What is the most common complication of a facelift?

Hematoma (a collection of blood under the skin) is the most common significant complication of facelift, occurring in approximately 1–8% of cases. Men, patients with high blood pressure, and patients who smoke have higher rates. Most hematomas present within the first 24 hours and require surgical drainage — they do not cause permanent harm when identified and treated promptly. All other serious complications are less frequent.

What is the risk of nerve damage from facelift?

Temporary sensory nerve changes (numbness, altered sensation) affect the majority of facelift patients and resolve within weeks to months. Temporary motor nerve weakness (affecting facial movement) occurs in approximately 0.5–2.6% of cases. Permanent motor nerve injury is rare — reported in 0–1.7% of cases across large series. The facial nerve is the primary concern; an experienced surgeon operating in correct tissue planes significantly reduces this risk.

Can a facelift leave permanent scars?

All facelifts leave scars — this is inherent to any surgical incision. The goal is scars that are inconspicuous. When incisions are correctly placed within natural anatomical landmarks and closed under minimal tension, facelift scars typically become difficult to detect at conversational distance by 12 months. Visible or problematic scars are most often associated with excessive skin tension at closure, incisions outside natural creases, or complications such as wound infection or dehiscence.

How dangerous is a facelift?

Facelift is a major surgical procedure, but serious complications are uncommon in healthy patients operated on by experienced surgeons in accredited facilities. Published mortality rates in large series are extremely low. The most common significant complication — hematoma — is treatable without lasting consequences when addressed promptly. Overall, facelift has a well-established safety profile in appropriate candidates with experienced surgeons and proper pre-operative assessment.

Facelift Risks and Complications: What the Evidence Says

Facelift Complications: Overview

The following table summarises the main facelift complications with approximate rates from published literature. Rates vary between studies depending on patient populations, techniques used, and how complications are defined and reported. A review of over 11,300 facelift patients provides one of the largest datasets for understanding these risk factors.³

Complication	Approximate Rate	Usually Reversible?
Hematoma	1–8%	Yes — with surgical drainage
Temporary sensory nerve changes	Common (majority of patients)	Yes — resolves weeks to months
Temporary motor nerve weakness	0.5–2.6%	Usually yes — resolves in most cases
Permanent motor nerve injury	0–1.7%	No — permanent by definition
Wound infection	<1%	Yes — with antibiotics or drainage
Skin necrosis (skin loss)	~1%	Partially — may require wound management or revision
Hypertrophic scarring	1–2%	Partially — responsive to treatment
Hair loss at incision sites	Uncommon (<1% permanent)	Usually temporary
Deep vein thrombosis / PE	Very rare (<0.1%)	Treatable; potentially serious if untreated
Seroma	Uncommon	Yes — with aspiration

Hematoma: The Most Common Serious Complication

A hematoma is a collection of blood beneath the skin at the surgical site. Published facelift literature identifies hematoma as a common significant complication, and risk varies by patient factors, technique, and peri-operative blood pressure control.¹ Men have higher rates in many series, likely related to higher skin vascularity.

When It Occurs

Most hematomas present within the first 24 hours after surgery — the majority within the first 6–8 hours. A small, slow hematoma may develop over the first few days. This is why overnight clinic monitoring after facelift is standard and important.

Signs

Rapidly increasing swelling on one side of the face (asymmetric)
Tightness and pressure that is increasing, not stable
Skin appearing dark or discoloured over the swelling
Pain disproportionate to the expected post-operative level

Treatment

Hematomas identified promptly are surgically drained — this is typically a straightforward procedure and, when performed promptly, does not cause lasting consequences. Delayed treatment risks skin compromise.

Risk Factors

Male sex, uncontrolled hypertension, aspirin or anticoagulant use before surgery, smoking, and post-operative vomiting (straining increases blood pressure) all increase hematoma risk. Post-operative nausea and vomiting (PONV) prevention is therefore an important component of facelift anesthesia planning.

Nerve Injury: Sensory and Motor

Facelift surgery takes place in close proximity to sensory and motor nerves. Understanding the distinction between types of nerve effects is important.

Temporary Sensory Changes

Numbness, tingling, and altered sensation in the cheeks, ears, and neck are experienced by the majority of facelift patients in the early recovery period. This reflects nerve stretching and tissue disruption during dissection — not nerve cutting. Sensation returns progressively over weeks to months as nerves recover. Permanent significant sensory loss is uncommon.

Motor Nerve Effects

The facial nerve (cranial nerve VII) controls facial movement. Temporary motor weakness — most often affecting the marginal mandibular branch (affecting the lower lip/chin) or the temporal branch (affecting the brow) — occurs in approximately 0.5–2.6% of cases. The majority resolve within weeks to months as nerve function returns.

Permanent motor nerve injury is rare, reported in 0–1.7% across large published series. Risk is significantly lower with experienced surgeons who operate in correct anatomical planes. The facial nerve runs in specific tissue layers — staying in the correct plane during deep plane dissection is an acquired surgical skill.

Skin Necrosis (Skin Loss)

Skin necrosis — the death of a patch of skin due to inadequate blood supply — is an uncommon but serious complication, occurring in approximately 1% of cases in published literature. It most commonly affects the area in front of or behind the ear.

The primary risk factor is smoking. Facelift-specific evidence links cigarette smoking with skin-flap survival problems.² Nicotine causes vasoconstriction (narrowing of blood vessels) and significantly impairs tissue perfusion. The elevated flap raised during facelift depends on its blood supply for survival — smoking can compromise this, particularly at the distal edges. This is the principal medical reason surgeons require patients to stop smoking at least 4 weeks before (and preferably longer) before surgery.

Small areas of necrosis typically heal with wound care; larger areas may require surgical management and can lead to visible scarring.

Wound Infection

Wound infection after facelift is uncommon, occurring in less than 1% of cases. The face has an excellent blood supply, which contributes to its relatively low infection rate compared to other surgical sites. Infections are typically managed with antibiotics; abscess formation may require surgical drainage. Stitch abscesses (localised infection around individual sutures) are occasionally seen and are minor — managed by removing the offending suture and local wound care.

Scarring Complications

All facelift surgery produces scars — this is inherent to surgical incisions. The question is not whether there will be scars, but whether they will be inconspicuous. Problematic scarring includes:

Hypertrophic scars: Raised, thick, itchy scars confined to the incision line. More common in patients prone to hypertrophic healing. Managed with silicone, steroid injections, or pressure therapy.
Keloid scars: Raised scars extending beyond the original incision margin. More common in patients of Afro-Caribbean descent or those with a personal or family history of keloids. Require specialist management.
Widened scars: Can result from excessive skin tension at closure — a technique issue. Prevent by redistributing tension to deeper tissue layers.
Hairline distortion: Visible shifts in the temporal or posterior hairline can result from incisions placed outside the scalp or from excessive traction. An experienced surgeon designs incisions to avoid this.

Hair Loss at Incision Sites

Temporary hair loss (effluvium) around the temporal and posterior hairline incisions is common and usually resolves within 3–6 months. Permanent hair loss at incision sites is uncommon and is typically related to tension, poor incision placement, or vascular compromise of the scalp.

Asymmetry and Appearance Issues

Some degree of post-operative asymmetry is normal and expected — swelling resolves at different rates on each side, and the face is not symmetrical to begin with. True surgical asymmetry (a lasting difference in results between sides that was not present before surgery) can occur and may require revision.

Other appearance-related outcomes that may require revision:

Pixie ear deformity — the earlobe attaches in an unnatural downward-pointing position due to excessive skin tension
Visible distortion of the tragus (the small cartilage in front of the ear canal)
Step-off deformity at the temporal hairline
Overcorrected or unnatural appearance — typically related to skin-only lifting without SMAS support

Revision surgery to address these outcomes is generally discussed no sooner than 12 months post-surgery, after full healing and result maturation.

Factors That Increase Complication Risk

Patient-related and surgical factors both influence risk:

Risk Factor	Primary Complication Risk	Modifiable?
Smoking	Skin necrosis, wound healing impairment	Yes — stop 4+ weeks before surgery
Uncontrolled hypertension	Hematoma	Yes — blood pressure must be controlled pre-operatively
Aspirin / anticoagulants	Hematoma, bleeding	Yes — stop as directed by surgeon
Male sex	Hematoma (higher vascularity)	No — but awareness and monitoring important
Prior facial surgery or radiation	Tissue perfusion and healing	No — informs surgical planning
Keloid tendency	Problematic scarring	Partially — preventive measures, patient selection
Surgeon inexperience	Nerve injury, hematoma, appearance outcomes	Yes — surgeon selection is within patient control
Non-accredited facility	All complications — reduced emergency response	Yes — facility selection is within patient control