Potential Facelift Complications and How to Avoid Them
A facelift, also known as rhytidectomy, is a popular surgical procedure that can rejuvenate your appearance by tightening sagging skin, smoothing deep folds, and restoring youthful contours. However, like any surgery, it carries potential risks and complications. Understanding these potential facelift complications and knowing how to avoid them can help you make an informed decision and ensure a successful outcome.
Common Facelift Complications
1. Hematoma:
A hematoma is a collection of blood that forms under the skin after surgery. It is one of the most common complications following a facelift, occurring in approximately 1-3% of patients . Hematomas can cause significant swelling, bruising, and discomfort, and may require surgical drainage to prevent further complications. If left untreated, hematomas can even cause the skin over it to be stressed and eventually lose blood supply.
Hematomas are more likely to occur for patients who have high blood pressure or have been taking supplements and medications that thin the blood. Men also are more likely to have a hematoma compared to women.
To minimize the risk of hematoma, patients should avoid medications and supplements that thin the blood, such as aspirin, ibuprofen, and vitamin E, for at least two weeks before surgery. Blood pressure should also be as close to the normal range as possible, and you should avoid strenuous activity that can raise blood pressure in the face.
Hematomas often occur in the first 24 hours after surgery, so surgeons will often place a drain at the time of surgery. If a hematoma occurs, a drain can usually remove any fluid and allow the skin to heal optimally.
2. Nerve Injury
Facial nerve injury is a rare but serious complication of facelift surgery, with an estimated occurrence of 0.5-2.6% . This injury can result in temporary or, in rare cases, permanent weakness or paralysis of facial muscles. Most nerve injuries are temporary and resolve within a few weeks to months, but they can be distressing for patients.
Risk of nerve injury can be elevated in revision facelift surgery. Any area that has had prior surgery will have scar tissue left behind. Scar tissue can obscure normal facial anatomy and can increase the risk of a small nerve branch being injured.
Those that have had prior biostimulatory fillers like Sculptra or Radiesse in the same tissue planes as a facelift can obscure anatomy leading to increased risk of nerve injury. Getting these injections from a facelift surgeon or an injector that works closely with a facial surgeon can avoid these risks. Some surgeons require a year between biostimulatory filler injections and facelift surgery to minimize risks.
The best way to avoid nerve injury is to choose a highly skilled and experienced facial plastic surgeon. A surgeon with extensive experience in facelift procedures will be familiar with the anatomy of the facial nerves and take the necessary precautions to avoid damaging them.
3. Infection
Infection is another potential complication, though it is relatively uncommon, occurring in less than 1% of facelift patients . Infections can range from mild to severe, potentially leading to prolonged recovery times, scarring, and the need for additional treatment.
Uncontrolled diabetes and other medical conditions that impair the immune system can predispose patients to infection.
To reduce the risk of infection, ensure that your surgeon operates in a sterile environment, and follow all postoperative care instructions, including keeping the incision sites clean and dry. Your surgeon may also prescribe antibiotics to prevent infection.
4. Scarring
While scarring is an inevitable part of any surgical procedure, visible or hypertrophic (raised) scars can be a concern for facelift patients. Scarring rates vary, but hypertrophic scarring occurs in about 1-3% of patients . Scars are typically hidden along the hairline and around the ears, but poor healing can result in noticeable scars.
Scars are generally better in deep plane facelifts compared to SMAS facelifts since there is less tension on the closure in a deep plane facelift.
Genetics plays a key role in scar formation. Those with thicker skin types like Asian Americans and African Americans are predisposed to a thicker scar.
It is important that you follow up with your facelift surgeon regularly to identify thickened or wide scars early on. Steroid injections can reduce thickness of scars while treatments like microneedling or laser resurfacing can help with texture. Hypopigmented or hyperpigmented scars can also be treated with micropigmentation.
5. Skin Necrosis
Skin necrosis, or the death of skin tissue, is a rare but severe complication that occurs in about 1% of facelift patients . This condition can result from compromised blood flow to the skin and is more common in smokers or patients with pre-existing vascular conditions.
The most effective way to prevent skin necrosis is to stop smoking at least four weeks before surgery and continue to abstain from smoking during the recovery period. Your surgeon will also evaluate your overall health to ensure you are a good candidate for surgery and discuss any potential risks.
If the skin shows signs of skin necrosis, facial surgeons often recommend hyperbaric oxygen treatments to give your body the best chance for a speedy recovery.
How to Avoid Facelift Complications
1. Choose an Experienced Surgeon
The most critical factor in avoiding complications is selecting a board-certified facial plastic surgeon with extensive experience in facelift procedures. A skilled surgeon will be familiar with the nuances of the facial anatomy, the latest surgical techniques, and the best practices for minimizing risks. Check the surgeon’s credentials, reviews, and before-and-after photos of previous patients to ensure you’re in good hands.
2. Follow Preoperative Instructions
Your surgeon will provide you with specific preoperative instructions to follow before your facelift. These instructions may include avoiding certain medications, stopping smoking, and maintaining a healthy diet. Adhering to these guidelines is crucial for reducing the risk of complications during and after surgery.
3. Adhere to Postoperative Care Guidelines
Proper postoperative care is essential for a smooth recovery and avoiding complications. This includes keeping your incision sites clean, taking prescribed medications as directed, avoiding strenuous activities, and attending follow-up appointments with your surgeon. Following these instructions can significantly reduce the risk of infection, scarring, and other complications.
4. Be Honest About Your Medical History
During your consultation, be completely transparent with your surgeon about your medical history, including any previous surgeries, medications you are taking, and any underlying health conditions. This information is vital for your surgeon to assess your suitability for a facelift and to plan the procedure in a way that minimizes risks.
5. Stop Smoking
Smoking significantly increases the risk of complications during and after a facelift, particularly issues related to wound healing, such as skin necrosis and scarring. If you smoke, you must stop at least four weeks before the procedure and continue to abstain during the recovery period.
Prepare for Your Facelift Surgery
Remember, the key to a successful facelift lies not only in the surgery itself but also in the careful planning, preparation, and aftercare. By taking the necessary precautions, you can enjoy a smoother, safer recovery and long-lasting, rejuvenating results.
