Facelift Complications: Risks, Causes and How They Are Managed

Summary

• Complications occur in around 2% of facelift cases. Haematoma is the commonest at roughly 1.5%; infection affects fewer than 0.5%.
• Side effects are not complications. Swelling, bruising, numbness and tightness are expected parts of healing — see our facelift recovery guide for what is normal at each stage.
• Each complication has its own timing. Haematoma in the first 24 hours, infection days 2–7, nerve symptoms in the early weeks.
• Smoking is the single biggest modifiable risk factor, and by a considerable margin. It is the dominant cause of skin necrosis.
• Risk varies by technique but not in the direction most people assume — a deep plane facelift carries lower necrosis risk than a SMAS lift, because the skin keeps its blood supply.

This page covers what can go wrong medically. If your concern is that your result looks wrong rather than that something has gone wrong medically, see botched facelift instead.

Side Effects vs Complications

The distinction matters, because conflating the two causes a great deal of unnecessary worry.

Side effects are expected. Swelling, bruising, numbness across the cheeks and ears, firmness, tightness and uneven settling all happen to essentially everyone. They are the consequence of surgery, not evidence that something has gone wrong. Numbness in particular can take two to three months to resolve fully, and patients frequently interpret it as nerve damage when it is simply healing.

Complications are unexpected. They occur in a minority of cases, require intervention, and have specific recognisable signs.

Our facelift recovery guide sets out the normal healing timeline in detail, including which symptoms to report and when.

How Common Are Facelift Complications?

Facelift surgery is among the more predictable procedures in facial plastic surgery, and the numbers reflect that.

• Overall complication rate: approximately 2% of cases
• Haematoma: approximately 1.5% — the commonest by a clear margin
• Infection: fewer than 0.5%
• Permanent nerve injury: rare; temporary weakness is considerably more common than permanent damage
• Skin necrosis: uncommon, and strongly concentrated among smokers

These figures assume surgery by an appropriately trained surgeon in a regulated facility. They do not describe outcomes where either of those is absent.

Haematoma

What it is. A collection of blood beneath the skin flap. Small ones resolve on their own; larger ones create pressure that compromises the blood supply to the overlying skin, which is what makes prompt treatment important rather than optional.

When it happens. Almost always within the first 24 hours, which is why the review at 24 hours exists.

Signs. Sudden swelling on one side, usually with increasing pain and a feeling of pressure. It is characteristically asymmetrical — both sides swelling evenly is normal healing; one side swelling rapidly is not.

Who is at higher risk. Patients with poorly controlled hypertension. Men, because of thicker skin and richer blood supply to facial hair follicles. Anyone taking blood-thinning medication or supplements. Smokers.

How it is reduced. Strict blood pressure control before, during and after surgery; drains where appropriate; stopping blood-thinning medication as directed; and controlling postoperative nausea, since retching raises venous pressure sharply.

How it is treated. Small collections may be aspirated. Larger ones need surgical evacuation, usually a short procedure. Treated promptly, a haematoma rarely affects the final result.

Infection

What it is. Bacterial infection of the surgical site, most often Staphylococcus species from the patient’s own skin.

When it happens. Typically days two to seven, though it can present later.

Signs. Spreading redness, warmth, increasing rather than improving pain, discharge that is green, yellow or malodorous, and fever above 38°C with feeling generally unwell.

Why the face is relatively protected. The face has an exceptionally rich blood supply, which is why infection rates after facelift surgery are lower than after surgery elsewhere on the body.

How it is reduced. Sterile technique, prophylactic antibiotics around the time of surgery, and careful wound care afterwards.

How it is treated. Most cases respond to oral antibiotics. Collections may need drainage. Early treatment matters because infection in the presence of a healing flap can affect the eventual scar.

Nerve Injury

What it is. Injury to one of the branches of the facial nerve, which controls facial movement, or to sensory nerves such as the great auricular nerve.

When it shows. Often apparent once swelling subsides, from around week two onward.

Signs. Weakness of a specific muscle group — an asymmetrical smile, difficulty raising an eyebrow, difficulty closing one eye, or a drooping mouth corner. Distinct from generalised numbness, which is a sensory side effect and near-universal.

Which nerves. The marginal mandibular branch, which controls the lower lip, and the temporal branch, which controls the eyebrow, are the two most vulnerable because of where they run relative to the dissection planes.

Temporary or permanent. The overwhelming majority of nerve weakness after a facelift is temporary, caused by stretching, bruising or local anaesthetic rather than division. Function usually returns within weeks to months. Permanent injury is rare.

How it is reduced. Detailed anatomical knowledge and careful dissection. This is the aspect of facelift surgery where surgeon experience matters most, and it is a strong argument for choosing a plastic surgeon on the GMC Specialist Register.

Skin Necrosis

What it is. Death of a portion of the skin flap because its blood supply has been compromised. Typically affects the skin behind the ear, where the flap is furthest from its blood supply.

Signs. Skin turning dusky, grey, purple or black, usually in the first week.

The dominant risk factor is smoking, and not by a small margin. Nicotine constricts the small vessels supplying the skin flap precisely when that supply is most marginal. This is why we ask patients to stop at least four weeks before and after surgery, and why the request is not negotiable.

Other contributors. Skin flaps raised too thin, excessive tension on closure, an undrained haematoma, and overly aggressive undermining.

How it is treated. Small areas are managed conservatively with dressings and heal by secondary intention. Larger areas may need debridement and later scar revision.

Less Common Complications

• Hypertrophic or keloid scarring — more likely where closure was under tension, and in patients with a personal or family tendency. See types of scars.
• Hair loss around the incisions — usually temporary shock loss; occasionally permanent where follicles were damaged.
• Persistent swelling or seroma — a collection of fluid rather than blood, drained if it does not resolve.
• Suture reactions or spitting sutures — minor and self-limiting.
• Delayed wound healing — more common in smokers, diabetics and where tension was excessive.
• Anaesthetic complications — rare, and reduced by day-case TIVA with a consultant anaesthetist present throughout.

How Risk Varies by Technique

This is where most information online is either absent or wrong. Deeper does not simply mean riskier — the risks trade off against each other.

Deep plane facelift complications

A deep plane facelift carries a lower risk of skin necrosis than a traditional SMAS lift. The reason is anatomical: the dissection occurs beneath the SMAS, so the skin and SMAS are lifted together as a composite flap that retains its own blood supply. Nothing is thinned.

The trade-off is nerve risk. Dissection is deeper and closer to the facial nerve branches, so temporary nerve weakness is somewhat more common — though still uncommon overall, and usually transient. This is the single strongest argument for choosing a surgeon who performs the technique regularly.

SMAS facelift complications

The SMAS facelift involves raising a skin flap separately from the SMAS layer. That flap is thinner and further from its blood supply, so necrosis risk is moderately higher than deep plane — particularly in smokers. Nerve risk is lower because dissection stays more superficial. Haematoma remains the commonest complication.

Mini facelift complications

A mini facelift involves less undermining and shorter incisions, so all complication risks are proportionally lower. The trade-off is not safety but correction — it addresses less, and lasts 8–10 years rather than 10 or more.

One stitch and MACS facelift complications

The one stitch facelift and MACS-type short-scar techniques involve minimal dissection, so serious complications are correspondingly uncommon. The most frequent problem is not a complication at all but under-correction — the procedure was too limited for the degree of laxity present.

Thread lift complications

Thread lifts are not surgery, but they are not risk-free. Thread extrusion, visible or palpable threads, dimpling, asymmetry, infection along the thread tract and early relapse are all reported. Results last 12–18 months. We do not offer thread lifts.

Lower facelift and neck lift

A lower facelift or combined neck lift carries the same complication profile, with marginal mandibular nerve injury being the specific concern given the dissection required around the jawline.

Who Is at Higher Risk?

• Smokers — substantially higher risk of necrosis, delayed healing and poor scarring. The most important modifiable factor.
• Patients with uncontrolled hypertension — markedly increased haematoma risk.
• Men — higher haematoma rates because of thicker skin and richer blood supply to beard follicles.
• Patients on blood thinners or certain supplements — fish oil, vitamin E, ginkgo and garlic all affect clotting.
• Poorly controlled diabetes — impaired healing and higher infection risk.
• Recent significant weight loss — thinner, less resilient tissue.

Age itself is not a major risk factor. General health matters far more than the number, and well-screened patients in their seventies undergo facelift surgery safely. See facelift age.

Reducing Your Own Risk

• Stop smoking at least four weeks before and after. Nothing else on this list comes close in impact.
• Get your blood pressure properly controlled before surgery, not on the day.
• Disclose every medication and supplement, including anything herbal.
• Check that your surgeon is on the GMC Specialist Register, and do not decide on price alone.
• Have surgery in a CQC-regulated facility with a consultant anaesthetist.
• Follow the postoperative instructions, particularly around head elevation, avoiding exertion, and not smoking.

What Happens If a Complication Occurs?

At Centre for Surgery, you have your surgeon’s direct number for the first 24 hours, a review at 24 hours, a wound check at 7–10 days, and a surgeon review at six weeks. Complications are managed by the team that performed your surgery, at no additional cost where they relate to the original procedure.

This is worth asking about wherever you have surgery, and particularly worth asking of clinics abroad, where the practical answer to “who manages a haematoma at 2am” may be nobody within reach.

Facelift Surgery at Centre for Surgery

Facelift surgery is performed by GMC-registered plastic surgeons at our CQC-registered facility on Baker Street, rated Good overall, under TIVA with a consultant anaesthetist present throughout.

• Phone: 020 7993 4849
• Email: contact@centreforsurgery.com
• Address: 95-97 Baker Street, London W1U 6RN

Facelift Complications: Frequently Asked Questions

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• Deep Plane vs SMAS Facelift
• How Long Does a Facelift Last?
• 6 Questions to Ask Before Getting a Facelift
• Revision Facelift