What Are The Risks Of Facelift Surgery

This will serve as an informational blog for my patients who have had a Deep Plane Facelift procedure, as all surgeons use different techniques and obtain different results. The following is based upon both facelift literature, and my own years of experience performing hundreds of facelifts. 

Part of the planning for every surgical procedure is weighing the expected benefits against the potential risks. In the case of elective cosmetic surgery, such as a facelift, it’s critical to have a low threshold for complications and negative events. Fortunately, in facelift procedures with experienced specialists, complications are rare. Nonetheless, as with anything in life, there is always the potential risk for complications. The very best facelift surgeons can minimize the possibility of negative events, but these risks will always be possible. Read on to learn more about the risks involved in facelift surgery, how to prevent them, and how to manage them if they should arise.

The first category of negative events after a facelift surgery is considered to be known as side effects of the procedure. Every patient from every surgery will experience some degree of the following with various durations. However, these side effects will all inevitably resolve on their own without any intervention from the surgeon. The only thing needed is familiarity and reassurance from the surgeon and patience and trust from the patient.

Swelling or Inflammation

The most common side effect after facelift surgery is swelling or inflammation. After any surgical procedure or injury, there will be inflammation of the soft tissues involved. With a Deep Plane Facelift surgery, there will be swelling to the skin and the deeper tissues like fat, glands, and muscles. The entire face and neck will notice some swelling. Some patients might have impressive amounts of facial swelling, and other patients might experience very little. Sometimes the early swelling will resolve over as little as a week, sometimes it might take up to six weeks for the initial swelling to subside. Inflammation is completely resolved between 6-12 months. Delicate handling of the face and neck during surgery can help to minimize trauma and reduce swelling. Low-dose postoperative steroids are typically given to patients to reduce inflammation after surgery.

Bruising

Bruising is also possible after surgery. It is completely variable from patient to patient and comes from areas of blood vessel trauma underneath the skin. Medications like tranexamic acid are given before surgery to reduce bleeding and bruising, and Arnica Montana is a supplement that has been clinically demonstrated to reduce bruising.

Numbness

Temporary numbness can occur after surgery and may vary from minimal to significant numbness around the cheeks or neck. The sensation nerves that serve the areas of the face and neck are microscopic and travel within the skin layer. During the period of swelling to the skin, the nerves within the skin also become inflamed, and sensation is reduced. The sensation in the skin will resolve spontaneously without any intervention and typically returns between 3-6 months. Sometimes sensation returns quickly in just a matter of weeks, and other times can take up to a full year.

Stiffness

Temporary facial stiffness or weakness is also a possible side effect. This might be so minor that it is essentially unnoticeable, or it might be some significant weakness. This can be from inflammation of the muscle fibers or even the motor nerves that control the muscles. Temporary facial weakness is not rare and can be visible in up to 20% of Deep Plane Facelift patients. It will resolve on its own in a matter of weeks. At its very longest, it might resolve over 12 weeks from surgery. Sometimes, a course of steroids can be prescribed to reduce inflammation and speed up the improvement.

Emotional Effects

Another side effect is emotional volatility. People are naturally social, and having to isolate during the 2-3 weeks of social downtime can be difficult. Even with in-depth preparation, it’s natural for patients to wonder if their swelling, bruising, and numbness are normal or if they have a problem. There are a lot of fluctuations during the first three weeks, and feeling emotionally let down during the lowest points of recovery is a risk. It’s important to have a great relationship with the surgeon and the medical team and reach out directly with absolutely any concerns. Immediate access and reassurance from the surgical team are critical for a healthy recovery period.

Next, there is also the risk of unplanned complications. Complications are events that occur after the surgical procedure that are not typically expected side effects and will require intervention from the surgical team. Again, the best surgeons will implement measures before, during, and after surgery to minimize all complications, but the risk is always present.

The most common risk after facelift surgery is bleeding, which can occur after the procedure has been completed. When there is bleeding after surgery, it is called a hematoma. Statistically, this can happen in about 1% of patients. Hematomas typically occur in higher-risk patient groups. Men are at higher risk for hematoma because of the thicker facial skin which requires more blood flow. Additionally, patients who are on medication for high blood pressure are at higher risk. Finally, patients on blood thinners or who have bleeding tendencies are at higher risk. The risk of hematoma can be reduced with meticulous surgical technique and minimal bleeding during the operation. Also, medication such as tranexamic acid is given to reduce the risk of bleeding during and after surgery. If a patient does notice bleeding after surgery, it is critical to contact the surgeon immediately and meet with the surgeon. When handled expediently by the surgeon, a hematoma can often be treated easily with no impact on the recovery process.

Another possible risk after surgery is called a serous fluid collection, or seroma. This is where a collection of body fluid (not blood) accumulates under the skin area where the facelift was performed. Our bodies are 60% water, and it’s possible that a small amount of watery fluid can gather in the space between the skin flap and the muscles until the skin attaches to the deeper layer. Seromas are very uncommon, and small drainage tubes are placed that allow passive suction to prevent the accumulation of fluid. Drains are the size of spaghetti noodles, which exit behind the neck hairline and are removed after a few days once the skin has reattached to the muscles. If a patient does develop a squishy area of fluid, it can typically be easily treated by draining the fluid directly with needle aspiration. Identified and treated early, it does not affect healing or results.

All surgical procedures carry some risk of infection. Bacteria and viruses are living microorganisms that exist on all surfaces and environments, and once they progress to a certain point, they can cause an active infection. Infections after facelift surgery are very rare, due to the large healthy blood supply to the face and the sterile conditions of surgery. Infection occurs in about 1 in 500 cases. In these cases, patients might notice redness, pain, inflammation, or odor. Antibiotics are prescribed to curb any active infection. Early detection is critical to stop an infection in its earliest stages.

Poor healing of the skin and the face are possible after any surgical procedure. Oxygen is critical for the survival and healing of all the tissue inside the human body, and this is especially important after surgery. Patients who are at higher risk of poor skin healing are those with a recent history of smoking, skin disease, or poorly controlled diabetes. I believe that reduced blood flow and inflammation are major risk factors for poor skin healing, which is why I do not use any facial compression dressings after facelift surgery. Facial compression dressings are historically used to prevent hematomas after facelift surgery, but I believe they are not necessary with modern techniques and cause more harm than good.

As of the time of this writing, I have never had a hematoma in a patient who did not wear a compression band. I also strongly believe in the routine use of hyperbaric oxygen therapy (HBOT) after facelift surgery. HBOT has been used for decades to assist with wound healing, and the therapy allows for significantly greater amounts of oxygen to be carried in the blood. It allows for faster wound healing and minimizes the risk of poor skin healing. If a patient were to develop poor wound healing, the initial management is to be conservative. HBOT can be used, as can medical-grade skincare like silicone scar cream. Later, laser energy devices or even surgical scar revision can be performed if needed.

Furthermore, one of the most feared complications of facelift surgery is permanent facial weakness due to facial nerve injury. The facial nerve is the nerve that controls and moves the muscles of the face, and if it is destroyed, the face can be permanently weakened. Fortunately, this complication is extremely rare and is reported as occurring between 1% and 0.1% of the time. I have never had a patient with permanent facial weakness. Interestingly, the risk of facial nerve injury is not related to the type of facelift. An extensive facelift like an Extended Deep Plane Facelift has not been shown to carry any more risk of nerve injury than a minimally invasive technique like a SMAS mini-facelift which is much simpler. The main variable for the risk of nerve injury is the skill and experience of the surgeon, regardless of the technique used. A novice surgeon performing a very simple facelift technique is far more likely to damage a facial nerve than a specialized Deep Plane Facelift surgeon.

Finally, a risk of any cosmetic surgery is that the surgery is performed well, and the patient’s appearance is improved, yet there is an area of unpredictable healing that does not meet expectations. For example, maybe one patient notices that there is one skin wrinkle or fold that is still noticeable to them. Or another patient might notice that one side of the neck seems to be slightly fuller than the other. These findings are typically the result of unpredictable healing after the surgery has been completed. About 1-3% of the time, a patient might benefit from a minor targeted surgical procedure to further improve an area of the facelift. If the desired change is especially minor and not worth undergoing a surgical procedure for such minor improvement, then the best option might be a non-surgical skin tightening treatment such as radiofrequency micro-needling.

A facelift is a reliable and safe surgical procedure with a very low risk of complications. Part of making an informed decision about proceeding with facelift surgery is being fully educated on the possible risks with the procedure, even if they are rare. In the event of an unexpected complication, whether large or minor, patients need to maintain a close relationship with the surgical team and trust the surgeon to manage the issue. When choosing a surgeon to perform your procedure, remember that you are also choosing that surgeon to prevent and manage the potential known complications of surgery. It is normal to sometimes feel that something went wrong during surgery to cause a complication, but with experienced specialists, this is rarely the case. Look for a surgeon with years of experience and expertise in performing facelifts every year. Complications can happen with any surgeon, and experienced surgeons will have seen complications in the past and will have experience with how to recognize them and manage them appropriately. Choose your surgeon wisely.