What are the risks and complications of a facelift (rhytidectomy)?
⚠️ Seek urgent care if you notice these warning signs after a facelift
Contact your surgeon immediately or go to an emergency room if you experience: rapidly increasing swelling or firmness on one side of the face (possible hematoma), signs of infection such as spreading redness, warmth, or fever, sudden weakness of facial muscles, or any area of the skin that turns dark or feels numb and does not improve. Early treatment of these complications leads to much better outcomes.
Short answer
Facelifts are generally safe, but like any surgery they carry real risks. The most common complication is hematoma (blood pooling under the skin), followed by unfavorable scarring, temporary nerve effects, and seroma (fluid collection). Most complications are manageable and temporary, and overall complication rates are low.
What the research shows
A large systematic review of facelift studies found that hematoma (a collection of blood under the skin) is the single most common complication, making up roughly one-third of all reported problems. [3] Other notable complications include unfavorable scarring, neurapraxia (temporary nerve disruption causing numbness or weakness), and seroma (fluid buildup). [3] Older research confirms this pattern, also noting skin necrosis (tissue damage), hair loss near incisions, and changes to earlobe appearance as less common but recognized risks. [6] [8] Permanent motor nerve injury (lasting muscle weakness) is rare. [6]
Reports of nerve-related complications and unfavorable scarring have increased in more recent studies, which may reflect better reporting rather than worsening outcomes. Seroma rates, on the other hand, appear to have dropped, possibly due to improved surgical techniques like tissue sealants and quilting sutures. [3]
What this means for you
The good news is that the overall complication rate for facelifts is low, and the vast majority of complications are temporary and manageable without additional surgery. [4] Most nerve effects resolve on their own, and hematomas can usually be drained. [7] Surgeons use preventive strategies such as careful blood pressure control, fibrin glue or sealants, and medications like tranexamic acid (TXA) to reduce risks. [3]
Male patients require special attention to incision placement and technique, which also affects their specific risk profile. [2] Having a thorough conversation with your surgeon before surgery, setting realistic expectations, and disclosing your full medical history are among the most important steps you can take to reduce your personal risk. [4] [5]
Caveats
Most of the available studies are observational (cohort or retrospective reviews) rather than randomized controlled trials, so exact complication rates vary between surgeons, techniques, and patient populations. [3] [6] The numbers reported in research may differ from what any individual patient experiences. Surgeon experience, your health history, and the specific technique used all influence your personal risk.
What to ask your surgeon
- What is your personal hematoma rate, and what steps do you take to prevent it?
- How do you handle nerve-related complications if they occur?
- Will I need drains after surgery, and what follow-up schedule do you recommend?
- Are there any factors in my health history that raise my risk of specific complications?