Facelift Risks and Complications: Haematoma, Nerves, Scars and Real Numbers

A facelift is generally considered a safe operation: in a large study of 11,300 facelift patients, the rate of major complications needing an emergency visit, hospital admission or another operation was 1.8%.¹ Like any surgery, though, it carries real risks, and knowing them in advance makes both the decision and the recovery easier.

This guide brings together the most common complications, their actual rates, the factors that raise risk, and the warning signs that need a call without waiting.

Facelift complications in numbers

In the study by Gupta and colleagues of 11,300 facelift patients (average age 59), the results were:¹

In this study, a “major complication” meant one needing an emergency department visit, hospital admission or reoperation within 30 days. Expected effects such as temporary swelling, bruising and numbness are not included in these figures.¹

Haematoma: the most common and most important complication

A haematoma is a collection of blood under the skin and is the most common complication of a facelift. It usually develops within the first 24 hours, and prompt treatment prevents damage to the tissues.² Men were found to have about a 3.9 times higher haematoma risk than women.¹ Blood thinners, painkillers such as aspirin and ibuprofen, and supplements such as ginkgo, ginseng and fish oil also raise the risk, so surgeons often ask for these to be stopped about three weeks before surgery.² Poorly controlled high blood pressure is another important risk factor.^2,4

Severe, increasing pain and swelling on one side of the face within the first 24 hours should be reported straight away.²

Nerve effects and numbness

Numbness in the cheeks and around the ears is common after a facelift and can last weeks or months.⁵ Nerve injury that affects facial feeling or movement is rare; it is usually temporary and recovers over a few months to a year, though it can occasionally be lasting.² According to StatPearls, facial nerve injury occurs in under 1% and permanent injury is extremely uncommon; the great auricular nerve, which supplies feeling to the earlobe area, is affected in up to 7% but usually recovers over weeks to months.⁴

Scars, hair and the earlobe

Facelift scars are permanent but are usually hidden along the hairline and the natural folds of the ear; raised scars are rare and may respond to corticosteroid injections.² Hair loss around the incisions can be temporary or lasting.² The NHS also notes that the hairline or sideburns can move up, hair growth at the temples can reduce, and the earlobes can sit asymmetrically.⁵ Too much tension on the earlobe can cause a pulled-down “pixie ear”.⁴ Where the scars sit is explained in facelift scars.

Skin loss and smoking

Skin loss from reduced blood supply is rare and is treated with wound care.² A classic 1984 study attributed a significant share of skin sloughs after facelift to cigarette smoking.³ Smoking impairs wound healing and markedly increases the risk of haematoma and skin loss.² Preparation is covered step by step in how to prepare for a facelift.

Other risks and expected effects

• Expected effects: swelling, bruising and numbness; stiffness of the face and mouth that usually settles within about 6 weeks; pain and low mood for a few days.⁵
• General surgical risks: bleeding, infection, blood clots and reactions to anaesthesia.^2,5
• Blood clots: hormone replacement therapy raises clot risk and is often stopped about three weeks before surgery.²
• Not achieving the hoped-for result: occasionally a further operation is needed.⁵

When to call straight away after surgery

Mayo Clinic advises contacting the care team immediately for:²

• severe pain on one side of the face or neck within 24 hours;
• shortness of breath;
• chest pain;
• an irregular heartbeat.

Rapidly increasing one-sided swelling, fever, redness or discharge from a wound should also be assessed the same day.

Frequently asked questions