Botched Facelift: The Six Signs and What Can Be Fixed

Summary

• A botched facelift usually looks wrong for one reason — skin was pulled tight instead of the layer beneath it being repositioned.
• The six recognisable signs are pixie ear, the swept-back look, a displaced hairline, joker lines, a hollow midface, and widened scars.
• Most of what looks wrong in the first three months is swelling, not a bad result. Nothing should be judged before six months.
• Most problems are correctable, but revision generally waits twelve months so tissues have fully settled and the blood supply has re-established.
• Some things cannot be fully undone — lost hair-bearing skin and severely displaced hairlines are the hardest, which is why prevention matters more than correction.

If you are reading this because you are worried about your own result, the timing section below matters more than anything else on this page. A great deal of what looks alarming at six weeks resolves on its own.

Why a Facelift Looks Wrong

Almost every recognisably bad facelift shares one root cause: the skin was used to do the lifting.

Skin is elastic. Pull it tight and it will stretch back, but not before it has dragged everything attached to it — the ear lobe, the hairline, the corners of the mouth — out of position. That tension is what produces the appearance people recognise instantly as surgical.

A properly performed SMAS facelift repositions the fibrous layer beneath the skin and fixes it there. The skin is then simply redraped over the new shape without tension. A deep plane facelift goes further still, releasing the retaining ligaments so the midface moves as one unit. See deep plane vs SMAS facelift for how the two differ.

The second factor is direction. The natural vector of facial ageing is downward and slightly forward, so the correction should run upward and slightly back. Pull horizontally toward the ear and you get a face that looks stretched rather than lifted — the appearance that gave facelifts their reputation in the 1980s, when skin-only technique was standard and results lasted 2–3 years.

The Six Signs of a Botched Facelift

1. Pixie ear deformity

The ear lobe is pulled downward and forward so that it appears stretched and attached directly to the cheek, losing its natural free edge. It is one of the most recognisable signs of a facelift and one of the hardest to disguise.

Why it happens: the incision was closed under tension, so the healing skin pulled the lobe down with it as it contracted. Even a well-closed facelift shifts the lobe: in a series of 44 facelift patients measured on life-size photographs, the attached part of the lobe lengthened significantly after surgery and the proportion of earlobes meeting the definition of pseudoptosis rose from 12% to 17%, as our guide to why earlobes get bigger with age sets out.

Correctable? Usually yes, by releasing the lobe and reconstructing its natural attachment. It is a relatively straightforward revision compared with the others here.

2. The swept-back or windswept look

The face appears pulled toward the ears rather than lifted upward. Expression looks slightly startled or tight, and the result reads immediately as surgical rather than rested.

Why it happens: a horizontal vector, usually combined with skin-only technique. Tension is placed where there is least support.

Correctable? Often, with revision using a deep-plane approach that lifts vertically and releases the tension. See revision facelift.

3. Hairline displacement and lost sideburn

The sideburn is raised or lost entirely, the temporal hairline is shifted backward, or there is a visible bald strip in front of the ear. Often the most distressing sign for patients because it restricts how they can wear their hair.

Why it happens: the incision was placed within hair-bearing skin and that skin was excised, or excessive tension distorted the hairline permanently.

Correctable? Partially. Hairline lowering or hair grafting can improve it, but lost hair-bearing skin cannot simply be replaced. This is the sign most worth avoiding in the first place.

4. Joker lines and distorted mouth corners

Lines running outward from the corners of the mouth, with the corners themselves pulled sideways so the mouth looks stretched. Named for the obvious reason.

Why it happens: over-tightening in the lower face, particularly where the lift was carried too far forward toward the mouth.

Correctable? Often improves with time as tension releases. Persistent cases may need revision, sometimes combined with volume replacement.

5. A hollow or flattened midface

The cheeks look drawn or empty even though the jawline may have improved. The face reads as gaunt rather than younger.

Why it happens: tissue was pulled backward rather than repositioned upward, so volume that should sit over the cheekbone has been dragged toward the ear. Sometimes compounded by fat being removed rather than repositioned.

Correctable? Usually, with facial fat transfer to restore midface volume, sometimes alongside revision surgery. See lifting the malar fat pad for the underlying anatomy.

6. Widened, raised or visible scars

Facelift scars should sit as fine pale lines hidden in natural creases and behind the tragus. Widened, raised or displaced scars are visible at conversational distance.

Why it happens: closure under tension is the main cause. Individual healing tendency plays a part, as does smoking, but tension is the factor within the surgeon’s control.

Correctable? Scar revision helps in many cases, though a scar can be improved rather than erased. See types of scars.

What a Good Result Looks Like

The counterpoint is worth stating, because “natural” is used so loosely.

• Nobody can tell. People say you look well, rested or that you have been on holiday. They do not say you look like you have had something done.
• Expression is unchanged. You still look like yourself when you smile, frown and talk. A facelift repositions tissue; it should not alter how your face moves.
• The ears and hairline are undisturbed. The lobe keeps its free edge, the sideburn sits where it always did.
• Scars are hidden. Fine pale lines in natural creases, not visible without looking for them.
• The jawline and neck are defined without the face looking pulled — the improvement is in the contour, not in the tension.

Timing: When Is It Actually a Bad Result?

This is the single most important section for anyone currently worried about their own face.

Weeks 1–6. Swelling, bruising, numbness, firmness and asymmetry are all normal. Faces routinely swell unevenly, and one side settling before the other is expected rather than alarming.

Months 2–3. Most swelling has resolved but tissues remain firm. Scars are typically at their most red and raised around this point — they improve considerably from here.

Months 3–6. The shape becomes reliable. This is the earliest point at which the contour can be fairly judged.

Months 6–12. Scars mature and pale. Residual firmness settles. A result that looked tight at three months often looks natural by nine.

A great deal of what patients identify as a botched facelift at six weeks is a normal healing facelift. Speak to your surgeon before concluding otherwise — and if you have lost confidence in them, seek a second opinion rather than acting on your own assessment during the swelling phase.

Can a Botched Facelift Be Corrected?

Most of the time, yes — but timing and expectations both matter.

Wait at least twelve months before revision surgery unless there is an urgent problem. Tissues need to have fully settled and the blood supply needs to have re-established through scarred planes. Operating too early risks a worse outcome than the one being corrected.

Revision is harder than a primary procedure. The tissue planes have been operated on before, scar tissue distorts the anatomy, the blood supply is altered, and the incisions are already placed. Revision facelift is the most technically demanding facial surgery performed in cosmetic plastic surgery, which is why surgeon selection matters even more than it did the first time.

What can usually be improved: pixie ear, the swept-back appearance, midface hollowing, joker lines, and most scar problems.

What is harder: significantly displaced hairlines, lost hair-bearing skin, and any result where a great deal of tissue was excised rather than repositioned. Improvement is realistic; a return to your original anatomy generally is not.

How to Avoid It

Nearly every sign on this page comes down to technique and case selection, both of which are decided before you go to theatre.

• Check the GMC Specialist Register for plastic surgery. Any doctor may legally call themselves a cosmetic surgeon in the UK; specialist registration is the meaningful credential.
• Ask which layer is being lifted. “SMAS” or “deep plane” is the answer you want. A skin-only lift is what produces most of what is described above.
• Ask about the vector — the direction of the lift. Vertical or oblique, not horizontal.
• Look at before-and-after photographs at a distance, and at ears and hairlines specifically. Those are where technique shows.
• Be wary of very short recovery claims. A procedure with no downtime is generally a procedure that has not repositioned much.
• Ask what happens if you are unhappy, and who performs any revision.

Our guide to questions to ask before a facelift covers this in more detail, and facelift age explains how suitability is genuinely assessed.

Revision Facelift at Centre for Surgery

We assess revision cases honestly, including cases where the right advice is to wait longer, or where the improvement achievable is smaller than the patient is hoping for. Revision surgery is performed by GMC-registered plastic surgeons at our CQC-registered facility on Baker Street, rated Good overall.

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

Botched Facelift: Frequently Asked Questions

Related Articles

• Revision Facelift
• Risks and Complications of a Facelift
• Deep Plane vs SMAS Facelift
• How Long Does a Facelift Last?
• 6 Questions to Ask Before Getting a Facelift
• Pixie Ear Correction After Botched Facelift