Facelift Risks and Complications: Haematoma, Nerve Injury, Healing and Scars
Key takeaways
- The most common complication is a haematoma, a collection of blood under the skin, at roughly 1 to 7%; it is much more common in men (about 6% in one series versus near 0% in women) and in smokers and people with high blood pressure.
- Nerve injury is usually temporary: weakness of the nerves to the forehead or lower lip most often recovers within 3 to 4 months, and permanent nerve injury is rare, around 0.1% or less.
- Healing problems affect the skin flaps in roughly 2% of cases and are much higher in smokers, whose wound-healing risk runs around 12-fold; infection sits at a few per cent.
- Scars can occasionally thicken (hypertrophic scarring), and other risks include asymmetry, hairline changes and the general risks of anaesthesia.
- Combining procedures raises the overall complication rate to about 3.7%, versus about 1.5% for a facelift alone.
By Paula Winters | Medically reviewed by Mr Alexander Frost, FRCS (Plast)
Published May 11, 2026 · 5 min read
The most common complication of a facelift is a haematoma, a collection of blood under the skin, reported at roughly 1 to 7% and much more common in men and in smokers; the more feared nerve injuries are usually temporary, and permanent nerve damage is rare at around 0.1% or less. No cosmetic operation is risk-free, and a face is not a place to be casual about that1.
When I was deciding, the risks were the part I read fastest and understood least, because most of what I found was either a reassuring shrug (“very safe”) or a frightening list with no numbers attached. What I actually wanted was the plain arithmetic: how likely, how serious, and how much of it I could influence. This is that version. For the wider picture of the operation itself, start with the pillar, facelift surgery.
What is the most common complication?
A haematoma, a collection of blood that builds up under the skin, is the most common complication of a facelift, reported at roughly 1 to 7% depending on the study and technique. It is much more common in men, in one series about 6% versus near 0% in women, and in smokers and people with high blood pressure1.
A small haematoma may just be watched and settles on its own. A larger one is the reason surgeons keep the first day or two under close review: it usually needs a prompt return to theatre to release and drain it before it stretches the skin or threatens the blood supply. The honest point Mr Frost made to me is that a haematoma is not a rare freak event, it is the complication, which is why blood-pressure control and avoiding anything that thins the blood around surgery matter so much. Smoking is a big part of that story too, set out in facelift and smoking.
Can a facelift injure a facial nerve?
Yes, but permanent nerve injury is rare, around 0.1% or less; far more common is temporary weakness, most often of the nerves to the forehead or the lower lip, which usually recovers within 3 to 4 months. The greater auricular nerve, a sensory nerve near the ear, is the one most often affected1.
This was the risk that frightened me most, because a weak brow or a lopsided smile is visible in a way a hidden scar is not. What steadied me was the size of the numbers: temporary and recovering within a few months in most cases, permanent in about 1 in 1,000 or fewer. The greater auricular nerve is different again; it carries sensation rather than movement, so if it is affected you get a patch of numbness around the earlobe rather than any weakness. Mine was numb for months and I still cannot feel the very tip of one earlobe, which is a small, odd thing I had not been warned to expect. How a careful surgeon reduces these risks is part of choosing a facelift surgeon.
What can go wrong with healing?
Skin-flap healing problems affect roughly 2% of facelift patients and are much higher in smokers, whose wound-healing risk runs around 12-fold; infection sits at a few per cent. Active smokers are advised to stop for at least 4 weeks before surgery for exactly this reason2.
The facelift skin is lifted as a flap and depends on a fragile blood supply to survive and knit back down. Anything that starves that supply, and nicotine is the classic culprit because it narrows the small vessels, raises the risk of the skin healing slowly or, at worst, an area of skin breaking down. This is not scaremongering: it is the single biggest thing a patient can change. I gave up before mine and I am glad I did. Infection is less common but real, usually treated with antibiotics and rarely serious. The candidacy factors that feed into healing are covered in am I a candidate for a facelift.
Will a facelift leave visible scars?
Scars are unavoidable but placed to hide, at the temples, in front of the ear, under the earlobe and behind the ear, and they fade and mature over about 6 to 9 months. Occasionally a scar thickens (hypertrophic scarring), or the hairline shifts, which are among the reasons a small revision is sometimes needed3.
Most facelift scars settle into the natural creases and the hairline so well that they are hard to spot once mature. But “most” is not “all”. How a scar heals depends on your skin type, your genetics, and again whether you smoke. A raised or red scar can often be improved with time, massage or minor treatment, and the full account of placement and care is in facelift scars. The slow settling, the months before the final look appears, is something I underestimated, and I have written about it in my facelift recovery.
Does combining procedures raise the risk?
Yes: combined procedures carry an overall complication rate of about 3.7%, versus about 1.5% for a facelift alone. Many people combine a facelift with a neck lift, eyelid surgery or fat transfer, so this trade-off comes up often14.
The appeal of combining is one recovery instead of two, and one anaesthetic instead of two. Set against that is a longer operation and a higher chance of something going wrong. It is not a reason to refuse combining, and for many people it is still the right call, but it is a real number to weigh rather than wave away. The general risks of anaesthesia, which rise with a longer operation, are covered in facelift anaesthesia, and the honest cost-benefit of the whole decision is in is a facelift worth it.
How do I lower my own risk?
The biggest levers a patient controls are not smoking, keeping blood pressure well managed around surgery, and choosing an experienced, board-certified surgeon. Smoking alone changes the wound-healing risk around 12-fold, and it is the one factor almost entirely in your hands2.
None of this makes a facelift risk-free, and no honest surgeon will tell you it is. But the arithmetic is manageable when you understand it: the common complication (haematoma) is usually treatable, the frightening one (permanent nerve damage) is rare, and the most dangerous factor (smoking) is one you can remove. Take the questions in questions to ask before a facelift to your consultation, and read the balanced myths piece at facelift myths and facts so the risks sit in proportion rather than in the shadows.
References
- A Systematic Review and Comparative Analysis of Rhytidectomy, PMC (systematic review). ↩
- InService Insights: Facelift anatomy, techniques and complications, American Society of Plastic Surgeons. ↩
- Facelift (rhytidectomy), NHS. ↩
- Facelift, American Society of Plastic Surgeons. ↩
Common questions
What is the most common complication of a facelift?
A haematoma, a collection of blood that builds up under the skin, is the most common complication. Reported rates range roughly 1 to 7% depending on the study and technique. It is much more common in men (about 6% in one series versus near 0% in women) and in smokers and people with high blood pressure. A large haematoma usually needs a quick return to theatre to drain it, so the first day or two of recovery is when surgeons watch most closely.
Can a facelift damage a facial nerve?
It can, but permanent damage is rare, around 0.1% or less. Far more common is temporary weakness, most often of the nerves to the forehead or the lower lip, which usually recovers within 3 to 4 months. The greater auricular nerve, a sensory nerve near the ear, is the one most often affected, which can leave a patch of numbness around the earlobe.
Are facelifts more risky for men?
Men do have a higher haematoma rate: one series reported about 6% in men versus near 0% in women. This is thought to relate to the richer blood supply of bearded skin and to higher rates of high blood pressure. It does not mean men should not have facelifts, but it does mean blood-pressure control and careful aftercare matter even more.
How does smoking affect facelift complications?
Smoking is the single biggest modifiable risk. Active smokers have around a 12-fold higher risk of wound-healing problems, because nicotine narrows the small blood vessels that keep the skin flaps alive. Surgeons routinely advise stopping for at least 4 weeks before surgery. Skin-flap healing problems affect roughly 2% of facelift patients overall and cluster heavily in smokers.
Will a facelift leave visible scars?
Scars are unavoidable, but they are placed to hide: at the temples, in front of the ear, under the earlobe and behind the ear. They fade and mature over about 6 to 9 months. Occasionally a scar thickens (hypertrophic scarring) or the hairline shifts, and these are among the reasons revision is sometimes needed. Genetics, skin type and smoking all influence how a scar settles.
Does combining a facelift with other procedures increase the risk?
Yes. Combined procedures carry a higher overall complication rate, about 3.7%, versus about 1.5% for a facelift alone. This is worth weighing against the appeal of a single recovery, since many people combine a facelift with a neck lift, eyelid surgery or fat transfer. A surgeon examining you in person is the right person to judge that trade-off.
Written by Paula Winters. Medically reviewed by Mr Alexander Frost, FRCS (Plast).
Our guides are written from personal experience and reviewed by a qualified clinician for accuracy. Read our editorial policy.