Facelift and necklift risks

The most common early complication of facelift surgery, occurring in up to 15% of patients. A haematoma is a collection of blood that accumulates in the surgical site after the wound has been closed. Risk is increased by elevated blood pressure, blood-thinning medications, and activities that raise blood pressure in the immediate post-operative period (straining, coughing, nausea). Approximately 4% are major or expanding haematomas, most occurring in the first 12 hours after surgery, and more commonly in male patients. Expanding haematomas require prompt return to theatre for drainage. Smaller haematomas can generally be managed with aspiration in the clinic. This is why it is essential to attend all post-operative appointments and to contact Dr Roth urgently if you develop sudden, rapidly increasing swelling on one side of the face or neck after surgery.

A rare complication. Higher risk in patients with diabetes, smokers, and those who are immunocompromised.

Death of a portion of elevated skin. Uncommon, but more likely in thin-skinned patients, those who develop a haematoma, and smokers. The affected area heals with time.

Wound opening is rare. Reclosure is required if it occurs.

Occurs in approximately 0.5–0.7% of facelift procedures. Approximately 85% resolve completely without treatment. Injuries typically affect a single small branch rather than the main trunk, and full recovery with time is usual.

Temporary numbness of the face and neck for several weeks is very common and largely unavoidable as a consequence of raising the skin flap. Typically resolves completely.

Incisions may widen during healing, most commonly behind the ear, and more likely following haematoma, infection, or skin necrosis. Most improve with time and conservative management.

The earlobe can be pulled downward during healing. Minimised by conservative skin management under the earlobe at the time of surgery.

Changes largely avoided through appropriate incision planning. Male patients should note that a portion of the beard may advance into the preauricular area. Some hairline irregularities can be improved with hair grafting.

Permanent hair loss is rare. Temporary thinning may occur, with normal regrowth within weeks to months.

The neck may appear uneven as swelling resolves. Most irregularities resolve within a few weeks with massage and time.

Some residual banding may occur in patients presenting with significant banding pre-operatively, or due to scar contracture. Management includes massage, exercise, and steroid injections.

Hyperpigmentation from melanocyte activation or iron deposits in bruised areas. More common in patients who bruise easily and in darker skin tones. Usually resolves over weeks to months. Telangiectasia may occur in thin-skinned patients and usually resolves over time.

Following surgery, a previously masked submandibular gland may appear more prominent. This is assessed at consultation where relevant.

A very rare complication following facial nerve branch injury. Generally responds to neuromodulator injections.

Pain lasting more than 12 weeks is extremely rare but can occur if a neuroma develops along a sensory nerve. Usually resolves over several months with appropriate management.

Very rare. May occur if the parotid gland is inadvertently entered during surgery. A postoperative saliva leak usually heals without long-term consequences.