By Masoud Saman, MD · About the author & editorial process

What can go wrong

This page covers facelift and neck surgery. Considering nasal surgery too? Read the rhinoplasty risks.

This is the page a brochure leaves out. Complications are uncommon in careful hands and none of them is impossible. Risk varies with technique, surgeon and patient. Ask how your surgeon defines and tracks each complication.

Common, and usually temporary

Numbness

Nearly everyone. The sensory nerves to the skin of the cheek and ear are disturbed by the dissection. Sensation returns over months. A small patch of permanently altered feeling, most often around the earlobe, occurs in a minority and is usually not troubling.

Swelling and bruising beyond the expected

Some people swell or bruise more, particularly those on supplements that thin the blood (fish oil, vitamin E, ginkgo, high-dose aspirin). Declaring everything you take, including herbal products, is the single easiest way to lower this.

Tightness and firmness

A band-like tightness behind the ears and along the jaw, and firm areas under the skin, are part of healing and resolve over weeks to months.

Less common, and treatable

Hematoma

Bleeding under the skin flap after surgery. It is the most frequent significant complication and the reason for the first-night rules about blood pressure, activity, and having someone with you. A large hematoma presents as sudden one-sided swelling and pain in the first day or two and needs prompt return to the surgeon to drain, which protects the skin. Small ones are managed in clinic. Risk is higher in men, in people with high blood pressure, and with any blood-thinning medication.

Skin healing problems

The skin flap depends on a reduced blood supply while it heals. If that supply fails, an area of skin, usually behind the ear, can break down and heal slowly with a wider scar. Smoking multiplies this risk several times over, which is why every careful surgeon insists on stopping.

Infection

Uncommon in the face because of its blood supply. Treated with antibiotics and occasionally drainage.

Poor scarring

Incisions are placed inside and around the ear and into the hairline, and most heal to a fine line. Some widen, thicken, or stay pink for longer. Earlobe distortion and hairline displacement are the visible tells of a poorly planned closure, and are largely avoidable.

Asymmetry and contour irregularity

Faces are asymmetric before surgery and remain so after. Meaningful new asymmetry, or an irregular contour along the jaw or neck, occasionally needs a minor revision, judged at six months or later.

Salivary gland issues

A collection of saliva under the skin (sialocele) or prominence of the submandibular gland after the neck is tightened. Both are uncommon and manageable.

Rare, and serious

Facial nerve injury: temporary or permanent

The nerve branches that move the face run close to the dissection, closer in deep plane techniques. Temporary weakness of a branch, most often the one to the lower lip or the forehead, resolves over weeks to months in the large majority of cases. Permanent weakness is rare and is the complication surgeon experience most directly protects against. Ask any surgeon their own rate; a good one will know it.

Anaesthetic and general surgical risk

Facelifts are done under general anesthesia or deep sedation, both of which carry their own small risks that your anesthesiologist will discuss. Blood clots in the legs are rare with a short operation and early walking, and are the reason you are told to move on day one.

The result not being what you wanted

This is the most common serious problem and it does not appear in complication statistics. Sources: expectations that surgery could never meet, a technique mismatched to the problem, over-tightening that produces a pulled or windswept look, or under-correction. Almost all of it traces back to the consultation. The candidacy and choosing a surgeon pages exist to lower it.

Sources and context

American Society of Plastic Surgeons: facelift risks and safety. Risk depends on the patient and operation; general lists do not predict an individual outcome.