A facelift is not considered a high-risk surgery, but it does carry real complications that happen to a meaningful number of patients. In a 15-year review published in the Aesthetic Surgery Journal Open Forum, 13% of facelift patients experienced some type of complication. Most of these were treatable and temporary, but a small percentage involved serious issues like nerve damage or blood collection requiring a return to the operating room.
The Most Common Complications
Hematoma, a collection of blood beneath the skin, is the most frequent problem after a facelift, occurring in roughly 6% of patients. Ninety percent of hematomas show up within the first 24 hours after surgery, which is why most surgeons keep patients under close observation during that window. Small hematomas sometimes resolve on their own, but larger ones typically need to be drained surgically to prevent pressure on the skin flap and further complications.
Infection follows at about 2.5% of cases, though rates in well-run surgical settings can be dramatically lower. One large study of over 8,700 patients in an office-based surgical practice found postoperative wound infections in only 0.08% of cases, suggesting that surgical technique and wound care matter as much as preventive antibiotics. Fluid collection under the skin (seroma) rounds out the top three at about 1.7%.
Nerve Damage: Temporary vs. Permanent
The risk that concerns most people is facial nerve injury, which can cause weakness or drooping on one side of the face. The overall incidence ranges from 0.3% to 2.6%, depending on the technique used and how the data is collected. The critical detail: 80 to 90% of these injuries are the mildest type, where the nerve is bruised but structurally intact. About 70% of patients with nerve injuries recover fully within six months without any intervention.
Permanent nerve damage is rare, affecting roughly 0.1% of facelift patients. Around 10% of those who do experience nerve injury have deficits that persist beyond a year. In the most severe cases (less than 2%), patients may have lasting facial paralysis. This is a low-probability outcome, but it’s the one worth understanding before making your decision.
How the Technique Affects Your Risk
There are two main approaches to facelift surgery, and they carry different complication profiles. The SMAS technique, which works on a muscular layer closer to the skin’s surface, has an overall complication rate of about 10%. The deep plane technique, which dissects beneath that muscular layer for potentially longer-lasting results, has a higher overall complication rate of about 17%. Both techniques produce high patient satisfaction and durable outcomes, according to a systematic review and meta-analysis comparing the two.
The higher complication rate with deep plane facelifts doesn’t necessarily mean they’re more dangerous in a life-threatening sense. It reflects the fact that working in deeper tissue planes involves more surgical complexity and a somewhat higher chance of bruising, swelling, or temporary nerve irritation. If a surgeon recommends one approach over the other, the tradeoff between longevity of results and complication risk is worth discussing directly.
Anesthesia Choices and Safety
Facelifts can be performed under general anesthesia (fully unconscious) or with local anesthesia combined with sedation. General anesthesia carries its own set of risks, including airway complications and cardiovascular events. Many facial plastic surgeons now prefer moderate or deep sedation because it reduces those risks, lowers the chance of blood clots, and leads to faster recovery from the anesthesia itself. Patients under sedation also tend to experience less postoperative nausea and vomiting.
If you’re offered a choice, sedation with local anesthesia generally has a stronger safety profile for facial procedures. That said, some more extensive operations or patient-specific factors may still call for general anesthesia.
What Raises Your Personal Risk
Your individual health profile matters more than averages. High blood pressure is one of the strongest predictors of postoperative hematoma, because elevated pressure in the hours after surgery can cause bleeding beneath the skin flap. Surgeons typically want blood pressure well controlled before and after the procedure.
Smoking significantly increases the risk of poor wound healing and skin flap necrosis, where the repositioned skin doesn’t get enough blood supply and tissue dies at the edges. Most surgeons require patients to stop smoking at least two to four weeks before surgery and for a similar period afterward. Diabetes and blood-thinning medications also raise complication rates. Being honest with your surgeon about these factors directly affects how safe the procedure will be for you specifically.
The First 24 Hours Matter Most
The highest-risk window after a facelift is the first day. With 90% of hematomas developing in the initial 24 hours, this is when close monitoring makes the biggest difference. Signs to watch for include sudden, one-sided swelling, increasing pain on one side of the face, or a feeling of tightness that gets rapidly worse. These symptoms can indicate a hematoma that needs prompt drainage.
After the first few days, the risks shift toward infection and wound healing problems. Swelling and bruising are normal and typically peak around day two or three before gradually improving. Most patients return to light daily activities within two weeks, though full healing of deeper tissues takes several months. Numbness around the ears and jawline is common and usually resolves over weeks to months as sensory nerves regenerate.
Putting the Risk in Perspective
A 13% overall complication rate sounds significant until you look at what that includes. The majority of complications are hematomas and minor infections that resolve with treatment. Life-altering outcomes like permanent nerve damage affect roughly 1 in 1,000 patients. For comparison, the complication rate for common orthopedic surgeries like knee replacement runs between 5% and 20%, depending on what’s counted.
The factors that most influence your safety are the surgeon’s experience, your own health status, and how well you follow pre- and post-operative instructions. A board-certified facial plastic surgeon or plastic surgeon who performs facelifts regularly will have lower complication rates than the published averages suggest, because those averages include surgeons across all experience levels. Asking a surgeon about their personal complication rates, specifically for hematoma and nerve injury, is a reasonable and revealing question.