Risks and Complications of Facelift Surgery

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) practising in Sydney with over a decade of experience in facial aesthetic surgery.

FaceAll surgical procedures carry risks, and facelift surgery is no exception. While modern techniques have made surgery safer than ever, patients should fully understand potential complications before proceeding. Dr Turner believes in open, honest communication so patients can make informed decisions about their care.

This page covers facelift surgery risks, factors that may increase the risk of complications, and safety measures used throughout treatment.

Understanding Surgical Risk in Facelift Procedures

Every surgery carries some degree of risk—this is true regardless of the surgeon’s skill or the procedure performed. Facelift surgery involves working near important structures, including facial nerves, blood vessels, and delicate skin. Understanding this helps patients approach surgery with realistic expectations.

The risk of complications varies among individuals. Key factors include overall health, lifestyle choices (especially smoking), how well you follow pre- and post-operative instructions, and your body’s natural healing ability.

How Surgical Technique Affects Risk

Different facelift techniques carry slightly different risks. More extensive procedures—like deep plane facelifts—take longer and involve more tissue work, which may slightly increase certain risks. However, these same techniques often produce longer-lasting, more natural results.

Less extensive procedures may have lower immediate risks but potentially shorter-lasting results. The best approach depends on your anatomy, goals, and comfort with risk—all of which are discussed during your consultation.

Dr Turner minimises risk through careful patient selection, thorough pre-operative assessment, precise surgical technique, operating only in accredited hospitals, and detailed aftercare. However, complications can still occur despite the best care.

Common Post-Operative Effects

Some effects happen to nearly everyone after facelift surgery. These are standard parts of healing, not complications. Knowing what to expect helps you distinguish between routine recovery and genuine concerns.

Swelling and Bruising

Almost all patients experience swelling and bruising—this is your body’s natural response to surgery. These effects usually peak 48 to 72 hours after surgery, then gradually improve over the following weeks.

Most visible swelling settles within two to three weeks, though subtle swelling may last several months. Bruising changes colour from purple-red to green and yellow before fading completely, usually within two to three weeks.

Discomfort and Tightness

Feeling tight, pulled, or uncomfortable in the days and weeks after surgery is normal. This reflects your tissues healing and settling into their new position. Prescribed pain medication manages discomfort in the first few days, and most patients switch to over-the-counter pain relief within a week.

Temporary Numbness

Temporary changes in sensation happen to everyone after facelift surgery. Small sensory nerves are disrupted when tissue is lifted during surgery. You may experience numbness, tingling, or strange sensations in your cheeks, ears, and neck.

These changes improve over weeks to months as nerves heal. Some patients have minor lasting numbness in specific areas—most commonly behind the ears or parts of the neck.

Temporary Asymmetry

During healing, one side of your face may look different from the other as swelling goes down at different rates. This usually corrects itself as tissues settle over the following months. Final symmetry cannot be assessed until healing is complete—typically six to twelve months after surgery.

Potential Surgical Complications

Beyond typical post-operative effects, facelift surgery carries risks of complications that may need treatment. While these are relatively uncommon when performed by an experienced surgeon, you should understand them before deciding on surgery.

Haematoma (Blood Collection)

Haematoma—blood collecting under the skin—is one of the most common facelift complications, occurring in about 2-5% of patients. The risk is higher in men and people with high blood pressure.

Small haematomas may resolve on their own. Larger ones usually need surgical drainage to prevent further problems. Prompt treatment prevents more serious issues.

Risk factors include uncontrolled high blood pressure, blood-thinning medications, returning to strenuous activities too soon, and being male gender. Dr Turner uses specific techniques to reduce the risk of haematoma.

Infection

Wound infection after facelift surgery is uncommon, with fewer than 1 to 2 per cent of cases when proper precautions are taken. The face has an excellent blood supply, which helps fight infection.

Signs of infection include increasing pain, spreading redness, warmth around incisions, unusual discharge, and fever. Antibiotic treatment usually resolves infections without lasting effects.

Seroma (Fluid Collection)

Seroma—clear fluid collecting under the skin—sometimes develops after facelift surgery. While not usually harmful, it may cause discomfort or visible swelling. Most seromas resolve with simple drainage using a needle and don’t affect long-term results.

Wound Healing Problems

Some patients experience delayed healing, particularly at points where incisions are under tension. Risk factors include smoking, poorly controlled diabetes, previous radiation treatment, and poor circulation. Wound separation may need extended dressing care or additional stitches, and could affect the final scar appearance.

Skin Necrosis (Tissue Death)

Skin necrosis—when skin tissue dies due to poor blood supply—is a serious but rare complication, occurring in fewer than 0.5 per cent of non-smokers. When skin doesn’t receive enough blood flow, tissue breaks down, requiring wound care and potentially leaving visible scarring.

Smoking is the most significant risk factor for skin necrosis. Nicotine dramatically narrows blood vessels that supply the skin. This is why smoking cessation is mandatory—you must stop all tobacco and nicotine products for at least six weeks before and after surgery. Other risk factors include diabetes, previous facial surgery, and extensive surgical dissection.

Blood Clots

Deep vein thrombosis (blood clots in leg veins) and pulmonary embolism (clots travelling to the lungs) are rare but potentially serious complications of any surgery requiring extended anaesthesia.

Dr Turner uses preventive measures, including the use of compression devices during surgery, and encourages early movement after surgery. If you experience calf pain, leg swelling, or unexplained shortness of breath after surgery, seek immediate medical attention.

Nerve-Related Concerns

The face contains a complex network of nerves controlling both sensation and movement. Facelift surgery near these structures poses a risk of nerve-related complications.

Motor Nerve Injury (Movement)

The facial nerve controls facial muscles—those responsible for expressions such as smiling, raising eyebrows, and closing the eyes. Temporary weakness affecting specific facial movements occurs in about 3 to 5 per cent of patients.

Most commonly affected are the nerves controlling lower lip movement or brow elevation. Most motor nerve injuries result from temporary swelling or irritation rather than actual damage. The function typically returns within 3 to 6 months.

Permanent motor nerve injury is rare—fewer than 1 per cent of cases—but possible. It could result in lasting weakness affecting facial expression. This risk highlights why choosing an experienced facial plastic surgeon matters.

Sensory Nerve Injury (Feeling)

Sensory nerves that provide sensation to the facial and neck skin are inevitably affected during tissue elevation. As mentioned earlier, temporary numbness is universal after facelift surgery.

More persistent sensory changes—such as continued numbness, heightened sensitivity, or altered sensation—occur in some patients. Most improve over six to twelve months as nerves regenerate. Some patients have minor permanent numbness in specific areas, though this is usually not functionally significant.

Aesthetic Outcome Considerations

Beyond medical complications, you should understand potential concerns about cosmetic results. While Dr Turner aims for excellent results in every case, outcomes depend on factors beyond surgical technique alone.

Asymmetry

No face is perfectly symmetrical—everyone has some natural asymmetry. After facelift surgery, minor asymmetries may become more noticeable, or new ones may develop due to different healing rates or tissue characteristics. Significant asymmetry may need minor revision surgery once healing is complete.

Unsatisfactory Results

Sometimes outcomes don’t meet expectations despite technically successful surgery. Contributing factors include unrealistic initial expectations, individual differences in healing, and tissue characteristics that limit improvement. An honest discussion of realistic expectations during consultation helps minimise this possibility.

If concerns persist after complete healing (typically six to twelve months), revision surgery may be considered.

Over-Correction or Under-Correction

Tissues may be lifted more or less than expected, resulting in either an unnatural, overly tight look (over-correction) or incomplete improvement (under-correction). Individual healing responses affect outcomes in ways that cannot be entirely predicted beforehand.

Contour Irregularities

Visible ridges, depressions, or surface irregularities may develop during healing. Minor irregularities often improve on their own; more noticeable concerns may need revision procedures.

Scarring

While incisions are placed in hidden locations—within natural facial creases, the hairline, and around ear curves—scarring is unavoidable. Most scars heal to fine, pale lines that become hard to see within twelve to eighteen months.

However, abnormal scarring can occur. Hypertrophic scars are raised and thickened but stay within the incision line. Keloid scars extend beyond the original incision. Patients with a history of abnormal scarring face a higher risk.

Scar care protocols, including sun protection and silicone products, help optimise healing. Problem scars can be treated with injections, laser therapy, or scar revision surgery.

Hair Loss

Temporary hair loss near incision sites commonly occurs due to surgical trauma to hair follicles. Hair typically regrows within three to six months. Permanent localised hair loss at incision sites is rare and can be addressed with hair restoration techniques if needed.

Factors That Influence Your Risk

Your individual characteristics significantly affect your likelihood of complications. Understanding these factors helps you assess your personal risk and take steps to improve safety.

Smoking and Nicotine Use

Smoking is the single most significant controllable risk factor for facelift complications. Nicotine—from cigarettes, e-cigarettes, patches, or any other source—dramatically narrows blood vessels, reducing blood flow to healing tissues by up to 40 per cent.

This substantially increases the risks of:

• Skin necrosis (tissue death)
• Wound healing problems
• Infection
• Prolonged swelling
• Poor scarring
• Unsatisfactory results

The risk increase is so significant that responsible surgeons will not operate on active smokers. Dr Turner requires complete cessation of all tobacco and nicotine products—including cigarettes, e-cigarettes, nicotine patches, and nicotine gum—for at least six weeks before and after surgery. This requirement is non-negotiable.

Medical Conditions

Certain health conditions increase surgical risks:

Heart disease: Raises anaesthesia risks and haematoma likelihood

Diabetes: Impairs wound healing and increases infection risk

Bleeding disorders: Increased haematoma and bleeding risks

Autoimmune conditions: May affect healing

High blood pressure: Significantly increases haematoma risk when poorly controlled

A thorough pre-operative assessment identifies conditions that require management before surgery. Some conditions may require clearance from other specialists.

Medications and Supplements

Various medications and supplements affect surgical safety:

Blood thinners: Increase bleeding and haematoma risk

Anti-inflammatory drugs (like ibuprofen): Affect blood clotting

Herbal supplements: Many affect bleeding, anaesthesia, or healing

Certain antidepressants: May interact with anaesthetic drugs

Dr Turner provides detailed instructions about which medications to stop or adjust before surgery. You must disclose all medications, including over-the-counter products and supplements, for safe surgical planning.

Age and Skin Quality

While age alone doesn’t prevent facelift surgery, older patients may face higher risks due to:

• Decreased skin elasticity
• Slower healing
• Higher likelihood of other health conditions
• Thinner, more fragile skin
• Reduced collagen production

Skin quality—affected by genetics, sun exposure, smoking history, and general health—significantly influences both results and complication risk.

Previous Facial Surgery

Patients with prior facial surgery may have altered anatomy, scar tissue, and reduced blood supply, which can increase complexity and risk. Revision facelift surgery generally carries higher complexity than first-time procedures.

Scar tissue disrupts normal tissue layers, potentially affecting the blood supply and making nerve identification more difficult. Careful assessment, detailed planning, and realistic expectations are essential for revision procedures.

Minimising Complications: Working Together

While complications cannot be eliminated, their likelihood can be substantially reduced through appropriate measures from both the surgeon and the patient.

What Dr Turner Does

Appropriate qualifications and experience: Selecting a Specialist Plastic Surgeon (FRACS) with specific expertise in facial surgery significantly reduces complications.

Careful surgical technique: Precise anatomical knowledge, gentle tissue handling, and refined methods minimise problems.

Thorough patient selection: Careful assessment ensures surgery only proceeds when benefits outweigh risks.

Accredited facilities: Surgery performed only in hospitals certified with experienced anaesthetic support maximises safety.

Comprehensive aftercare: Detailed post-operative protocols and accessible follow-up enable early identification of any concerns.

What You Can Do

Be completely honest during consultation: Full disclosure of medical history, medications, supplements, and lifestyle factors enables proper planning.

Stop smoking completely: Abstaining from all nicotine products for the required time dramatically reduces complications.

Follow pre-operative instructions: Medication adjustments, fasting requirements, and preparation protocols are in place for specific safety reasons.

Follow post-operative care instructions: Activity restrictions, wound care, and medication schedules optimise healing.

Attend all follow-up appointments: Scheduled reviews enable early identification of developing concerns.

Report concerns promptly: Early recognition of complications improves outcomes.

Maintain realistic expectations: Understanding what surgery can and cannot achieve reduces dissatisfaction.

Warning Signs: When to Seek Help

Most facelift recoveries proceed smoothly, but certain warning signs need immediate medical attention. Contact Dr Turner’s practice promptly if you experience:

• Sudden, significant swelling on one side of the face (may indicate haematoma)
• Increasing pain not controlled by prescribed medication (may suggest developing complication)
• Fever over 38°C (100.4°F) (may indicate infection)
• Increasing redness, warmth, or discharge from incisions (may suggest infection)
• Darkening or colour change of facial skin (may indicate blood supply problems)
• Difficulty breathing or chest pain (may indicate pulmonary embolism—seek emergency care immediately)
• Calf pain or swelling (may indicate a blood clot)
• Any symptom causing significant concern

Dr Turner provides all patients with 24-hour emergency contact information throughout recovery.

What Happens If a Complication Develops

If a complication occurs, prompt recognition and proper management usually achieve good outcomes. Haematomas may require drainage, infections respond to antibiotics, wound-healing problems are managed with dressings and time, and nerve injuries typically resolve on their own.

Dr Turner’s aftercare includes scheduled follow-up appointments for early detection, plus an emergency contact for concerns between appointments. Most complications, when promptly addressed, don’t significantly affect long-term results. Revision surgery can address persistent concerns once complete healing has occurred.

Making an Informed Decision

Understanding risks and complications is essential to making a good decision about surgery. Facelift surgery offers significant benefits for suitable patients, but these must be weighed against genuine risks that exist regardless of the surgeon’s expertise.

Dr Turner’s commitment to honest communication ensures you receive complete information for truly informed consent. During consultation, specific risks relevant to your situation—based on your health, anatomy, and proposed surgical plan—will be discussed in detail.

For patients who proceed after thorough consideration, Dr Turner uses careful technique, operates only in accredited facilities, and provides comprehensive aftercare to minimise complications while optimising results. However, accepting that some risk accompanies all surgery is fundamental to being a suitable surgical candidate.

If you have questions about the risks of facelift surgery or wish to discuss your individual circumstances, contact Dr Turner’s practice to arrange a consultation.

This content is suitable for an 18+/adult audience only.

Individual results will vary from patient to patient and depend on factors such as genetics, age, diet, and exercise. All invasive surgery carries risk and requires a recovery period and care regimen. Be sure you do your research and seek a second opinion from an appropriately qualified Specialist Plastic Surgeon before proceeding. Any details are general in nature and are not intended to be medical advice or constitute a doctor-patient relationship.Retry