On this page, you can read about things to watch out for, and how they are treated.
Facelift Risks & Complications
Although complications following fat transfer are infrequent; the following may occur:
- Bleeding, which in rare instances could require hospitalization and blood transfusion. Blood clots may form under the skin and require drainage.
- Skin irregularities, lumpiness, hardness and dimpling may result; some problems disappear with time and from massage, but skin irregularities, hardness, lumps, dimpling or other problems may persist and additional treatments may be necessary.
- Infection is rare but may occur and treatment with antibiotics and/or drainage may be required. In rare instances surgery may be required for severe cases.
- Wound dehiscence (wound opening) may occur and may be treated by allowing it to heal on its own.
- Outpatient nursing may be required to assist with the wound care. You may be required to travel to a local clinic for daily wound care.
- Injury to the facial nerve which provides movement to the facial muscles may occur. Most of the time the injury is temporary and the nerve function returns. In very rare cases nerve injury can be permanent.
- Numbness of the skin over treated areas may persist for months. Localized areas of numbness or increased sensitivity may be permanent in rare instances.
- Objectionable scarring is rare because of the fine nature and location of the incisions used in facelift/necklift surgery, but abnormal scar formation is possible.
- Dizziness may occur during the first week following facelift/necklift surgery particularly upon rising from a lying or sitting position. If this occurs, extreme caution may be exercised while walking. Do not drive a car if dizziness is present.
- Deep Venous Thrombosis, Pulmonary Embolism and Fat Embolism may occur. If left untreated they may be fatal.
What Happens If You Develop Complications After A Facelift?
No surgeon is perfect, no procedure is fool proof. That is why every facelift consultation should also include a discussion of potential complications and their treatments.
The best treatment for any complications is prevention:
- choosing an experienced Plastic Surgeon which experience in Facelift procedures
- getting proper medical screening before surgery to ensure you are healthy and suitable for a facelift
- following all pre- and post- surgery instructions which we provide you before your surgery
If a complication does occur, it is important that you let us know right away. Any complication, when caught early, is easily treated. If allowed to go on for a long period of time, even the simplest problem can become serious.
So what are possible complications of a facelift?
- Bleeding (most common)
- Skin necrosis
- Nerve Injury
- Abnormal scars
Bleeding after a Facelift
Bleeding is the most common complication after a facelift surgery. In the published literature, the average risk of bleeding after a facelift is 3% (8% for patients who have high blood pressure or men).
Having a little bit of blood oozing from your wounds is normal and expected. A serious bleeding is when you notice significant swelling under the skin to a point that your skin protrudes. If that happens, please let us know immediately.
The most common cause of bleeding is uncontrolled blood pressure. For that reason, we treat your blood pressure before, during and after the facelift. Prior to the surgery, we will give you medication to lower your blood pressure, and continue to keep it low during the time of the surgery. Following your facelift, we will provide you with more medication for blood pressure, if needed. We also prefer that you stay at our Hotel facility overnight, stay relaxed and comfortable to avoid raising you blood pressure.
Prior to surgery, you should avoid all of the following, to lower the risk of bleeding:
- Aspirin, Ibuprofen, Advil, Plavix, Coumadin, Warfarin (or any other blood thinner)
- Vitamin E
- Fish Oils / Omega 3s
- Glucosamine / nutritional supplements
- any homeopathic medications
- any herbal medications / supplements /herbal tea
- high fish diet
All of the above should be discontinued at least 2-3 weeks before surgery.
Skin necrosis happens when the blood supply to the skin is compromised and some parts of the skin then lack proper oxygen and nutrient supply. The rate of this complication is 1% in sub-SMAS procedures, and 3.6% in skin-only facelifts.
Causes of skin necrosis
- smoking (you must stop smoking >2 weeks before a facelift)
- very thin skin elevation
- excessive tension on the skin
- bleeding under the skin
- excessively tight compression garment after the surgery
- pre-existing vascular disease
The treatment of this complication is with wound care. The area affect is allowed to heal on its own and requires additional surgery in only very rare cases.
Infection is a very rare complication after a facelift because the face is very well vascularized. There is no scientific evidence to support pre-treating patients with antibiotics to prevent an infection from taking place. If one does develop an infection, the treatment depends on the type of bacteria isolated. Infections around the ear may be related to a species Pseudomonas aeruginosa, which is naturally found in the ear canal. These are treated with antibiotics, and sometimes require drainage of any collection that may be found.
Signs of an infection include the following: Your skin is red, hot, especially tender and there may be some pus visible.
If you think you may have an infection after a facelift, send us a photo of the area of concern before becoming overly concerned, as very often little bit of redness is normal and does not represent an infection.
You can click the above before and after images to enter our Facelift Photo Gallery
The incidence of a permanent facial nerve injury is less than 1 percent, although transient nerve dysfunction for the first few hours after a facelift are common due to the lingering effects of the local anesthetic used during the surgery.
Prolonged nerve dysfunction can be due to traction, use of the cautery (to stop bleeding), sutures, or nerve transection. In most of these situations, there is a spontaneous recovery which can take place at any time between 2 weeks and 4 months.
There is not much to do in this situation, aside from waiting for the facial nerve to regain its function. While waiting, use of an injection such as BOTOX to temporarily relax the other side of the face is used to create symmetry.
If a surgeon notices a branch of the facial nerve has been cut during the surgery, that requires surgical repair to reapproximate the cut edges to allow them to heal. The healing can take 3-6 months, which is the time it takes the nerve to regrow and re-innervate facial muscles.
Abnormal scars are scars that are placed incorrectly, that are obvious and one that my be hypertrophic or keloid.
Improper scar placement can lead to obvious scars, distortion of the ear, and un-natural shifting of the hairline. Excessive tension can cause scar widening, loss of hair, loss of pigmentation, and the development of hypertrophic scars.
If you do develop any abnormal scar, you will need to wait at least 6 months to allow for them to heal before a scar revision can be performed.
Smoking is one of the worst things you could do before a facelift, and that is a reason why some surgeons will refuse to operate on smokers. A smoker has skin necrosis risk that is 12 times higher than a non-smoker.
Smoking cause blood vessels to constrict, limiting the oxygen delivery to the skin. This in effect suffocates the skin. Skin can die, wound healing is delayed, and incisions can break open.
You should abstain from smoking 4 weeks before surgery and 4 weeks after surgery to minimize smoking-related complications