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Face Lifts - Rhytidectomy



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There is going to be some expected discomfort with having a facelift procedure.  Because having a facelift is major surgery, there are some surgery related risks involved as well.  However, most consider the risks infrequent and minor.

List of possible complications:



The blood has collected under the skin and may have to be removed. Hematoma is the most common complication after rhytidectomy.  Hematoma risks are higher in men than in women.  Other factors that are associated with an increased risk of hematoma include anterior platysmaplasty (neck lift), high systolic blood pressure, aspirin or anti-inflammatory medications were not stopped before surgery, and smoking.

Read more about Hematomas




A seroma is fluid accumulations between the skin and the underlying tissues.  If this complication arises, it may require additional procedures for proper drainage of fluid.

Read more about Seromas




Permanent motor nerve paralysis can occur after a rhytidectomy. Depending on the extent of the facelift, injury to the facial nerve can occur up to 1-2% of the time. The facial nerve is the nerve that provides motion for the face.  Injury to the zygomatic branch of the facial nerve can result in temporary weakness of the lower eyelid muscle.  Should injury arises, a temporary or possibly permanent asymmetry to the smile and facial expressions may occur.

The nerves most commonly injured are:

  • marginal mandibular branch - temporary weakness of the corner of the mouth

  • frontal branch - temporary weakness of facial nerve responsible for raising the brow

  • buccal branch - temporary weakness of the mouth area - difficulty eating -flaccid cheek area




The human face is normally not symmetrical to being with.  There can be distinct differences between one side of the face versus the other.  During your consultation with your surgeon, he or she will tell you what the chances are for this happening with a rhytidectomy (face lift).




During any surgical procedure where the skin is broken, infection can be a risk. 

Symptoms of an infection are:

  • redness

  • drainage from the incision site that is not clear

  • sensitivity

  • localized heat

  • swelling  

Most surgeons put their patients on oral antibiotics after the rhytidectomy (face lift) procedure to prevent this complication from occurring.

Read more about infections




Blistering of the skin near the incisions seems to be a complication that is seen more often with smokers.




Each time surgery is performed on any part of the body the risk of bleeding is there.  Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after cosmetic surgery. Bleeding risks can start from the day of surgery to several days after the procedure. It is important during the recovery period that the patient does not get their blood pressure elevated or their heart rate increased - as this can add to the risk of possible bleeding.  If bleeding does occur and it is not stopped sometimes a wound will have to be surgically opened - and the blood vessels contributing to the bleeding will have to be cauterized. 




With the procedure rhytidectomy (face lift) - the patient might experience some numbness after the procedure.  For the most part, this is common and the numbness generally is only temporary.  However, sometimes numbness can be a permanent situation with this procedure.




Deeper structures such as blood vessels, muscles, and particularly nerves may be damaged during a rhytidectomy.  Different techniques can sometimes have higher risks than others.  Injury to these deeper structures can be temporary or permanent.




Changes can occur in the positioning of the earlobe and tragus (cartilage in front of the ear opening) after a face lift procedure.




An attached earlobe or "pixie ear" occurs when too much skin has been removed nearby.  The remaining, stretched skin pulls the earlobe area down and into the surrounding skin.  It can be corrected through minor surgery.




A wide open ear canal appears unnatural.  Cartilage in front of the ear canal partially hides the canal from view.  If a face lift places tension on the skin of this cartilage, it will be pulled forward and widen the canal.  Most people do not notice a wide open ear canal and are not bothered by it. This complication can be difficult to fix until the facial skin loosens up from the face lift.  Most who desire to have this fixed may need to wait for the next face lift.




Some cheek numbness is expected after a face lift procedure - however numbness of the ear is not.  Temporary numbness of the skin surrounding the ear can be caused by surgical injury of the great auricular nerve.  If this nerve is severed, permanent numbness can be the result.  Damage to the great auricular nerve is very rare, occurring in less than 1 percent of patients.  If the nerve is severed or cut during surgery and is recognized - it can be repaired.  Recovery of sensation can be partial or complete with also having sharp pains in the neck or ear.




After a face lift and while healing, the incision lines can be red for a time period.   This eventually does lessen as you continue to heal during recovery. 

Read our Wound Color Chart




Pain associated with a rhytidectomy is generally for the most part moderate to minimal, however some patients have a harder time than others simply because everyone's own pain threshold is so different. Your surgeon will be prescribing narcotic pain medication for several days after surgery, to make sure you are comfortable during the initial recovery.




Your surgeon will  provide medications before surgery to prevent nausea and vomiting, and surgeons monitor patients before, during and after surgery as precautionary measures for serious complications. Speak to your surgeon about changing medications if you are experiencing any allergic reaction or side effect.  If you have a reaction to any medication that has been given to you, contact your plastic surgeon immediately.




For patients that are known to keloid or have hypertrophic scarring, it is best to ask your plastic surgeon what type of face lift is going to be right for you.   Most surgeons believe that the best way to prevent keloids is meticulous, expert technique.  Not too much tension on the closure with clever suturing.  The mini-lift is known for producing keloid scars.  Reasoning is because there is too much tension placed on the incisions and they tend to stretch out causing excessive scarring.  Patients who are darker skin have more melatonin in their tissue, and tend to get hypertrophic or keloid scarring much easier.

Read our section on hypertrophic and keloid scarring




As with all surgeries that require general or twilight anesthesia, nausea and vomiting can sometimes happen.  Your surgeon will prescribe a anti-enemic (anti-nausea) medication to help you alleviate this symptom if it should occur.  Also, the medication you are prescribed to take after the procedure, the antibiotics and also the pain medication can also contribute to nausea.  Make sure you always take your medication on a full stomach. 




Hair loss in the incision lines can occur with having a face lift procedure. This is generally temporary but can be permanent.




Men's sideburns will migrate upward with each face lift.  After two face lifts, sideburns can be lost completely.  Many women do not consider sideburns a vital facial feature, but some do realize their importance if they are lost.  Modification in surgical technique may preserve the sideburn area.  This complication can be difficult to correct.




Bruising and swelling normally occurs following a rhytidectomy or face lift procedure. The skin near the incision site can appear either light or darker than the surrounding tissue.   In rare circumstances, swelling and skin discoloration or bruising can be permanent or lasts for long periods of time following the face lift procedure. 




There are many surgeons who believe that any face lift procedure done with a patient who smokes is taking undue chances with not being able to heal correctly.  Most surgeons prefer their patient to quit smoking prior to any elective cosmetic procedure, especially a rhytidectomy (face lift).  The nicotine from the cigarette smoke constricts the blood vessels not allowing the healthy tissue the oxygen it needs to heal.  The carbon monoxide smoke starves the healing tissue of much needed oxygen as well.  Quitting for at least two to four weeks before and at least two to four weeks after your face lift procedure will help to ensure of a much better result.  Blistering and skin death are also seen much more frequently with smokers.

Read more about Cosmetic Surgery and Smoking





A tightly pulled face lift is known as the "wind-tunnel" look.  This appears unnatural and results from removing too much skin.  This also can develop from a patient having multiple face lifts.  Once the skin has been removed, it cannot be easily replaced.  This complication can be difficult to correct.




The possibility of a substandard result from a face lift can occur.

The following can occur during a rhytidectomy (face lift):

  • unacceptable visible deformities

  • loss of facial movement

  • wound disruption

  • loss of sensation

  • disappointed with the results of the procedure

Sometimes it is necessary to perform additional cosmetic surgery to improve your results.




Early relapse is the premature return of sagging skin and jowls, well before the give 7 to 10 year time that a face lift is expected to last.  Relapse may occur within six months.  The cause of relapse is not really clear, but it seems to be more common in women with fair complexions and sun damaged skin.  Early relapse occurs in 1 percent and can be treated by another face lift, which is normally for the most part - longer lasting.




With any surgical procedure, most patients will experience some sort of emotional let down after surgery.  Face lift (rhytidectomy) patients are no exception.  The chemical changes that occur in our bodies after extensive surgery, high expectations of seeing a change immediately all can contribute to post operative depression.  Most patients are aware of this happening and can usually work things out on their own. 

The main factors causing depression after surgery are:

  • medications

  • post-surgical traumatic stress syndrome

  • constipation from the medications

  • long period of just lying in bed

  • being restricted to many activities

There are many plastic surgery patients feeling the after-effects of the surgery not only on their own body - but also their mind.  Finding a group of people to talk about your situation will help tremendously and help the recovery period.  The forum on  is here for patients to help them understand their thoughts and see how other cosmetic surgery patients have dealt with it.  However, if the depression is worse and you feel you need some professional guidance, be sure you contact your plastic surgeon so he is aware of what you are going through. 





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