New techniques and years of experience have made facelifts far safer and more successful than they were even 10 years ago, and most patients are very pleased with the outcome.
Every patient is an individual and reacts uniquely to the whole procedure, so generalizations are of limited value. Your surgeon will discuss possible complications with you in a discussion customized to your particular features, strengths and weaknesses.
However, there are seven main potential complications as follows.
Hematoma
This is a pooling of blood under the skin, where it will clot, as blood does when it isn’t moving. A minor hematoma, if it’s going to happen at all, will usually show up within the first two weeks post-op as a localized swelling. It can be drained with a needle and usually a pressure dressing will be applied. It will usually resolve nicely, though sometimes a slight irregularity in the tissue remains. If neglected, it can lead to infection and even necrosis (death) of the skin.
A major hematoma is a medical emergency and must be surgically drained as soon as possible. If it’s going to occur, it will be within the first 12 hours post-op. It’s accompanied by pain, hypertension, swelling, and general agitation. Sometimes they can be caused during the recovery time by excessive coughing or vomiting. If detected early, scarring and necrosis of the tissue can be avoided.
Hematomas are more common in men and the reason for this is still being debated.
Nerve Injury
This is probably the most dreaded complication after a facelift, but it’s very rare. There are two types of nerves that could be affected: nerves that affect movement and nerves that affect feeling. Damage to the first type will cause asymmetrical facial movement or paralysis; and damage to the second causes numbness.
Usually, any paralysis or numbness is temporary and is the result of a nerve’s conduction of impulses being interfered with, but not the result of any structural damage to the nerve. It could also be a result of the anesthetic. Sometimes it’s caused by a hematoma being formed in that place and post-op monitoring should catch this and deal with it.
It’s not uncommon for people to feel a weakness in the lips during the first couple of days post-op.
Infection
If this occurs, the symptoms will be noticeable: fever, chills, pain, facial swelling, and drainage from the face. Again, it can be the result of a hematoma forming, and can also be caused by wound contamination. Anyone with diabetes will be pre-disposed towards it, but the plastic surgeon will either not perform the procedure on a diabetic, or will discuss it with the patient beforehand and will watch closely for any signs of infection.
Usually the infection will be from staphylococcus and if it occurs, will be minor. An oral antibiotic will be prescribed. Major infections are rare and will require intravenous antibiotics. If treatment is delayed, there might be some residual irregularity in the tissue.
Skin flap necrosis
A skin flap is a piece of skin, taken from another part of the body, that the surgeon stitches in place where tissue has been removed. It has its own subcutaneous tissue with small blood vessels and usually it merges with the surrounding tissue leaving slight scarring only. But sometimes not enough blood circulates through it in the early stage so that it becomes cyanotic (bluish colored from lack of oxygen) and then necrotic (dead). When cyanotic it can be treated and enabled to fuse with the surrounding skin.
Necrosis is more likely to happen in larger skin flaps and in people who’ve smoked for a long period (and therefore have impaired circulation). It can also be caused by an underlying hematoma or an infection. Sometimes it heals with a large, thick scar known as a hypertrophic scar.
Hypertrophic scarring
When the incision is behind the ear, it can heal into a large scar because of the tension in the area, from the skin having been pulled back and stitched into its new position. Sometimes extra tension is the result of less-than-perfect skin re-draping, or inaccurate placement of the incision.
It can be repaired to some extent by either corticosteroid injections at the site, or silicone gel treatment. Full scar revision is not done until the wound is fully healed, several months later.
Alopecia (hair loss)
Again because of excess tension at the suture line, hair can be lost, but it will be temporary. Sometimes too the hair follicles are traumatized by the incision, but will recover, usually within three months.
Any permanent hair loss can be corrected with micrografts, minigrafts or skin flaps.
Parotid gland pseudocyst
This is a name for an infection and swelling in the main salivary gland, which is just in front of, and below, the ear. If it’s going to happen, it will be between the third and tenth day post-op. The fluid can be aspirated with a needle, in several sessions, or maybe will need a suction drain inserted into the site. It will usually get resolved within 3 weeks.
Minor post-op conditions
There’s always a certain amount of swelling, which sometimes becomes prolonged and takes several weeks to subside.
Because the skin is stretched during the surgery, there can be changes in the skin, such as persistent bruises and increased pigmentation. Small veins visible before surgery may become more visible afterwards. In older people, or anyone with thinner skin, damage may show up where the skin was punctured.
