Risks of Face Lift Surgery (Rhytidectomy)

Face Lifts: Risks and Complications

List of possible complications:
Abnormal facial contour
Anesthesia reaction
Attached earlobe
Blistering of skin (may lead to permanent scarring)
Ear nerve damage (risk is less than 1%)
Early Relapse (risk is less than 1%)
Facial weakness or paralysis
Hematoma (risk is 3-4%)
Infection (risk is less than 1%)
Injury to facial nerves (temporary or permanent)
Keloid (heavy scar)
Loss of sideburns
Nerve Damage
Open ear canal
Permanent numbness (risk is less than 1%)
Reactions to medications
Skin irregularities
Skin necrosis or skin death (1500% more likely with smokers)
Slow healing
Tight face
Visible scar
Weak facial muscles (usually temporary)

Although complications and bad results are infrequent for face-lifts, they do occur. Some complications require further surgery. Complications can cause slow healing, abnormal scarring, discomfort, inconvenience and permanent deformity.

Complications, especially blistering and skin death, are seen much more frequently in smokers. One major study concluded that smokers had a 1500% increase in complications following a face-lift. It is strongly advised to quit smoking as soon as possible, but at least a month prior to surgery and for four weeks following the procedure.

You can help minimize your risks by choosing a board certifed surgeon and carefully following the advice and instructions of your surgeon.

Face Lift Scars

Surgical scars are permanent. However, the incisions are placed so that they are not normally noticeable except on very close observation (they usually run in the natural contours of the ear beginning in front of the earlobe and extending behind the ear into the hairline).

General Risks and Complications

Cosmetic surgery has a low rate of complications among board certified plastic surgeons. However, every surgery carries risk. Be sure to discuss the possible risks and complications with your plastic surgeon so you feel fully informed before surgery.

Risks with any surgery

Anesthesia/Sedation Complications

Some patients have serious reactions to the anesthesia or sedation used during surgery. Most anesthetic complications occur with general anesthesia.

Possible complications:
  • abnormal heart rhythm
  • airway obstruction
  • blood clots
  • brain damage
  • death
  • heart attack
  • malignant hyperthermia
  • nerve damage
  • stroke
  • temporary paralysis
Airway obstruction: Anesthesia can sometimes irritate air passages, causing the vocal cords to spasm and this can block the airway. The anesthesiologist may need to insert a tube down the throat or cut into the windpipe.

Brain Damage: Brain damage can occur if blood circulation is depressed at dangerous levels.

Malignant Hyperthermia: This is a rare complication where body temperature, blood pressure and heart rate all rise to hyperactive levels. If not recognized and treated quickly, can lead to death. This may be inherited.

Temporary paralysis: This occurs if muscle relaxants have not fully worn off after surgery. It is easy to detect and easily treatable.

Patients who have heart trouble, lung disease or are obese are at greater risk of complications due to anesthesia. To reduce your risk, tell your doctor about any medications you are on and let her know your complete medical history.

Aspiration occurs if you vomit (aspirate) during surgery and the vomit is forced into the lungs. Aspiration can cause mild discomfort, and can also lead to infections, chronic cough, an obstruction in the lungs or pneumonia.

Blood Loss
Bleeding is normal with any procedure. However, if there is excessive bleeding, it can create major complications. If this occurs during surgery, your plastic surgeon and anesthesiologist will be aware of by pooling blood or by a blood pressure drop. If bleeding occur after surgery, it can accumulate under the skin and require an additional surgery. Discuss with your physician what you can expect as far as bleeding and bruising.

Blood Clots (DVT)
A blood clot in the veins can be fatal. Longer operating time and general anesthesia increase the risk of a DVT. They can occur as a result of a medical condition or from immobilization (which allows the blood to pool) such as pregnancy, international airplane flights, and recovery from surgery. They are difficult to predict. To help prevent them, during recovery do not stay in one position for too long and flex your feet often. Patients who have liposuction in their legs are at higher risk. Compression garments worn reduce the risk of DVT.

Drop in Blood Pressure
Some decrease in blood pressure is normal during surgery. However, a sudden drop due to blood loss could lead to irregular heart beat and possibly a heart attack.

The risk of infection is less than 1% and antibiotics reduce this risk dramatically. However, if infection does occur, it is very serious. People who smoke, take steroids or have certain vascular conditions are at greater risk. The longer your surgery lasts and the more blood you lose, the more likely you are to have an infection.

Loose Sutures
If the sutures come loose this can lead to internal bleeding or a hernia. Such problems would require additional surgery.

Source: The Surgery Handbook.

General Risks for Cosmetic Surgery

See specific procedures for more information

Skin Death or Necrosis: usually follows an infection or hematoma and is much more likely among smokers. The skin is excised (surgically removed) and this may affect the cosmetic outcome.

Asymmetry: moderate or severe asymmetries may require a second surgery. Mild asymmetry is normal.

Slow Healing: due to age, skin type, failure to follow doctor's advice or factors beyond anyone's control.

Numbness/Tingling: often temporary, sometimes permanent loss of sensation. This results from injury to sensory or motor nerves.

Irregularities, dimples, puckers, and divots: can be due to surgeon error, healing irregularities or body make-up.

Seroma: fluid can collect under the skin and can occur after breast augmentation, liposuction or a tummy tuck.

The American Society for Aesthetic Plastic Surgery (ASAPS) has a very informative article about outpatient surgery:

What You Should Know About the Safety of Outpatient Plastic Surgery

Plastic surgery procedures performed in accredited surgical facilities by board-certified plastic surgeons have an excellent safety record. A 1997 survey1 based on more than 400,000 operations performed in accredited facilities found that:
  • The rate of serious complications was less than half of 1 percent.
  • The mortality rate was extremely low – only one in 57,000 cases.
  • The overall risk of serious complications in an accredited office surgical facility is comparable with the risk in a freestanding surgical center or hospital ambulatory surgical facility.

You will also be evaluated for other factors that may increase the risk of blood clots. These include:
  • being extremely overweight
  • having recent traumatic injury
  • any disorder of the heart, lungs or central nervous system
  • a history of cancer, recurrent severe infection or genetic problems that affect blood clotting
For women, additional risk factors include:
  • taking oral contraceptives or having recently ceased taking them
  • undergoing hormone-replacement therapy

If you are considered low risk, your doctor may simply ensure that you are positioned on the operating table in a way that allows for adequate blood circulation to the legs. If you are of moderate or high risk for developing blood clots, you may also be advised to wear elastic stockings before, during and after your procedure, or to take special anti-clotting medications. Compression devices on the legs may be used during surgery to support your normal circulation.

1. Morello, D.C., Colon, G.A., Fredericks, S., Iverson, R., Singer, R. Patient safety in accredited office surgical facilities. Plast. Reconstr. Surg. 99: 1496, 1997.

Information provided is for general education about face lifts and other cosmetic plastic surgery procedures. This information is subject to change. Smart Face does not guarantee that it is accurate or complete, and is not responsible for any actions resulting from the use of this information. General information provided in this fashion should not be construed as specific medical advice or recommendation, and is not a substitute for a consultation and physical examination by a physician. Only discussion of your individual needs with a qualified physician will determine the best method of treatment for you. All board certified plastic surgeons listed are board certified by the American Board of Plastic Surgery. Board certified plastic surgeons are verified by the American Board of Medical Specialties.

© Copyright 2002-2013. Smart Face All rights reserved.