A facelift carries the same risk profile as any major facial surgery: bleeding under the skin (haematoma), infection, visible scarring, hairline distortion, and temporary or, less commonly, permanent nerve injury affecting facial movement or sensation. Published rates put haematoma between roughly 1% and 3% of facelift patients and temporary nerve weakness higher; permanent motor nerve injury remains uncommon, on the order of less than 1% in modern series. Most side effects, including swelling, bruising, numbness, and tightness, are expected and resolve over weeks to months; a smaller set are true complications that need prompt review.
Usually occurs around the cheeks and eyes and can last up to two weeks.
Temporary nerve sensitivity can occur, usually resolving within a few weeks.
Minimal and often hidden along the hairline, but careful post-surgery care is essential.
Pre-operative medical evaluation, smoking cessation where applicable, blood-pressure control, and a clear medication plan (including aspirin, clopidogrel, warfarin, DOACs, fish oil, and NSAIDs) are the most reliable ways to reduce the specific complications discussed below. Surgery in an accredited facility with a qualified anaesthetist and a specialist plastic surgeon who performs facelifts regularly rounds out the risk-reduction picture. If you are weighing up a deep plane or SMAS facelift, the most useful single step is a candid consultation that reviews your own medical history, medications, and prior surgery before the operation is booked.
What “Side Effects” and “Risks” Actually Mean After a Facelift
Side effects are the expected, usually temporary responses your body has to the operation: swelling, bruising, numbness, tightness, and a short period of asymmetry while one side settles before the other. They are not failures of surgery. They happen to almost every patient in some form, and the question is how long they take to settle rather than whether they will occur.
Risks, in the surgical sense, are unintended events that may need treatment: haematoma (a collection of blood under the skin), infection, nerve injury, skin-flap compromise, poor scarring, hairline distortion, and contour irregularities. Some of these are uncommon. None are rare in absolute terms across a large enough series of patients. The categories below give the published ranges so you can interpret your own risk against the documented numbers.
The distinction matters because patients often search for “side effects” when they actually mean complications, and vice versa. If your concern is whether you will look puffy or numb for a while, that is the side-effects section below. If your concern is whether the operation could damage a nerve or leave a haematoma that needs drainage, that is the risks section. Most of what worries patients in advance falls into the first category, and most of what a surgeon actually plans around falls into the second.
Expected Side Effects in the First Weeks
Swelling and bruising. Swelling peaks at 48 to 72 hours after surgery and then settles steadily. Most bruising has faded by two to three weeks. Residual swelling can persist, particularly around the cheeks and lower eyelids, for three to six months, and this is normal rather than a complication. Make-up or camouflage can usually be applied from around day ten once the incisions are closed.
Numbness, tingling, and tightness. Small sensory nerves in the cheeks, ears, and neck are stretched or divided during a facelift. Numbness in these areas is expected and recovers over weeks to months as the nerves regrow at roughly 1 mm per day. Tingling and a “pins and needles” sensation during recovery are signs of nerve regrowth and are reassuring rather than worrying. Tightness across the cheeks and neck reflects the lift itself and eases as the tissues settle.
Asymmetry during early recovery. One side of the face often swells more than the other, particularly in the first two to three weeks, and this can look like a surgical asymmetry when it is not. As swelling settles, symmetry returns in the great majority of patients. True surgical asymmetry that persists beyond six months is uncommon and is treated differently, usually with revision rather than watchful waiting.
Fatigue and mood changes. Anaesthesia, interrupted sleep in the first week, reduced activity, and the emotional response to any surgery commonly produce fatigue and a low mood for the first two to four weeks. These are normal responses, not complications, and they lift as recovery progresses.
Documented Risks and Complication Rates
Published complication rates vary by technique (SMAS, deep plane, mini-lift), whether the facelift is combined with other procedures, surgeon volume, and patient mix. The ranges below come from peer-reviewed systematic reviews and cohort studies of facelift surgery.
Haematoma. A collection of blood under the skin, sometimes requiring drainage. The most commonly quoted major complication of facelift surgery. Reported in roughly 1 to 3% of facelifts overall in modern series, and historically higher in men because beard-follicle vascularity makes the skin flap more prone to bleeding. A haematoma that is expanding or under tension needs prompt evacuation to protect the skin flap; small collections are watched and often resorb on their own.
Infection. Uncommon with perioperative antibiotics, generally reported under 1 to 2%. Signs include increasing redness, warmth, swelling, fever, or foul-smelling wound discharge after the first few days. Early review and treatment matter; an untreated infection can compromise the skin flap and the final result.
Nerve injury. Temporary or permanent facial nerve injury can affect expressions. The facial nerve has several branches at risk during a facelift, and each has a different risk profile:
- Great auricular nerve (sensation to the lower ear and cheek): the most commonly affected sensory nerve. Numbness is expected; persistent sensory loss is less common.
- Marginal mandibular nerve (movement of the lower lip): less commonly affected. Temporary weakness occurs in a small percentage of patients; permanent injury is reported in well under 1% of cases in modern series.
- Temporal and zygomatic branches (forehead and eyelid movement): uncommonly affected. Transient weakness is more frequent than permanent injury.
- Cervical branch (movement of the lower lip and neck): uncommonly affected.
Permanent motor nerve injury rates sit in the low single-digit percentages or below in modern series. The honest framing is that nerve injury is uncommon but not vanishingly rare, and a surgeon who claims it never happens in their practice is overstating.
Skin-flap compromise. The skin flap raised during a facelift depends on its blood supply to heal. In smokers, the blood supply is reduced and partial skin loss at the edges of the flap is more common; in non-smokers with good vascular health, this is rare. A patch of skin that turns dark purple or black after surgery is a sign that the flap is not being perfused and needs same-day review.
Scarring. Every facelift leaves a scar. The incision is placed in front of and behind the ear and within the hairline so that it follows the natural contours of the face and is hidden in most hairstyles and ear contours. Poor scarring (hypertrophic, widened, or pigmented) is more likely in patients with a personal or family history of keloid scarring and is the exception rather than the rule. Most scars fade well over six to twelve months with standard scar care.
Hairline distortion. Incisions that cross the hairline can, in some patients, shift the sideburn or temple hairline in a visible way. Hairline distortion is one of the more common reasons for revision after a facelift, and the planning of where the incision crosses the hair-bearing scalp is one of the surgical details that separates an experienced facelift surgeon from a less experienced one.
Contour irregularities. Residual jowling, banding in the neck, an over-tightened “wind-tunnel” appearance, or visible asymmetry between the two sides can occur after a facelift. These outcomes depend more on surgical technique and judgement than on patient factors, and they are the categories most often addressed in revision surgery.
Risk Factors That Move Your Individual Risk
Some factors consistently move a patient’s individual complication risk, and they are worth knowing before consultation because several are modifiable.
Smoking. The single most modifiable risk factor. Nicotine impairs skin-flap blood supply and roughly doubles the rate of wound-healing complications. Facelift surgeons routinely ask patients to stop smoking (including vaping, which carries the same nicotine exposure) at least four to six weeks before and after surgery. If you smoke, plan the quit window around the operation date rather than the other way around.
Anticoagulant and antiplatelet medication. Aspirin, clopidogrel, warfarin, direct oral anticoagulants (DOACs), fish oil, and NSAIDs all increase haematoma risk. These should not be stopped on your own initiative; the stopping and restarting plan is agreed between your surgeon and the prescribing doctor, usually in the two weeks before and after surgery.
Uncontrolled blood pressure. A known contributor to post-operative haematoma. Blood-pressure control before and after surgery is part of risk reduction, and patients on antihypertensive medication should continue their usual regimen unless told otherwise.
Combined procedures. Adding a blepharoplasty, brow lift, fat grafting, or chemical peel lengthens operative time, increases the area of dissection, and modestly increases the rate of haematoma and wound complications. The combined-procedure decision should be made deliberately, not by default.
Male sex. Higher haematoma risk due to the vascularity of beard-follicle skin. The risk is real and consistent across published series; it is not a reason to avoid facelift surgery in men, but it is a reason to plan for it.
Age and general health. Older patients and those with diabetes, vascular disease, or compromised immunity heal more slowly and have higher wound-related complication rates.
Conditions like diabetes, heart disease, or autoimmune disorders can influence outcomes.
Surgeon and facility factors. HPCSA registration as a specialist plastic surgeon, an accredited operating facility, and a qualified anaesthetist are independently associated with lower complication rates. Surgeon volume (number of facelifts performed per year) is also associated with outcome in the published literature. These are modifiable in the sense that the choice of surgeon and facility is yours.
What’s Normal vs What’s a Warning Sign
This section is written to be usable at home in the first two weeks after surgery. The aim is for you to know what to wait out and what to escalate.
Normal in the first two weeks. Swelling that comes and goes and is worse in the mornings; bruising that tracks down the neck and onto the chest; numbness of the cheeks, ears, or neck; mild itching as incisions heal; low-grade fatigue and reduced exercise tolerance. All of these settle in their own time and are not reasons to contact the surgeon urgently.
Contact the surgeon the same day for:
- Rapidly increasing swelling on one side, particularly if it is painful, firm, or visibly expanding (possible haematoma).
- Fever, spreading redness, or foul-smelling discharge from an incision after the first few days (possible infection).
- Sudden weakness of the lower lip, the eyelid, or the forehead that was not present immediately after surgery (possible nerve involvement; early review matters).
- A skin patch near the incision that turns dark purple or black (skin-flap compromise).
- Shortness of breath, chest pain, or calf swelling (possible DVT or pulmonary embolism; uncommon but a true emergency).
Seek immediate care if you experience severe swelling, uncontrolled bleeding, high fever, or sudden facial asymmetry.
If you cannot reach your surgeon and the symptom is severe (particularly breathing difficulty, chest pain, or rapidly expanding swelling), go to an emergency unit rather than waiting for a callback.
How Risk Is Reduced , What Actually Helps
The risk-reduction steps below are graded by how much evidence supports them and how modifiable they are.
Stopping smoking well before surgery. The single biggest modifiable lever. Aim for at least four weeks off nicotine before and after the operation; vaping and nicotine-replacement products count.
Pre-operative medical optimisation. Blood pressure under control, diabetes under control, anaemia identified and treated, and a clear medication plan agreed in writing with the surgeon and the prescribing doctor before the operation date.
A surgeon who performs facelifts regularly. Specialist plastic surgical training (HPCSA registration as a specialist), accredited theatre and recovery facility, and a qualified anaesthetist. Surgeon volume is associated with lower complication rates in published series.
Adhering to after-care instructions. Head elevation for the first week, no bending or straining, no smoking, wound care as directed, attending follow-up, and reporting concerning symptoms the same day rather than waiting to see if they pass.
Common Mistakes and Misconceptions About Facelift Risk
“Side effects and risks are the same thing.” They are not. Side effects are expected responses to surgery; risks are unintended events that may need treatment. Conflating the two leads patients to be either falsely reassured (because they assume swelling means something went wrong) or unnecessarily alarmed (because they assume any mention of nerve injury means paralysis).
“If a surgeon is good, complications won’t happen.” Even in the best hands, complications occur. The question is whether they are recognised and managed promptly. A surgeon who claims zero complications is overstating their own record; the published literature across many surgeons and techniques gives the actual ranges.
“Smoking a few cigarettes a day does not matter.” It does. Wound-healing risk tracks with ongoing nicotine exposure, including vaping, nicotine patches, and chewing tobacco. The blood-vessel constriction that impairs skin-flap healing is a nicotine effect, and the risk reduction depends on being nicotine-free, not on cutting down.
“All numbness means nerve damage.” Most post-facelift numbness is from sensory nerve stretching rather than motor nerve injury, and recovers over weeks to months. Persistent weakness of movement is the finding that needs urgent review; numbness alone, even if it lasts several months, is usually not a motor nerve problem.
“If it looks fine at two weeks, the risk is over.” Late complications (scar maturation, residual swelling, contour settling, nerve recovery that can take twelve months or more) mean that follow-up continues well past the early healing phase.
“Medical aid will cover complications of cosmetic surgery.” Generally no, for purely cosmetic procedures. Reconstructive facelifts (after trauma, facial palsy, or massive weight loss) may attract cover. The funding reality is worth understanding before the operation is booked.
“A cheaper surgeon is the same operation.” Surgeon training, facility accreditation, anaesthetic cover, and follow-up arrangements differ, and these factors measurably affect complication rates. Price is not a reliable proxy, but credentials and setting are.
Recovery Timeline at a Glance
| Stage | What is expected | What is a warning sign |
|---|---|---|
| Days 1 to 3 | Peak swelling and bruising, dressings in place, mild discomfort controlled with prescribed medication | Rapid one-sided swelling, fever, severe pain, sudden facial weakness |
| Week 1 | Drains (if used) removed; stitches or staples out around day 5 to 10 | Spreading redness, wound discharge, sudden facial weakness |
| Weeks 2 to 3 | Most bruising faded; presentable in public with make-up or camouflage | Skin darkening at incision edges, persistent asymmetry, new swelling |
| Weeks 4 to 6 | Most swelling gone; activity increasing | New swelling, persistent nerve symptoms beyond the expected course |
| Months 3 to 6 | Residual swelling fully settles; scars mature | Scar thickening, contour irregularities needing review |
| 12 months | Final result visible; scars faded | Any late changes reviewed at follow-up |
When Facelift Risk Specifically Does Not Apply
Non-surgical skin-tightening treatments (HIFU, radiofrequency, thread lifts) have a different risk profile, generally lower but with their own specific complications (such as thread visibility, burns, or temporary facial asymmetry). They are not the same procedure as a surgical facelift and the risk categories in this article do not directly apply to them.
Revision facelift surgery (operating on a face that has had a previous facelift) carries its own elevated risk. Scar tissue alters the anatomy, the skin is often thinner, and the dissection planes are less predictable. Revision surgery is a separate conversation and a separate consent.
Reconstructive facelifts for facial palsy, post-traumatic deformity, or post-weight-loss skin excess follow a different risk-and-funding pathway, and the medical-aid position is different from that of a purely cosmetic procedure.
Frequently Asked Questions
What are the most common side effects after a facelift?
Swelling, bruising, numbness, and tightness are expected in the first weeks and settle over two to six weeks, with residual swelling lasting up to three to six months. They are not the same as complications, and most resolve fully.
How often do serious facelift complications happen?
Published rates put haematoma at roughly 1 to 3%, infection under 1 to 2%, and permanent motor nerve injury in the low single-digit percentages or below in modern series. Individual risk depends on smoking, blood pressure, medications, and the surgeon’s technique and setting.
When should I contact my surgeon after a facelift?
The same day for rapidly increasing one-sided swelling, fever or wound discharge, sudden weakness of the lower lip, eyelid, or forehead, dark discolouration of the skin near the incision, or any chest pain, breathlessness, or calf swelling. These can signal haematoma, infection, nerve involvement, skin-flap compromise, or a blood clot.
Can facelift scars be hidden?
Incisions are placed in front of and behind the ear and within the hairline to follow natural contours, and most fade well over six to twelve months. Poor scarring (hypertrophic or widened) is more likely in patients with a personal or family history of keloid scarring and is the exception rather than the rule.
Does medical aid cover facelift complications in South Africa?
For purely cosmetic facelifts, medical aid generally does not cover the procedure or its complications. Reconstructive facelifts (after trauma, facial palsy, or massive weight loss) may attract cover and are assessed case by case. This is a funding question to confirm with your medical aid before surgery.
Take the Next Step
Facelift risk is assessed individually at consultation, not from a checklist. If you are weighing up a deep plane or SMAS facelift and want a candid discussion of what your specific risk profile looks like, including smoking, medications, prior surgery, and the technique being proposed, you can book a consultation at our Fourways practice on 011 875 1694. Dr Deon is HPCSA-registered as a specialist plastic surgeon and an APRASSA member.
Also Read:
- Common Facelift Side Effects and How to Manage Them
- What Can Go Wrong With a Face-Lift? | Risks and Complications Explained
This article is general information about the side effects and risks of facelift surgery, not medical advice for an individual. Outcomes, recovery, and candidacy vary from person to person and can only be assessed in person by a HPCSA-registered specialist. Discuss your own circumstances with a qualified practitioner before making any decision about surgery.
