part of the skin dries and forms a scab that eventually heals, leaving a scar. Necrosis of the skin occurs if the skin is dissected too thinly, or pulled too tight or in patients with vascular problems like those who smoke. Smoking drastically increases the likelihood of this complication. Luckily, when this does occur it is usually behind the ear where a less than ideal scar is reasonably well hidden. In some cases, the scar can be revised several months later.

Infection

Infection is extremely rare after facelifting, probably because the face is well vascularized compared to some parts of the body. A busy surgeon may only see a few infections after facelifting in a career. Infection is usually easily treated with antibiotics but occasionally requires surgical drainage, depending on the type and extent of the process.

Nerve Injuries

The most dreaded complication after a facelift is a nerve injury. There are two types of nerves in the face: nerves that cause facial movement and nerves that provide feeling or sensation to the face. These two types of nerves are totally separate. The nerves that provide feeling are always injured by the dissection and normal feeling returns to the face several months later. The motor nerves (the ones that control smiling and movement) are DEEP to the muscles and are avoided by dissecting on top of the muscles. Nerve injuries of this type occur in less than 1% of cases and in some cases spontaneously resolve. If the injury does not resolve it can lead to asymmetry of the smile and other facial movements which is extremely distressing to the patient and the surgeon.

Other Side Effects

The most common “complication” after facelifting is the same as after any cosmetic procedure and only loosely fits into the category of complication; that is, the patient does not feel that he/she has as much improvement in appearance that he/she expected. This problem goes to the importance of communication between the surgeon and the patient; the surgeon needs to know what the patient wants and the patient needs to know what the surgeon can deliver. If the patient’s goals are too far from what the operation can reasonably provide, the procedure should not be performed

Consult a Plastic Surgeon

Consult an experienced board-certified plastic surgeon to determine your candidacy for facelift surgery. A good plastic surgeon will always discuss the complications and risks of the surgery during the consultation.

Dr. Charles Thorne is an established, senior plastic surgeon with extensive experience in facelift surgery. Schedule a virtual consultation with Dr. Throne to know whether it is safe for you to get a facelift.