A facelift is generally a safe operation when carried out by a qualified plastic surgeon in an accredited hospital, but like all surgery it carries risks. The most common significant complication is a haematoma (a collection of blood under the skin); others include infection, scarring, numbness, hair loss near the incisions, skin healing problems and, uncommonly, injury to the facial nerve, which is usually temporary.
Risks common to all surgery
- Bleeding: some oozing is expected; significant bleeding is uncommon but may need a return to theatre.
- Infection: the face has an excellent blood supply, so infection is uncommon, but it can occur and is treated with antibiotics.
- Blood clots (VTE): deep vein thrombosis and pulmonary embolism are rare after facial surgery; compression stockings, early walking and, where appropriate, blood-thinning injections reduce the risk.
- Anaesthetic: modern anaesthesia is very safe, and a consultant anaesthetist assesses your health 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, tightness and pain, often on one side. Small collections may settle or be drained; larger ones need a return to theatre to protect the skin. The risk is higher in men and in anyone with raised blood pressure. It is reduced by careful control of blood pressure before and after surgery, stopping blood-thinning medicines and supplements when advised, meticulous technique, a gentle recovery without straining and, in some cases, drains.
Nerve and sensation changes
Numbness of the cheeks and around the ears is expected and usually improves over several months. The great auricular nerve, which supplies feeling to the earlobe, can occasionally be injured. Weakness of a facial nerve branch, affecting the smile, lip or brow, is uncommon; in most cases it is caused by bruising or stretching and recovers over weeks to months. Permanent weakness is rare. Deep plane techniques require particular familiarity with the anatomy of these nerves.
Skin, scars and hair
Poor blood supply to the lifted skin can cause areas to heal slowly or, rarely, skin loss, most often behind the ear. Smoking and nicotine products greatly increase this risk, which is why you will be asked to stop well before surgery. Scars usually mature well over 12 to 18 months but can occasionally stretch, thicken or be visible. Hair can thin temporarily along incisions in the hairline. Earlobes can be pulled down if tension is poorly placed, and the hairline or sideburn can shift.
Aesthetic risks
Asymmetry, residual laxity, an over-tightened or ‘wind-swept’ look and relapse of loose neck skin are possible. Some pre-existing asymmetry remains after any facelift. Careful planning, a natural vector of lift and avoiding excessive skin tension reduce these risks. A small number of patients benefit from a minor revision, usually after at least a year; the revision facelift guide explains more.
What is normal and what is not
It is normal to have swelling, bruising, tightness, numbness and mild discomfort for the first two weeks, with swelling settling gradually over months. Mild lumpiness in front of the ears often softens with time. Contact the surgical team urgently if swelling increases rapidly on one side of the face or neck, or pain becomes severe. Contact the team the same day if you develop a fever, spreading redness, discharge or darkening skin. Sudden one-sided calf pain or leg swelling needs a same-day GP or NHS 111 assessment. Chest pain or breathlessness, or difficulty breathing or swallowing, requires a 999 call.
Reducing your risk
Stop smoking and nicotine products, keep a stable weight, control blood pressure, follow instructions on medication and supplements, keep your head elevated, avoid bending and heavy lifting for the first weeks, and attend all follow-up appointments. Choose a surgeon on the GMC Specialist Register in Plastic Surgery operating in a CQC-registered hospital. A facelift costs from £14,500 and the £150 consultation is separate. Surgery is for adults aged 18 and over.
Frequently Asked Questions
What is the most common facelift complication?
Haematoma is the most common significant complication, typically appearing within the first day. It is treated promptly by the surgical team.
Can a facelift damage facial nerves?
Nerve injury is uncommon and usually temporary, recovering over weeks to months. Permanent weakness is rare.
Why is stopping smoking essential before a facelift?
Nicotine narrows blood vessels and increases the risk of the skin healing poorly or breaking down.
How long does numbness last after a facelift?
Numbness around the cheeks and ears usually improves gradually over several months.
Is a deep plane facelift riskier?
It involves working closer to the facial nerves, so it requires specific training, but in experienced hands the overall risk profile is similar.
