What is the most common complication after a facelift?

Haematoma, a collection of blood beneath the skin flap, is the most frequently reported significant early complication. It usually appears within the first 24 to 48 hours and presents as rapidly increasing swelling on one side with escalating pain. It is treated urgently, often by returning to theatre to evacuate the collection, because pressure on the flap can compromise its blood supply.

How likely is nerve damage from a facelift?

Facial nerve injury is uncommon, and the great majority of cases are temporary, caused by stretching or bruising rather than division of the nerve, recovering over weeks to months. Permanent weakness is possible but rare. We do not publish a percentage because reported rates vary widely by technique, definition and case series. Ask your surgeon for their own experience with the specific operation they are proposing.

Can I have a facelift if I smoke?

Many surgeons will decline, and those who proceed will require complete abstinence for a specified period before and after surgery. Nicotine constricts the small vessels supplying a raised skin flap, and the association with wound healing problems and skin necrosis is well recognised. Vaping and nicotine replacement products deliver nicotine and are not an acceptable substitute during that period.

What is pixie ear and can it be avoided?

Pixie ear describes an earlobe pulled downwards so that it appears attached to the cheek rather than hanging free. It results from tension being placed on skin rather than on the SMAS, which is a technique issue rather than bad luck. It is largely avoidable by proper incision design and tension distribution, and it is considerably harder to correct after the event than to prevent.

Will my facelift scars be visible?

Facelift scars are permanent, but well designed incisions sit within hair, inside the natural creases of the ear and behind it, where they are difficult to see once mature. They pass through a red and firm phase before flattening over roughly twelve months. Some people form widened or raised scars, and anyone with a personal or family history of keloid scarring should raise it specifically at consultation.

What is a normal revision rate for facelift surgery?

There is no single meaningful figure, because practices count revision differently. A surgeon who offers minor refinements freely will report a higher rate than one who does not, and the higher number may indicate better aftercare rather than worse surgery. Ask your surgeon what their revision rate is and, more importantly, what it includes and who pays for it.

Facelift risks and complications

01How to read a risk list

Every operation carries risk, and the useful question is never whether something can go wrong. It is how likely a given event is, how serious it would be if it happened, whether it is temporary or permanent, and what would be done about it. Those four questions are the frame for everything below.

We deliberately do not publish percentages on this page. Published rates for facelift complications vary widely between studies depending on technique, patient selection, how complications are defined and whether the series comes from a single surgeon or a registry. Quoting a single figure would suggest a precision that does not exist. Your surgeon should give you their own experience and the figures they work from, and you should ask for them.

What to ask for instead of a number. Ask your surgeon how many of this specific operation they perform in a year, what their own rate of return to theatre is, what their revision rate is, and what the last complication they managed was. A surgeon who can answer those without hesitation is a surgeon who audits their work.

02Haematoma

A haematoma is a collection of blood that accumulates beneath the raised skin flap. It is the most frequently reported significant early complication of facelift surgery and the one most likely to require unplanned surgical management.

How it presents. Usually within the first 24 to 48 hours, most often in the first twelve. The characteristic picture is rapidly increasing swelling on one side, escalating pain that does not respond to the analgesia you have been given, and sometimes a feeling of pressure or tightness that is clearly different from the general tightness of the operation. It is one sided far more often than not.

Why it matters. A large or expanding haematoma puts pressure on the skin flap and compromises its blood supply. Left alone, that pressure is what turns a manageable event into skin loss. This is why it is treated urgently rather than observed.

How it is managed. A small haematoma may be aspirated or drained under local anaesthetic. A significant one usually means returning to theatre so that the flap can be opened, the collection evacuated, and any bleeding point controlled. Managed promptly, the eventual result is generally unaffected.

What raises the risk. Uncontrolled or poorly controlled blood pressure, which is why surgeons take blood pressure seriously before and after surgery. Medicines and supplements that affect clotting, which is why you will be asked for a complete list including anything bought over the counter. Straining, vomiting, coughing and vigorous activity in the first days. And, in the reported literature, male patients appear more affected, which is generally attributed to the greater blood supply of facial hair bearing skin.

03Facial nerve injury

This is the complication patients fear most, and the fear is disproportionate to the frequency while being entirely proportionate to the consequence.

The facial nerve controls the muscles of facial expression. It divides into branches that supply different regions, and several of those branches run close to the planes a facelift dissects through. The branches most often discussed in this context are the one supplying the muscles of the lower lip, the one supplying the frontal region and eyebrow, and the branch affecting the cheek.

How it presents. Weakness or absence of movement in a specific area: an eyebrow that will not raise, a lower lip that does not pull down evenly when you smile or speak, an asymmetric smile. It is usually noticed in the first days once swelling begins to settle.

Temporary or permanent. The great majority of facial nerve weakness after facelift surgery is temporary, caused by stretching, bruising or local anaesthetic rather than by division of the nerve, and recovers over weeks to months. Permanent weakness is uncommon but is a recognised possibility, and it is not correctable in the sense that most other complications are.

What affects the risk. The plane of dissection, since working beneath the SMAS runs closer to certain branches. The extent of the operation. Individual anatomical variation, which is real and unpredictable. And, more than any other factor, the surgeon's familiarity with the specific plane they are working in.

Sensory nerve effects are a separate matter and much more common. The great auricular nerve, which supplies sensation to the ear and the skin below it, sits in the operative field. Numbness in that distribution is near universal after facelift surgery and usually recovers over months, though a small area of permanently reduced sensation near the earlobe is possible.

04Skin flap necrosis, and the smoking problem

Raising a skin flap means the skin's blood supply is temporarily reduced to what reaches it through the remaining attachments. If that supply is inadequate, the skin at the most distal part of the flap, typically behind the ear, can die. That is skin necrosis, and it is one of the few facelift complications that can produce permanent visible damage.

How it presents. Skin that becomes dusky, purple, dark or black, sometimes with blistering. It usually appears in the first days. This is a reason to contact your team, not to wait.

How it is managed. Small areas may be managed conservatively with wound care and allowed to heal, which can take weeks and may leave a scar requiring later revision. Larger areas need active management and may need reconstructive work later.

Smoking is the dominant modifiable risk factor. Nicotine constricts the small blood vessels that a raised flap depends on. The relationship between smoking and wound healing problems in facelift surgery is well recognised, which is why many surgeons decline to operate on current smokers and why those who do proceed require complete abstinence for a stated period before and after surgery. Vaping and nicotine replacement deliver nicotine too and are not a workaround. This is not a moralising position. It is the one variable in this list that a patient controls completely.

Other contributors include tension at the wound edge, which is one of the arguments made for techniques that place tension in the SMAS rather than the skin, haematoma putting pressure on the flap, diabetes and some vascular conditions.

05Scars, hairline and earlobe

A facelift always leaves scars. The aim of good incision design is not to avoid them but to place them where hair, shadow and the natural creases of the ear conceal them.

Where the scars go. Well designed incisions sit inside hair and within the natural creases of the ear. Poorly designed ones displace the hairline and pull the earlobe down.

Scar quality

Scars pass through a red, firm phase before flattening and fading over roughly twelve months. Some people form widened, raised or hypertrophic scars, and a minority form keloid, which is more common in some skin types and is worth raising specifically if you or your family have a history of it. Sun exposure on immature scars produces darker, more visible results, which is why protection through the first year matters.

Hairline distortion

The temporal hairline can be displaced backwards if skin is advanced without accounting for it, and the result is a hairline that sits higher or further back on one or both sides, along with an area of bare skin where hair used to be. Similarly, the hairline behind the ear can be stepped, so that the hair no longer meets in a continuous line. Both are largely preventable by incision design that respects the hairline, and both are far harder to correct afterwards than to avoid.

The earlobe

The pixie ear deformity, in which the earlobe is pulled downwards and appears attached to the cheek rather than hanging free, is the classic sign of a facelift where tension was placed on skin rather than on the SMAS. It is a technique issue, not bad luck. It is also difficult to correct.

Hair loss around incisions

Temporary shedding of hair near the incisions is common and usually recovers. Permanent loss along the scar itself is possible, particularly where tension was high.

06Other recognised complications

Infection

Uncommon in facial surgery, which has an excellent blood supply.
Presents with spreading redness, heat, fever or discharge.
Usually responds to antibiotics; occasionally needs drainage.

Seroma

A collection of clear fluid rather than blood.
Usually appears later than a haematoma.
Often managed by aspiration in clinic.

Asymmetry

Every face is asymmetric before surgery and remains so afterwards.
Early asymmetry is usually swelling and should not be judged before six months.
Persistent asymmetry may be addressed at revision.

Anaesthetic risk

Applies to any operation and depends on your general health.
Discussed by the anaesthetist rather than the surgeon.
Includes the risk of clots, which is why mobilising early matters.

Salivary gland injury

Uncommon, associated with deeper dissection.
Can produce a persistent collection of saliva needing management.

Prolonged swelling and firmness

Not a complication as such, but a common source of distress.
Resolves over months rather than weeks.

07Revision, and how to think about it

Revision surgery after a facelift happens for several different reasons, and they are worth separating because they are not equally the surgeon's responsibility.

Correction of a complication

Scar revision after a wound healing problem, correction of an earlobe, or addressing hairline displacement. These are corrections of something that went wrong.

Refinement of the result

A small area of residual laxity, an asymmetry that persists past six months, or a feature that did not respond as expected. Common enough that many practices have a stated policy on it.

Further ageing

A second lift years later because the face has continued to age. This is not a failure of the first operation, and it is generally priced as new surgery.

We do not publish revision rates on this site, because the figures reported in the literature and by individual practices depend heavily on what is counted as a revision. A practice that offers a touch up freely will report a higher revision rate than one that does not, and the higher number may reflect better care rather than worse. Ask your surgeon for their own figure and, more usefully, for what it includes.

Establish the revision position in writing before surgery. On what basis would revision be offered, within what timeframe, and who pays for the surgeon, the theatre and the anaesthetist? The answer varies considerably between practices and is far easier to discuss before an operation than after one.

08What you can actually control

Stop smoking completely, for the period your surgeon specifies, including vaping and nicotine replacement.
Disclose every medicine and supplement, including anything herbal or bought over the counter, because several affect clotting.
Get blood pressure properly controlled before surgery, not on the day.
Choose the surgeon before the price, since the biggest single variable in this list is who operates.
Follow the activity restrictions, particularly around lifting and exercise in the first fortnight.
Have someone with you for the first 24 to 48 hours.
Know the urgent signs and know how to contact your team out of hours.

The NHS publishes general guidance on considering cosmetic procedures, and the Royal College of Surgeons of England sets out professional standards for cosmetic surgery including what should be covered during consent. Read both before you sign anything. Then take our consultation checklist with you and work through the recovery timeline so you know what normal looks like.