What the research shows
In a database of facelifts by board-certified plastic surgeons, the major complication rate matched that of other cosmetic operations. Bleeding under the skin (a hematoma) was the most common, followed by infection. Combining the facelift with other operations more than doubled the rate, men had about four times the hematoma risk of women, and patients with a body mass index of 25 or more had more infections (Gupta 2016). About 1 in 28 needed a visit to a hospital or surgery center in the first month, most often for a hematoma (Lee 2018).
The type of facelift changes which problems are likely, and permanent facial nerve injury was equally rare across techniques. Temporary nerve weakness was more frequent after high SMAS and composite lifts, major hematoma somewhat more frequent after deep plane and SMAS imbrication, and skin loss more frequent after SMAS flaps. The authors advise choosing a technique for the quality of its result (Jacono 2019). Limited incision facelifts, mostly done awake or under light sedation, had low complication rates, and their hematomas rarely needed a return to the operating room (Amador 2024).
Blood clots in the legs are rare. In one center's series, both cases followed combined procedures, and the risk rose when surgery lasted over five hours. That series also found more complications in men, patients over 55 and those with a body mass index over 30 (Abboushi 2012).
Surgeons now have tools that lower bleeding. Tissue sealants (fibrin glue) applied under the skin reduced hematoma and swelling (Giordano 2017). Tranexamic acid, a drug that slows clot breakdown, reduced small hematomas, drainage, swelling and bruising without raising major complications (Alenazi 2024). Across the published reports, hematoma still makes up about a third of all complications, while reports of fluid collections halved and reports of unfavorable scars and temporary nerve weakness doubled (Fang 2025).
What bothers patients most is often not what surgeons count. In a 1970s review, numbness, hair loss and scars troubled patients more than the major complications (Leist 1977). Patient-reported and surgeon-reported problems still overlap only in part, so both belong in the consultation (Fleury 2018).
Where surgeons disagree
- Age. One center found more complications in patients over 55 (Abboushi 2012). A 2026 single-surgeon series with strict screening found age had no effect, including in patients over 75 (Vishwanath 2026).
- Fibrin sealant. Pooled comparative studies favor sealant for preventing hematoma (Giordano 2017); a national database found no difference in facelift complications with or without it (Eberly 2025).
What is new
- Patients taking antidepressants had slightly more wound problems after cosmetic facial surgery, mainly infection, which belongs in the pre-surgery discussion (Chaudhry 2026).
- Earlier facial injectable treatments did not significantly raise facelift complications (Salsberg 2026).
- A second facelift is harder because of scar tissue and thinner layers, yet overall complication rates are similar to a first facelift; temporary nerve weakness reached about 1 in 8 in some series (Saad 2026).
- Thread lifts are not free of problems: swelling and bruising are common, and about 1 in 10 could see or feel the threads later (Zhou 2026).
What is still unknown
- The full rate of minor problems. Database studies count hospital visits and miss problems handled in the surgeon's office (Lee 2018).
- The risks of a facelift abroad. The published data are too few to draw conclusions (Raggio 2020).
Key papers
- Leist 1977: showed that numbness, hair loss and scars trouble patients most.
- Abboushi 2012: linked leg clots to long combined operations.
- Gupta 2016: the main risk factors for major complications in a large prospective database.
- Giordano 2017: tissue sealants reduced hematoma.
- Fleury 2018: compared what patients and surgeons report as problems.
- Jacono 2019: complication rates by facelift technique; permanent nerve injury was the same across them.
- Alenazi 2024: tranexamic acid lowered small hematomas without raising major complications.
- Vishwanath 2026: age alone did not predict complications, even over 75.