Facelift and necklift risks

Infection is a rare complication of facelift and neck lift surgery. The face has a robust blood supply which reduces infection risk. Risk is higher in patients with diabetes mellitus, those who are immunocompromised, and smokers. Most infections respond well to antibiotic treatment. Signs of infection — increasing redness, warmth, swelling, discharge, or fever — should be reported promptly.

Skin flap necrosis refers to partial or full-thickness death of the elevated skin flap. It is uncommon but has a higher incidence in patients with thin skin, those who develop a haematoma, and — most significantly — smokers. Smoking significantly impairs the microcirculation of the skin flap and is the most important modifiable risk factor. Loss of skin can involve the superficial layers only or be full-thickness. Affected areas usually heal with time, though may leave scars requiring further management.

Wound dehiscence — separation of wound edges — is rare in facelift and neck lift surgery. It is more likely following complications such as haematoma, infection, or skin flap necrosis. Where it occurs, reclosure is generally required and the affected area is monitored closely until healed.

Injury to the motor branches of the facial nerve — which control facial movement — is one of the most feared complications of facelift surgery. The overall incidence is low, occurring in approximately 0.5–0.7% of procedures. Of these, the vast majority (around 85%) resolve completely without further treatment over weeks to months.

A typical injury involves one small branch of the facial nerve rather than the main trunk, and due to the overlapping innervation of facial muscles, significant functional deficit is uncommon. Temporary weakness visible in the recovery room often reflects the effect of local anaesthetic rather than nerve injury and resolves within hours. Injury from cautery (electrical coagulation used to control bleeding) and from traction or compression during dissection are the most common mechanisms.

Permanent significant facial nerve weakness is rare in experienced hands. Any facial weakness persisting beyond the immediate post-operative period should be reported to Dr Roth for assessment.

Temporary numbness of the face and neck for several weeks to months is very common after facelift and neck lift surgery and is a largely unavoidable consequence of elevating the skin flap. The great auricular nerve — which provides sensation to the earlobe and lower face — is the sensory nerve most commonly affected; injury results in temporary or, rarely, permanent numbness of the earlobe. Sensation typically recovers fully over weeks to months and requires no specific treatment.

Facelift incisions are carefully placed around the ear, within the hairline, and under the chin to minimise visibility. Even so, abnormal healing can occur. Incisions may widen during healing — most commonly behind the ear — particularly following a haematoma, infection, or skin flap necrosis. Conservative management with silicone sheeting and steroid injections is helpful, and most incisions improve significantly in appearance over 12 months.

The earlobes can be pulled inferiorly during healing — a deformity sometimes called a “pixie ear.” This is largely avoidable through conservative skin removal under the earlobe and careful attention to the tension distribution at closure. Where earlobe distortion does occur, it can usually be corrected with a minor revision procedure.

Changes in the hairline can largely be avoided through appropriate incision design. In male patients, a portion of beard-bearing skin may be advanced toward the ear during surgery, which may require shaving or electrolysis for permanent hair removal. Other hairline issues may be improved with hair grafting techniques.

Permanent hair loss after facelift and neck lift surgery is rare. Some temporary thinning around incision sites may occur but growth normally returns within weeks to months.

As post-operative swelling (oedema) resolves, the neck may appear irregular or lumpy. This is normal during the recovery phase and resolves within several weeks with neck massage, compression, and time. Persistent irregularities, particularly in the submental region, are assessed at follow-up and managed appropriately.

Some residual platysmal banding is common in patients who presented with severe submental banding before surgery. In some situations, residual banding is attributable to scar contracture over the platysma during healing. This can be managed with neck massage, rolling exercises, and steroid injections. Persistent banding may occasionally require revision platysmaplasty.

Hyperpigmentation — darkening of the skin — may occur from activation of melanocytes or from iron pigment deposits in areas of bruising. It is most common in patients who bruise easily and in darker skin types. It usually resolves over several weeks to months. Sunscreen and topical steroid creams can be helpful.

In patients with thin skin, small dilated blood vessels (telangiectasia) may appear near incision sites. These usually resolve with time but can respond to laser treatment if needed.

The submandibular glands normally descend with ageing. Their descent may be concealed by overlying jowling, fat, and redundant skin before surgery. Occasionally after facelift and neck lift surgery, with removal of these overlying tissues, the submandibular glands become more prominent. Where this is identified pre-operatively, it can be addressed at the time of surgery. A thorough neck assessment at consultation allows this to be planned for.

Pain lasting more than 12 weeks is extremely rare but can occasionally occur if a neuroma forms along one of the sensory nerves in the neck during healing. The pain may feel migraine-like and often has a localised trigger point. Regional nerve blocks or medications can provide relief. The pain usually resolves after several months.

A parotid gland fistula — where saliva leaks through the surgical wound — is a very rare complication that may occur in patients with a very thin SMAS layer if the parotid gland is inadvertently entered during surgery. It can usually be closed at the time of surgery. If a leak develops post-operatively, drainage may be required, but these typically heal without long-term effect.