A deep plane facelift is a major operation, and like all surgery it carries risks. The most common early complication is bleeding under the skin (haematoma); other risks include temporary facial nerve weakness, numbness, poor scarring, skin healing problems, infection, blood clots and anaesthetic complications. Careful patient selection, meticulous technique and close aftercare aim to keep these risks as low as possible.
General surgical risks
- Bleeding: some oozing is expected, but a collection of blood needs prompt treatment.
- Infection: uncommon in the well-supplied tissues of the face; antibiotics are sometimes needed.
- Venous thromboembolism (VTE): blood clots in the leg veins or lungs; reduced with early walking, stockings or compression devices and, where appropriate, blood-thinning injections.
- Anaesthetic risks: a general anaesthetic is given by a consultant anaesthetist, who assesses your fitness beforehand.
Your medical history, medications and supplements are reviewed in advance, and some, including aspirin, fish oil and certain herbal remedies, may need to be stopped before surgery.
Haematoma
A haematoma is a collection of blood beneath the lifted skin, usually within the first 24 hours. It causes rapidly increasing swelling, often on one side, with tightness or pain. It needs urgent return to theatre to remove the blood and stop the bleeding, and if treated promptly usually does not affect the final result. Risk is higher with high blood pressure, straining, vomiting or blood-thinning medication, which is why blood pressure is carefully controlled and most patients stay overnight.
Facial nerve injury
Branches of the facial nerve, which control expression, lie close to the deep plane. Temporary weakness, for example a slightly uneven smile or lip movement, can occur from stretching or swelling and usually recovers over weeks to months. Permanent weakness is rare. Detailed anatomical knowledge and careful dissection are the main protection. Numbness of the cheeks and ears is much more common and is caused by division of small sensory nerves; it generally improves, though the earlobe can occasionally remain less sensitive.
Skin, scar and hair concerns
The skin flaps depend on a good blood supply. Smoking, vaping and nicotine replacement significantly increase the risk of delayed healing or areas of skin loss, particularly behind the ears, so you must stop well before and after surgery. Scars may widen, thicken or become more visible than expected, and hair can thin temporarily along incisions in the hairline. Earlobe distortion can occur if tension is placed on the lobe. Most of these issues are improved with time or minor revision.
Aesthetic risks
Some asymmetry is normal, as no face is perfectly symmetrical before surgery. Irregularities, persistent firmness, residual jowls or neck laxity, and a change in the position of the hairline are possible. Results cannot be promised, and ageing continues after surgery. A small number of patients may benefit from a later touch-up procedure.
What is normal and what is a concern
Normal: swelling that fluctuates, bruising that tracks into the neck, tightness, numbness, mild asymmetry in the first weeks and small firm lumps that soften. Concerning: rapidly increasing swelling on one side, a fever, spreading redness, discharge, dark or blistering skin, or new weakness of facial movement. Contact the surgical team urgently for rapid one-sided swelling, and the same day for fever or spreading redness. Sudden one-sided leg swelling or calf pain needs a same-day GP appointment or NHS 111, and chest pain or breathlessness needs a 999 call.
Reducing your risk
Stop smoking, keep a stable weight, disclose every medicine and supplement, and have any high blood pressure well controlled beforehand. Follow the instructions on rest, head elevation and avoiding strain. Surgery in a CQC-registered hospital with overnight nursing care and ready access to the surgeon is an important safeguard. Mr Nassab will discuss your personal risk profile in detail at your deep plane facelift consultation.
Frequently Asked Questions
Is a deep plane facelift riskier than a standard facelift?
The dissection is deeper and closer to the facial nerve branches, so experience matters. The overall risk profile is broadly similar when performed by a trained specialist.
What is the most common complication?
Haematoma, a collection of blood under the skin, is the most common early complication of facelift surgery. It is treated urgently in theatre.
Can smokers have a deep plane facelift?
Smoking greatly increases the risk of skin healing problems. You will be asked to stop all nicotine for several weeks before and after surgery.
Will facial movement be affected?
Temporary weakness can occur and usually recovers. Permanent nerve injury is rare.
How long does numbness last?
Numbness usually improves steadily over several months, although some reduced sensation around the ears can persist.
