Possible Complications
Haematoma - Abnormal collection of blood under the facial skin (comprises 70% of all facelift complications): You should expect a small amount of bleeding from your incision line during the first 24 to 36 hours after your surgery.
Any type of surgery may result in excessive bleeding in the operated area. This may be due to a temporary increase in blood pressure, for example due to coughing. It can also occur from the effects of medication like aspirin or anti-inflammatory drugs. Bleeding is usually manifested by acute swelling of the area, discolouration of the skin, pain and a feeling of tension. External compression of the wound usually stops it. In rare cases, if it continues, we may have to stop it after reopening the incision. Massive bleeding may require hospitalization and transfusion.
If the accumulation of blood is small, it may be allowed to absorb by itself or aspiration may be indicated as with a seroma. However, if it is large, formal drainage in an operating room may be necessary
Post operative swelling: Some swelling after your operation is normal. Time and elevation of the head are the two most important factors in reducing swelling. Ice may also be carefully used to decrease swelling.
Bruising: If you bruise easily, discolouration may remain for several weeks after surgery. You should advise us of any past history of bleeding disorder. In rare cases, discolouration may be permanent.
Nerve injury: In general, nerve injuries following facelifts are rare.
However, when they do occur, the major sensory nerve most commonly injured is the great auricular nerve. Injury to this nerve can lead to numbness of the ear and occasionally the development of a painful nerve ending. If the nerve is damaged, it can be repaired which will significantly reduce the incidence of any permanent sequelae.
The superficial sensory nerves supplying the skin of the cheek and temple are divided during the elevation of the skin and no attempt is made to identify these small branches. All patients have a temporary loss or alteration of sensation in the area of the facelift, as well as the earlobes and ear margins. Sensation spontaneously returns within a relatively short period of time and is usually complete in 3-4 months. Only in rare instances will sensation fail to return.
The reported incidence of nerve injury is less than 1%, with the temporal branch of the facial nerve being the most common. Injury to this nerve results in the inability to raise the eyebrow and forehead on the involved side along with loss of forehead wrinkles. The injury can be caused by stretching or trauma from the cautery or a stitch. Almost all nerve weaknesses will improve with time. This recovery period varies from 2-6 months. It is very rare for nerve function not to return.
Injury to the mandibular branch of the facial nerve has been reported very infrequently and can lead to drooping of the lower lip. Similarly injury to the buccal branch of the facial nerve supplying the cheek muscles can lead to weakness of the upper lip. In extremely rare cases, injury to the spinal accessory nerve supplying the trapezius muscle has been reported.
Unsightly Scarring - Prominent, unsightly scars (thick, red, ropy, itchy, and painful): The normal healing of wounds is a physiological process which continues to take place in the depths of the tissues for many months before final resolution. At first, the surgical scar is almost invisible. Then it becomes red and somewhat elevated for about 3 months. It then becomes paler, softer and flatter and reaches its resolved state in 6 to 12 months. Aesthetic surgery has its limitations. Any time the skin is opened a scar of some kind results. This may be a good scar (fine white line) or a conspicuous one, but there is always a scar of some sort.
Each individual’s healing is different. Some form fine white lines while others will form heavier ones. The surgeon has no influence on the actual formation of a scar. Factors that can influence the quality of healing include smoking, obesity, infection and nutrition. The complete mechanisms of wound healing are not yet fully understood. Thus, the factors that may lead to formation of a conspicuous scar are not yet known.
Very heavy (hypertrophic) scars or keloids (scars which escape the confines of the original wound) are uncommon. They are found most frequently on the front of the chest, abdomen, and shoulder area. Dark skinned peoples (particularly those of African, Asian or Mediterranean descent) are more susceptible to the development of hypertrophic scars.
Sun exposure of a new scar should be avoided for the first year following your operation. An immature scar exposed to sun may become more visible and pigmented.
Despite meticulous technique and attentive post operative management, a small percentage of patients will develop some unsightly scarring. The scars may widen over a period of several weeks or months or possibly exhibit a true hypertrophy (red, raised, itchy, and painful). These scars can be treated by a variety of methods including local pressure, massage, cortisone injections, topical creams, and surgical revision. Rarely, hypertrophic scars are permanent and will not respond to treatment
Skin slough - death (necrosis) of tissue resulting in delayed healing: When blood circulation is inadequate to bring sufficient oxygen to the tissues, some of the tissue furthest away from the blood supply may be lost. The skin will become discoloured and form a dark dry crust which will eventually separate off. The underlying normal tissues heal by themselves. This may leave a wide scar. Skin necrosis is not infrequent in patients who smoke but it is uncommon in non-smokers. Other causes of skin slough include infection and haematoma. Significant necrosis may necessitate further operative procedures to remove the unhealthy skin and revise the scar in the future. Occasionally if nature does not correct the problem a skin graft may be necessary.
Fluid collection (seroma): This is a collection of serum in small pockets beneath the skin, in most cases in the cheeks. Generally, the seroma will spontaneously resorb. Occasionally, needle aspiration is necessary.
Contour irregularities: If the skin flap is very thin, it may adhere to the underlying facial and neck muscles causing puckering and wrinkling. This may become visible after the swelling subsides. Massage can sometimes improve this significantly.
Infection: Infection following a facelift is rare. The incidence is less than 1% and severe infections are extremely uncommon. However, any surgical wound can become infected. An infection usually will become apparent a few days after the surgery. The signs are: pain, redness, heat and swelling. Antibiotics and dressing changes will often control it. On rare occasions, hospitalization and formal drainage in the operating room may be needed to control more significant infections.
You will be given a prophylactic antibiotic when undergoing your facelift. In addition you will be sent home with a prescription for antibiotics for 4-5 days.
Blood clots in the legs (venous thrombosis) and lungs (pulmonary embolism): These complications, though rare, are among the most serious from this type of surgery. Conditions predisposing a patient to these complications would include obesity, smoking, and a history of cardiac and pulmonary disease or blood clotting disorders, length of surgery and prolonged post operative immobility.
