Risks and Complications of Facelift Surgery: What the Evidence Shows

Key Takeaways

• In two of the largest published databases, about 2 in every 100 facelift patients had a major complication within 30 days, and about 5 in 100 had a problem of any kind. Most are treatable and don’t decide the final result.
• Haematoma, a collection of blood under the skin, is the most common complication that needs a return to theatre. About nine in ten appear in the first 24 hours, and blood pressure control has the most consistent evidence for preventing it.
• Temporary facial weakness happens in about 0.7% to 1.2% of patients in pooled studies and usually recovers over weeks to months. Permanent nerve injury is reported in about 1 in 2,000.
• Nicotine in any form, high blood pressure, being male, combined procedures and some medicines and supplements all raise the risk. Age on its own doesn’t appear to.
• No technique is free of trade-offs. Deeper techniques have fewer skin-healing problems but, in some studies, slightly more temporary nerve weakness and haematoma.
• Sudden swelling on one side, pain that’s getting worse, darkening skin, fever, new facial weakness, chest pain or breathlessness all need a call the same day, or 000, not a wait for your next review.

One of the first things I go through at any facelift consultation is what can go wrong. It’s the right question to ask, and it deserves a straight answer with real numbers behind it, not a vague reassurance that complications are rare.

A facelift is major surgery. Most of the published figures are reassuring, but a percentage only means something when you know what was counted, in which patients and over how long. So in this guide I’ve pulled together the largest studies and the current Australian rules, and I’ve explained each complication the way I would in the consulting room: how often it happens, when it tends to show up, what makes it more or less likely, and what we do about it.

If you’re already recovering and wondering whether something is normal, start with the sections on what’s expected and on warning signs.

I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS). Everything here is general information. Your own risk depends on your anatomy, your health and the operation planned, and that’s what we work through together at consultation. Detail on the operation itself, suitability and cost is on my facelift page.

Is a facelift dangerous?

Serious complications are uncommon, but they’re not so rare that you can ignore them. Two large US databases give the clearest overall picture.

• Major complications. A 2016 analysis of 11,300 facelifts in a large US insurance database found that 1.8% of patients had a major complication within 30 days, meaning an emergency department visit, a hospital admission or a return to theatre. That’s roughly 1 patient in 55.
• A problem of any kind. The American Society of Plastic Surgeons’ outcomes registry, covering 13,346 facelifts, recorded an adverse event of some kind in 5.1%, with haematoma and infection the most frequent.

How you count makes a big difference. A 2026 series of 541 patients from one surgeon’s practice reported major complications in 0.4% and minor ones in 7.6%. Small things, like a pocket of fluid drained in the rooms, are far more common than anything that needs a return to theatre.

Life-threatening problems, such as a blood clot travelling to the lungs, can happen after any operation under anaesthesia. They’re rare after a facelift, and I explain below how that risk is kept low.

Why the numbers vary between studies

You’ll see quite different figures quoted for the same complication. That’s usually not because one of them is wrong. Studies:

• Define things differently. A “haematoma” might mean any collection of blood, or only one that needed surgery.
• Follow patients for different lengths of time. A 30-day database misses later problems such as scarring or earlobe changes.
• Include different combinations of procedures. Rates go up when eyelid, neck or body surgery is done at the same time.
• Come from different sources. Large databases capture many surgeons; a single surgeon’s series describes one practice.
• Under-report some problems. A major 2021 review of facelift complications notes that permanent nerve injury is probably under-reported.

It also helps to keep absolute and relative risk apart. When you read that men have about four times the haematoma risk of women, that’s relative. If the risk in women were 1 in 100, four times that is about 4 in 100. Higher, but nowhere near a certainty.

What’s normal after a facelift, and what isn’t

A lot of what you feel in the first few weeks is simply healing. Knowing that saves a great deal of worry, and it makes it more likely that a real problem gets picked up early.

What’s normal: bruising and swelling; a tight or heavy feeling; numbness over the cheeks and around the ears; one side settling faster than the other; firmness under the skin; and incision lines that start pink and fade over 12 months or more. Many patients find the second week harder emotionally than they expected, when the bruising is still there and the result isn’t clear yet. All of this peaks in the first week or two and then settles.

Complications are the things that need something extra: treatment, closer monitoring, medication, drainage, a return to theatre or a revision later on.

The rule of thumb I give patients is simple. If it’s slowly getting better, it’s usually normal. If it gets worse suddenly, is much worse on one side, or is a new symptom after you’d been doing well, call us.

How common are facelift complications?

These are the figures most often quoted, where they come from, and what they describe. Because of the differences above, they aren’t directly comparable with each other.

When do problems usually show up?

Each complication has its own window. Knowing the timing helps you make sense of a symptom and decide how quickly to act.

Haematoma

A haematoma is a collection of blood under the lifted skin. It’s the most common complication that needs a return to theatre, and it’s the one I watch most closely in the first 24 hours. A large, expanding haematoma presses on the skin and can threaten its blood supply. Rarely, swelling in the neck can affect breathing.

How often, and when

The two large US databases put it at 1.1% to just under 2%. For deep plane facelifts specifically, a 2026 meta-analysis of 31 studies and 8,841 patients found 2.7% overall and 0.97% for major haematoma.

About 90% happen in the first 24 hours, and in one series of 1,236 patients, every haematoma that needed surgery appeared within 48 hours. It’s one of the reasons the first night after surgery is spent in hospital.

Who’s at higher risk

In a 2001 study of 1,078 facelifts, the factors linked with haematoma were:

• Systolic blood pressure above 150 mmHg around the time of surgery, with a relative risk of 3.6
• Being male, with a relative risk of 2.8
• Aspirin or anti-inflammatory medicines, with a relative risk of 2.0
• Smoking, with a relative risk of 2.0

The 11,300-patient US database showed the same pattern for men, at about 3.9 times the risk of women. It’s thought to come partly from the richer blood supply of beard-bearing skin and partly from higher blood pressure on average. It may not be fixed, though. Data from the same 541-patient practice recorded no haematomas in 34 men treated under a standardised prevention protocol, against 2.0% of women. That’s encouraging, but 34 men is too few to be sure. The 2001 study also found that adding neck surgery through an incision under the chin raised the risk about fourfold.

What reduces the risk, and what doesn’t

A 2024 review of 45 studies on preventing haematoma gives a useful summary:

• What helps: strict blood pressure control, with systolic pressure kept below at least 140 mmHg; heading off pain, nausea and vomiting before they start; fibrin sealants; and local anaesthesia.
• What hasn’t been shown to help: drains, compression dressings and steroid medication.

Blood pressure has the most consistent evidence. In one surgeon’s series of 502 patients, bringing in a target systolic pressure below 120 mmHg after surgery was followed by a fall in haematoma from 3.76% to 0.5%. That’s a before-and-after comparison rather than a trial, but it fits everything else we know. It’s why blood pressure, pain, nausea, coughing and straining are all managed so closely in the first hours after surgery.

Other measures have evidence of varying strength:

• Bleeding-control medication applied to the tissues. A 2026 meta-analysis of seven non-randomised studies with 1,122 patients found that patients who received a local antifibrinolytic medication, which slows the breakdown of blood clots, had about one-third the odds of haematoma of those who didn’t (odds ratio 0.35).
• Fibrin sealant. A 2023 meta-analysis of seven randomised trials found a borderline reduction in haematoma, while the 2021 review concluded that sealants more clearly reduce drainage, bruising and swelling than haematoma itself.
• The haemostatic net. This is a series of temporary stitches placed through the skin to close the space under the lifted tissues, removed after two to three days in published studies. Pooled haematoma rates with the net are low, around 0.6% in 2,748 patients across 11 studies of facial and neck surgery, although the evidence was rated low certainty. A 2025 randomised trial comparing the net with drains in 160 patients found no significant difference, and the same meta-analysis rated the comparative evidence as very low certainty. Small red marks where the stitches passed are common and usually fade over two to three months.

Whether drains are used is a separate decision, which I explain in facelift without drains. Which of these measures suit you, and why, is something we go through at consultation.

How haematoma is treated

A large or expanding haematoma means going back to theatre to remove the clot and stop the bleeding point. A small collection found later can often be drained with a needle in the rooms. The reason I’d always rather see you early is that blood left in place can cause contour irregularity, skin discolouration or loss of skin.

Facial nerve injury

This is the complication patients ask me about most, so it’s worth understanding properly.

The facial nerve moves the muscles of facial expression. Within the parotid gland in front of the ear, it divides into branches that come out of the front of the gland and fan out beneath the layers lifted in a facelift. Feeling in the skin is carried by different nerves, which I cover in the next section.

There are three kinds of nerve problem after a facelift:

• Local anaesthetic effect. Weakness in the first few hours that wears off as the anaesthetic does.
• Neuropraxia. The nerve has been stretched, bruised or affected by swelling or heat but is still intact. It recovers, usually over weeks to a few months.
• Division or permanent injury. Uncommon. Recovery may be partial or may not happen, and further treatment may be considered.

How often, and how long recovery takes

A 2025 meta-analysis of 67 studies and 15,404 patients found motor nerve injury, temporary and permanent combined, in 0.66%, and permanent injury in about 0.05%. That’s roughly 1 in 2,000. For deep plane facelifts, a 2026 meta-analysis of 45 studies and 10,784 patients found temporary weakness in 1.2% and no permanent injuries.

Individual series can report much higher temporary rates, depending on how closely weakness is looked for. A 2026 prospective study of 166 patients recorded transient weakness in 11% to 12% at around three months.

As for recovery, a 2025 systematic review found that 80% to 90% of injuries were neuropraxia and that about 70% of affected patients recovered fully within six months. Weakness that lasts beyond the first few days usually resolves within three to four months, although a minority of injuries leave a lasting deficit.

Which branch, and what you’d notice

If weakness lasts

Most weakness is managed by watching and waiting while the nerve recovers. If eye closure is affected, the eye is protected with lubricating drops and taping at night. Where weakness lasts, injections that temporarily relax the matching muscles on the other side can balance the face while recovery continues. Permanent weakness of the brow can be treated with a brow lift, and a nerve divided during surgery may be repaired if it’s recognised.

There’s also a rare pattern of complete one-sided facial weakness, like Bell’s palsy, that can appear after a facelift. A 2024 case series described ten cases, and the authors suggest it be included in consent discussions. I include it in mine.

Numbness and the earlobe (great auricular nerve)

Numbness over the cheeks and around the ears is expected, because small sensory nerve branches are divided as the skin is lifted. Feeling usually comes back gradually over 6 to 12 months, often with tingling or itching along the way.

The great auricular nerve is a different matter. It supplies feeling to the earlobe and lower ear, and the 2021 review describes it as the most commonly injured nerve in facelift surgery, with reported rates up to 7%. Injury leaves the earlobe numb. Most of what we know about recovery comes from parotid surgery, where the nerve is often divided on purpose. In one study of these patients, about half had no numbness at 12 months. Some found it a day-to-day nuisance in the first year, for example when using the phone or wearing earrings, but described it as tolerable and lessening over time. Occasionally a painful nerve ending (a neuroma) forms and needs surgery. Overall, pooled rates of sensory nerve injury are low, at 0.39%, with permanent injury at about 0.05%.

I go through timelines and what to expect in numbness after facelift surgery.

Skin compromise and necrosis

The lifted skin survives on blood vessels coming in from its edges and from the tissue underneath. The skin behind the ear is furthest from that supply and under the most tension, so that’s where problems usually appear. Early signs are skin that turns dusky, purple or dark, or blisters. A small area of skin slough at the wound edge is much more common than full-thickness skin loss.

How often

The 2021 review reports skin slough in about 3.6% of skin-only (subcutaneous) facelifts, falling to under 1% with a deep plane technique, where more of the blood supply stays attached to the skin. A 2026 meta-analysis of deep plane facelifts reported necrosis in 0.1%. In a 2019 meta-analysis comparing facelift techniques, the SMAS flap technique had a significantly higher necrosis rate than SMAS plication, at 1.57%.

Why I’m strict about nicotine

Nicotine narrows the small blood vessels that keep lifted skin alive. The clinical evidence on skin loss is strongest for smoking. For vaping, patches and gum it rests largely on how nicotine acts on blood vessels, which is why I ask patients to avoid every form.

In a classic review of 1,186 facelifts, smokers were 12.46 times more likely to have skin slough. The evidence isn’t all one-sided: a 2018 meta-analysis of smoking in elective plastic surgery found that, in its facelift subgroup, smokers had higher odds of complications that didn’t reach statistical significance. Across all types of surgery, though, a 2012 meta-analysis of 140 cohorts and 479,150 patients found smokers had 3.6 times the odds of tissue necrosis.

There’s no agreed evidence-based nicotine-free interval for facelift surgery. Published advice usually starts at four weeks, and the benefit seems to build with each extra week. I generally require complete cessation of all nicotine products for six to eight weeks before surgery and throughout recovery, and I may use a urine test for cotinine, a nicotine breakdown product, to confirm it. That isn’t about mistrust. A 2013 study found that 4.1% of plastic surgery patients who said they didn’t smoke tested positive. Quitting is hard, and I’d much rather postpone an operation than manage skin loss. More on this in why stopping smoking before facelift surgery is critical.

Other things that raise the risk include too much tension on the skin, very thin skin flaps, an untreated haematoma, poorly controlled diabetes, previous radiotherapy and previous facial surgery.

How it’s treated

Most areas of skin compromise are looked after with dressings and allowed to heal in from the edges over several weeks. Once healing is complete and the scar has matured, a scar revision can be considered if it’s wider or more visible than we’d like.

Infection, seroma and salivary collections

Infection

Infection after a facelift is uncommon. A review of 6,166 facelifts found infection needing readmission to hospital in 0.18%, and most of those patients healed without lasting effects. The 11,300-patient US database found major infection in 0.3%, and the 13,346-patient registry recorded infection in 0.89%. Staphylococcus is the usual cause, and resistant strains have been reported. In the 11,300-patient database, combined procedures (relative risk 3.5) and a body mass index of 25 or more (relative risk 2.8) were linked with more infection.

A single dose of antibiotic before surgery is standard, and the 2021 review found no evidence to support continuing antibiotics afterwards. Signs of infection include spreading redness, warmth, increasing pain, discharge, odour and fever. Treatment is antibiotics and, if a collection has formed, drainage.

Seroma

A seroma is a collection of clear fluid rather than blood. It usually shows up in the first one to two weeks as a soft swelling that can feel as though it moves under the skin, and it often causes little pain. Pooled data for deep plane facelifts report seroma in 1.7%, and the 2025 randomised trial found no difference in seroma between the haemostatic net and drains. A seroma is less urgent than a haematoma, but I still want to see it, because it’s usually drained with a needle in the rooms, sometimes more than once.

Sialocele and salivary fistula

The parotid salivary gland sits in front of and below the ear, beneath the layers lifted in a facelift. If the surface of the gland is injured, saliva can collect under the skin (a sialocele) or leak through the wound (a fistula). After a standard facelift this is rare: a 2012 literature review found only 24 reported cases. It’s more likely when deep neck surgery or reduction of the salivary glands is done, with rates of 0.3% to 2% in published neck lift series.

A sialocele usually appears within the first one to two weeks as a fluid swelling in front of the ear or near the angle of the jaw. It often gets bigger with eating and comes back after it’s drained. In one 2025 case series it appeared 10 to 14 days after surgery. It’s managed with needle drainage and a pressure dressing, sometimes with injections that temporarily reduce saliva production, and it usually settles over several weeks. Occasionally further surgery is needed.

Scars, hair loss and hairline changes

Every facelift leaves scars. They sit in front of and behind the ear and into or along the hairline, and they mature over 12 months or longer. Most fade to fine lines, but scars can widen, thicken or stay red. A 2026 meta-analysis of deep plane facelifts reported raised (hypertrophic) scarring in 2.8%. The risk is higher when the closure is under tension, if you or your family tend to form keloid scars, after infection or skin problems, and with nicotine use. Raised scars are treated with silicone products, steroid injections and, once mature, revision if needed.

Hair loss near the incisions. Temporary shedding along the incisions is common in the first few months, and the hair usually grows back. Permanent loss can happen if follicles are damaged or the scalp closure is tight, and it can be treated with scar revision or hair transplantation.

Hairline and sideburn changes. When a lot of skin is moved, an incision placed inside the hair can raise the temple hairline or shift the sideburn up and back. Healthdirect lists a raised hairline and reduced hair growth at the temples among the possible effects of a facelift. Incision design is the main way to avoid it: where a large skin shift is expected, I place the incision along the hairline rather than inside it. In one surgeon’s series, changing the design of the temple incision cut scar revisions from 4.28% of 865 patients to none of the next 125.

I explain placement and healing in more detail in facelift scars: placement, healing and how to hide them.

Earlobe and ear changes, including pixie ear

Pixie ear is an earlobe that’s been pulled down and forward so that it looks stuck to the cheek rather than hanging freely. It happens when the earlobe ends up carrying tension from the lifted skin as the tissues settle. There isn’t much incidence data: one small series of 44 patients reported it in 5.7%. Prevention comes down to letting the deeper layers carry the lift, so that the skin, and the earlobe especially, is set in place without tension. If it does happen, repair is a minor procedure, usually under local anaesthetic, once the tissues have settled.

Tragal distortion affects the small flap of cartilage in front of the ear canal. If the incision runs behind it and the skin is under tension, the tragus can be pulled forward, flattening it or opening up the view into the ear canal. There are no reliable figures on how often this happens. Careful skin tailoring and matching the incision to your anatomy reduce the risk, and it can be revised.

Asymmetry, contour and results you’re not happy with

No face is symmetrical to begin with, and swelling often settles at different rates on each side. Most early asymmetry resolves with time, which is why I judge the result at 6 to 12 months rather than in the first few weeks.

A complication and a result you’re not happy with aren’t the same thing. The aesthetic outcomes that can lead to a revision include:

• Contour irregularity, such as dimpling or ridging under the skin
• Skin pleats around the ear or in the neck
• Residual laxity, including neck bands that are still visible
• A pulled or swept look, usually when the lift is directed too far back towards the ear rather than upwards
• Visible scars or hairline change, covered above

There are no reliable pooled figures for most of these, and no large validated studies of how often patients are dissatisfied. Single-surgeon series report minor revisions or touch-ups in about 3% to 4% of patients.

Long-term effects. Some changes last beyond the first year, including small patches of altered sensation, the scars themselves, hairline position and earlobe shape. Ageing also carries on after surgery. Two 2026 studies from individual practices reported an average of about 11 years before a second facelift, with a longer gap in patients who were younger at their first operation. Those are averages from particular practices, and how long a result appears to last varies a lot from person to person. A second facelift is a more complex operation, as I explain in signs a revision facelift may be needed and on my revision facelift page.

How you feel along the way. Low mood in the early weeks of recovery is common and usually passes. Body dysmorphic disorder is something different: a preoccupation with perceived flaws that other people barely notice. It’s far more common among people seeking surgery than in the community, at about 13% in cosmetic surgery settings and about 19% across plastic surgery settings in a 2024 meta-analysis, compared with about 2% in the community. Surgery is unlikely to ease that kind of distress, which is why screening is now a requirement before cosmetic surgery in Australia.

Blood clots, anaesthesia and general medical risks

Blood clots

A deep vein thrombosis (DVT) is a clot in a deep vein, usually in the leg. A pulmonary embolism (PE) is when part of a clot travels to the lungs. In a survey covering 9,937 facelifts, DVT occurred in 0.35% and PE in 0.14%, mostly in patients having general anaesthesia. A 2017 analysis of 129,007 cosmetic surgery patients found clots in 0.01% of face-only procedures, rising when face and body procedures were combined.

Preventing clots in facial surgery involves a trade-off. In one series of 126 facelift patients, bleeding after surgery occurred in 16.2% of those given blood-thinning injections compared with 1.1% of those who weren’t, and there were no symptomatic clots in the 89 patients who didn’t receive them. Everyone in that series had sedation rather than general anaesthesia, compression stockings and walking on the day of surgery, so the result doesn’t transfer directly to every setting. Prevention is therefore tailored to the person: compression devices on the legs during surgery, walking early afterwards, keeping the operation to a reasonable length, and medication for patients whose individual risk is higher. Oestrogen-containing hormone therapy and contraception increase clot risk, and whether to pause them is something I decide with you and your prescribing doctor. Long-haul travel soon after surgery adds risk too.

Anaesthesia

General anaesthesia has its own risks, including nausea, a sore throat, reactions to medication and, rarely, heart or breathing problems. The specialist anaesthetist goes through your medical history, medicines and any previous anaesthetic problems beforehand. Studies disagree on whether the type of anaesthesia changes facelift complication rates. The 13,346-patient registry linked general anaesthesia and office-based surgery with more adverse events, and the 2024 review associated local anaesthesia with less haematoma, but older single-centre series reported conflicting results.

I operate under general anaesthesia with a specialist anaesthetist in accredited private hospitals, and you stay overnight. The first night is when haematoma is most likely, so it’s spent where your blood pressure, nausea and swelling can be checked.

Does the facelift technique change the risk?

Facelift techniques differ mainly in which layer of the face is lifted. The deeper the dissection, the more of the skin’s blood supply stays attached, but the closer the surgery works to the branches of the facial nerve. The published comparisons show trade-offs rather than one technique being free of risk.

In the 2019 meta-analysis, which pooled 183 studies, deep plane facelifts had a major haematoma rate of 1.22%, higher than SMAS plication (odds ratio 1.67), and SMAS imbrication also had a significantly higher rate, at 1.92%. Composite lifts, a closely related deep technique, had higher odds of temporary nerve weakness (1.52%, odds ratio 2.22). Permanent nerve injury didn’t differ between techniques. The 2026 prospective study of 166 patients found no significant difference in complications between deep plane and SMAS plication at around three months, although the authors pointed out the short follow-up and unequal group sizes.

These comparisons have real limits. Most of the underlying studies are case series from individual surgeons, the techniques overlap, and a surgeon’s experience with a technique matters at least as much as its name. My facelift surgery is based on a deep plane technique, and I explain to each patient why, along with its trade-offs. I compare the techniques in more detail in the difference between deep plane and traditional facelifts and on my deep plane facelift page.

Combined procedures and laser resurfacing

Doing other procedures at the same time saves you a second anaesthetic and a second recovery, but it makes the operation longer and changes the risk. In the 11,300-patient database, major complications rose from 1.5% after a facelift alone to as high as 3.7% when other procedures were added, and combined procedures were also linked with more infection and, in a separate 129,007-patient analysis, more blood clots. Fat grafting alongside a facelift was considered safe in a 2021 systematic review.

Laser resurfacing at the same time needs particular care, because lifted skin has a reduced blood supply early on. A 2026 meta-analysis of 17 studies and 1,361 patients found complications were uncommon when the two were combined, with skin slough in 0.21% and raised scarring in 0.51%. The same analysis found that treating lifted skin at the same laser energy as the rest of the face was linked with more skin slough, which is why the settings over lifted areas are turned down.

Risk factors: what you can and can’t change

Age on its own isn’t a strong predictor. The 2026 series of 541 patients found age wasn’t an independent risk factor once general health was taken into account, which matches earlier findings that carefully assessed older patients can have surgery with relatively low risk. For men, I schedule additional theatre time and adapt blood pressure management and the neck plan, as I explain in male facelift vs female facelift.

If you’ve lost a lot of weight recently, including with weight-loss medication, tell me, because it’s part of planning. The anaesthetist will also give you specific instructions about any such medicines before surgery.

How risk is reduced at each stage

Facelift risk can’t be removed entirely, but it can be reduced before, during and after surgery.

Before surgery

• A full medical assessment, including blood pressure, medicines, supplements and anaesthetic history
• Complete nicotine cessation, sometimes confirmed by testing
• A plan matched to your anatomy and health, including whether procedures are combined or staged
• A frank conversation about goals, so that your expectations and the planned operation line up

During surgery

• An accredited hospital with a specialist anaesthetist
• Careful control of blood pressure, including as you wake from the anaesthetic
• Heading off nausea and pain before they start
• Meticulous control of bleeding and closure of the space under the lifted tissues
• Compression devices on the legs
• Adjuncts such as fibrin sealant or a haemostatic net, used selectively

After surgery

• An overnight stay in hospital
• Keeping your head up, and avoiding bending, straining and heavy lifting
• Pain, nausea and blood pressure control at home
• Reviews with me at around day 3 and day 7, with stitches removed in stages from day 7
• Telling us about any change early rather than waiting for the next appointment

The usual recovery pattern is set out in recovery after facelift and the deep plane facelift recovery timeline.

Warning signs: when to call

Call the practice the same day, on the number you’re given when you leave hospital, if you notice:

• Swelling that increases quickly, especially on one side, or feels tight and firm
• Pain that’s getting worse rather than settling, or isn’t controlled by your prescribed pain relief
• Bleeding that soaks through the dressings
• Skin that turns dark, purple or black, or blisters, particularly behind the ears
• A temperature above 38°C, spreading redness, warmth, discharge or odour from a wound
• New weakness of the face, or difficulty closing an eye
• Swelling near the angle of the jaw that gets bigger with eating, or clear fluid leaking from a wound
• Pain, tenderness or swelling in one calf

Call 000 for difficulty breathing or swallowing, chest pain, sudden breathlessness or collapse.

Please don’t sit on it. I would far rather hear from you early and reassure you than see a problem late. Many calls turn out to be normal healing, and the problems that aren’t are generally easier to treat when they’re found early.

How complications are treated

I generally wait until swelling has settled and the tissues have softened, usually 6 to 12 months after surgery, before doing a revision, unless there’s an urgent reason to act sooner. Before any surgery, it’s reasonable to ask in writing how the cost of treating a complication or a revision would be handled, and to check with your health fund what it does and doesn’t cover.

Australian safeguards before cosmetic surgery

Since 1 July 2023, Medical Board of Australia guidelines have set out what has to happen before any cosmetic surgery, including a facelift. In practice, that means:

• A referral, preferably from your usual GP, or otherwise from another GP or a specialist who works independently of the surgeon and doesn’t perform cosmetic procedures
• At least two consultations before surgery, at least one of them in person with the surgeon who will operate
• Consent that can’t be signed at the first consultation
• A cooling-off period of at least seven days after the second consultation and signed consent, before surgery is booked or a deposit is paid
• Screening for body dysmorphic disorder using a validated tool, with referral for independent assessment if significant issues come up

A few other checks are worth doing yourself:

• Registration. The public register on the Ahpra website shows whether a doctor holds specialist registration, for example in plastic surgery, and whether any conditions apply to their practice.
• The hospital. Surgery under general anaesthesia should be done in an accredited hospital with a specialist anaesthetist.
• Aftercare. Ask who looks after you out of hours, and who manages a complication if one happens.
• Surgery overseas. Follow-up and early treatment of complications are much harder when your surgeon is a flight away.

There’s a fuller checklist in how to choose a facelift surgeon.

What to do if something goes wrong

1. For urgent symptoms, contact your surgeon straight away, or call 000 or go to the nearest emergency department if the symptoms are severe.
2. For anything less urgent, raise it at your next review or call sooner. The surgeon who operated knows exactly what was done and is usually well placed to assess a problem first.
3. Keep a record of dates, symptoms, photos and medicines. It helps any doctor who reviews the problem.
4. A second opinion from another Specialist Plastic Surgeon is reasonable if a problem isn’t settling or the explanation isn’t clear.
5. If you need to make a complaint, you can raise it with the practitioner or hospital, and with Ahpra through its Cosmetic Surgery Hotline (1300 361 041). Ahpra’s published view is that a non-disclosure agreement doesn’t prevent a complaint to Ahpra. Ahpra can’t arrange compensation or financial settlements; for those, the health complaints entity in your state or territory is the place to go.

Broader information on surgical risk across procedures is on my risks and complications of cosmetic surgery page. If you’d like to talk through your own risk, you can contact the practice.

Frequently asked questions

Is a facelift a risky surgery?

A facelift is major surgery, and every operation carries some risk. In a US database of 11,300 facelifts, 1.8% of patients had a major complication within 30 days, meaning an emergency visit, a hospital admission or a return to theatre. Most complications can be treated and don’t decide the final result. Your own risk depends on your health, nicotine use, blood pressure, sex and whether other procedures are combined, and we go through it in detail at consultation.

What is the most common complication after a facelift?

Haematoma, a collection of blood under the lifted skin, is the most common complication that needs a return to theatre. Large databases report it in about 1% to 2% of patients, and about nine in ten appear within the first 24 hours. High blood pressure, being male and aspirin or anti-inflammatory medicines all raise the risk. Sudden swelling on one side with pain that’s getting worse needs a call the same day, because a large haematoma is treated by going back to theatre.

Can facelift nerve damage be permanent, and how long does recovery take?

Permanent motor nerve injury is rare, reported in about 0.05% of patients in a 2025 meta-analysis of more than 15,000 people. Temporary weakness is more common, at about 0.7% to 1.2% in pooled studies, and is usually caused by stretching or bruising of a nerve that’s still intact. About 70% of affected patients recover fully within six months; a smaller group recover more slowly or only partly. Numbness of the cheeks and ears is a separate, expected effect that settles over 6 to 12 months.

What are the signs of a bad facelift, and can it be fixed?

The signs I look for are a pulled or swept look, earlobes pulled down onto the cheek, a raised or shifted hairline, visible or widened scars, skin pleats and leftover neck laxity. Many early irregularities settle as the swelling goes down, so I judge the result at 6 to 12 months. Single-surgeon series report minor revisions in about 3% to 4% of patients. Most of these problems can be revised, although a second operation is more complex than the first.

Is a deep plane facelift riskier than a SMAS facelift?

The evidence shows trade-offs rather than a simple answer. A deep plane technique keeps more of the skin’s blood supply, and skin slough falls from about 3.6% after skin-only lifts to under 1%. In a 2019 meta-analysis, deep plane lifts had a somewhat higher major haematoma rate than SMAS plication, and composite lifts, a closely related technique, had more temporary nerve weakness, while permanent nerve injury didn’t differ. Most comparisons come from individual surgeons’ case series, so a surgeon’s experience with the chosen technique matters as much as the technique itself.