My husband has watched my face settle and now wants a facelift himself, but his consultation ended with "men bleed more". Is it genuinely riskier for a man?

Eight months out from my own SMAS lift and, after all the drama I put this forum through, I've come to the end of my own questions. So naturally my husband has started generating new ones.

He is 64, he has spent the whole year saying nothing while my jaw and neck came back, and then last month, completely out of the blue, he asked for my surgeon's number. He's got the classic set: heavy jowls, a soft neck, the loose bit under the chin that he tugs at when he's reading. He went to see my surgeon on Tuesday and came home a bit rattled. Surgeon was keen enough, said he was a good candidate, but then spent what my husband described as "a suspicious amount of time" on bleeding. Apparently men bleed more after this operation, his blood pressure needs to be "properly controlled" before a date is even booked, and the surgeon wants a letter from his GP and wants him off the little daily aspirin he takes, but only if the GP agrees.

My husband's takeaway was that the surgeon thinks he's a risk and is trying to put him off politely. My takeaway is that nobody said any of this to ME and I'd like to know why. So: is a facelift actually riskier for a man, or is this a surgeon covering himself? And is a "bleed" the same thing as the haematoma everyone here talks about, because my husband is now using the words interchangeably and I don't think they are?

Nobody said it to you because you're a woman, Cheryl, and that is not the surgeon being sexist, it's the surgeon reading the numbers. This is one of the few things in facelift world where the sex difference is real and large rather than marketing.

My brother-in-law had a lift eighteen months ago, and his pre-op was exactly this: blood pressure sorted first, a GP letter, and a very long chat about aspirin and what he was allowed to restart when. He found it patronising at the time. He felt differently at 5am on night one when the nurse came in to check his face for the third time and explained that this is precisely when it goes wrong for men, if it goes wrong.

For what it's worth, his did not go wrong. He's thrilled. His beard now grows slightly closer to his ears than it used to, which is the thing nobody warned him about and which he now finds funny.

Adding the bit that made it click for me when I read about men and haematomas before my own lift: it isn't that men are frailer, it's almost the opposite. The skin is thicker and the beard area has a much richer blood supply than a woman's cheek, because hair follicles need feeding. More vessels under a lifted flap means more that can leak in the first day or two. Add that men on average have higher blood pressure and are more likely to be on something like aspirin, and you've got a stack of small things pointing the same way.

So your husband is not "a risk" in the sense he's hearing it. He's a man, and the surgeon is doing exactly what a surgeon who has read the literature does with a man.

The "bleed" versus "haematoma" thing: a haematoma IS the bleed, or rather it's what the bleed becomes, a collection of blood trapped under the skin that has to be let out. They're the same event described from two ends.

CherylB63 said:

he tugs at when he's reading

Six weeks out from my own and the tugging line made me laugh, because that was me for two years before I booked. Tell him he's in good company.

One practical thing from my own pre-op: the blood pressure conversation felt like an obstacle course and turned out to be the single most useful bit of preparation. Mine was borderline, my GP adjusted one tablet, and by the time surgery came round it was steady. The surgeon wasn't looking for a reason to say no. He was looking for a reason to say yes safely.

Cheryl, the direct answer first: yes, a facelift carries a genuinely higher risk of one specific complication in men, the surgeon is describing that plainly rather than hedging, and everything he asked for is the standard way of shrinking that risk before it has a chance to happen.

The complication is a haematoma, a collection of blood under the skin, which is the most common complication of a facelift at roughly 1 to 7% across studies. In one series it ran at about 6% in men against near 0% in women, and the other named risk factors are smoking and high blood pressure. So a man with untreated high blood pressure on a blood thinner is sitting on three of the named risk factors at once, and a surgeon who did not raise it would be the one worth worrying about. Annelise has the mechanism right: thicker skin, the beard's blood supply, and the tendency for blood pressure to spike as the anaesthetic wears off. The full list, with the numbers next to each, is in facelift risks and complications.

On the aspirin, and this is where I have to be careful, because I'm a patient and not anyone's doctor. Whether a daily aspirin is stopped, and for how long, and what it's for in the first place, is exactly the conversation the surgeon has just set up between himself and your husband's GP, and it is the right conversation. What I can tell you from my own pre-op is that the question is never just "stop it", it's "stop it for what reason, restart it when, and what does the GP think it's protecting". The site's piece on medications and supplements before a facelift goes through why the whole list traces back to that same haematoma, which is probably why the surgeon sounded so single-minded.

Two things I'd add from watching it happen rather than reading about it. The first day or two are when a haematoma declares itself, which is why Rosemary's brother-in-law got his face checked three times in a night, and why the head-up, calm, no-exertion instructions matter more for a man than they did for either of us. And the beard thing is real: the incision in front of the ear moves bearded skin slightly, and some men end up shaving a little closer to the ear than before, which is worth asking the surgeon to show him on his own face rather than discovering afterwards.

What none of this is: a reason not to have it. More than 85% of patients across studies are satisfied, and men are in those studies too. My own husband, for the record, has watched all of this happen from close range and has not asked for the number. I find I'm slightly envious of yours.

Reported back to the patient, who has calmed down considerably now that "men bleed more" has turned into an actual number with an actual reason attached.

GP appointment was Thursday. Blood pressure was higher than either of us thought, which was a small shock, so he's on something for it now and gets rechecked in six weeks, and the aspirin has its own plan that I'm not going to relay here because it's his and it's specific. No surgery date until the numbers are steady. He's grumbling about it, which I'm taking as a sign he's serious. Thank you all, and Paula, he says your husband should get on with it.