This article has been medically reviewed for accuracy by St. Louis, MO facial plastic surgeon, Dr. Brock Ridenour on November 4, 2020.
Every plastic surgery procedure carries a risk of complications, and facelifts are no exception. As the body heals throughout the recovery process, a slew of side effects can take shape—some of them expected and normal, others rare and potentially dangerous.
Of course, it is important to note that facelifts are generally safe and effective surgeries and that certain hiccups can be mitigated by seeking out an experienced board-certified plastic surgeon. Before we get into what can go wrong, let’s recap what a “normal” facelift recovery should look (and feel) like—bearing in mind that every patient, surgeon, and operation is uniquely different.
The full recovery timeline will depend on the type of facelift procedure you have, the technique your surgeon uses, and your body’s own healing process. But if all goes well, generally, “the recovery is usually not as bad as a patient may imagine,” says Dr. David Shafer, a board-certified plastic surgeon in New York City, who describes the healing process in three phases.
During the first few days post-op (phase one), there’s swelling, bruising, and general discomfort, which can usually be managed with pain medication. Throughout the second phase, which Dr. Shafer considers to be the first few weeks after surgery, “the swelling is reducing, bruising is dissipating, [and] any numbness is normally resolving;” stitches are typically removed around the one-week mark. The third and final phase—the first few months after surgery—“minute amounts of swelling are finally resolving, the incisions are fading, and the patient is back out socially and at work,” according to Dr. Shafer.
That’s if everything goes according to plan—which, again, is all the more likely if your surgeon is board-certified and highly trained in facelift procedures. Still, before going under the knife, it behooves patients to be aware of potential problems that may arise during recovery—things that may prompt one to ask, “Is this normal?”
Ahead, plastic surgeons share five facelift recovery concerns, some of them common and treatable and others more under-the-radar and potentially dangerous.
Facelift recovery concern #1: earlobe deformities
Deformities of the earlobe following a facelift often have to do with surgical technique (rather than the patient’s biological healing processes) and tend to take shape weeks or even months after surgery (rather than being noticeable right away), explains Dr. Adam Rubinstein, a board-certified plastic surgeon in Miami.
A pixie ear deformity, is one such example, and it looks as if the earlobe is being pulled downward, into the neck. Pixie deformities occur as a result of the skin around the earlobe or bottom of the ear being pulled and sewn too taut during a facelift, which over time causes a sort of bounce-back effect.
“If you put the skin under a lot of tension, and you sew it in initially at more or less the same position [that it was originally], then there’s going to be some drift back in the direction where the skin used to be,” Dr. Rubinstein explains. “That skin is going to pull that junction between the earlobe and the face down and forward, and as it does, it’s going to stretch out and elongate the earlobe.”
A second potential ear complication involves the tragus, the tiny tab of cartilage that sits in front of the ear canal. This is, again, a result of poor technique—either the skin in front of the ear is pulled too tight, causing the ear canal to look abnormally wide and visible, or, in the worst-case scenario, the tragus is flattened and deformed, losing its delicate shape altogether.
Both pixie and tragus ear deformities can be corrected under the right circumstances, though “it depends on the severity of the deformity as well as the amount of tension that’s been set on the skin,” Dr. Rubinstein says. For a proper revision, the surgeon basically has to have enough malleable skin to work with. So “if things were done so tight that they’re rebounding forward and you’ve got no skin to recruit and move back again, then you’re stuck,” he adds.
Related: 11 Recovery Rules to Know Before Undergoing a Facelift
Facelift recovery concern #2: facial numbness
“Numbness after a facelift is an expectation, not a complication,” explains Dr. Anthony Youn, a board-certified plastic surgeon in Detroit. The majority of numbness typically occurs in the lower face and central neck area and begins to dissipate as the nerve endings reconnect—a process that often takes up to two years. Fun fact: Nerves regrow at a rate of about one inch per month
In some cases, however, numbness can linger for years—indefinitely, even. “It’s not uncommon for someone to have lasting numbness, particularly right in front of the ear,” Dr. Rubinstein says, as “that’s the area that takes the longest to recover sensation.”
This lasting numbness isn’t cause for panic, however. “There’s always a chance that some of the numbness could be permanent,” Dr. Youn explains, “but it’s not necessarily a sign that there’s anything wrong [with the patient] or anything wrong with the surgery.”
Facelift recovery concern #3: poor scarring
Scarring is something that can be somewhat mitigated with proper surgical technique, though everyone heals (and scars) differently.
“Bad healing along the scar line, where you get a thicker scar, [is] not entirely controllable and can happen randomly at any time, to anyone,” Dr. Rubinstein explains. Of course, the placement of scarring is dependent on the placement of incisions, and the best facelift surgeons are careful to hide cuts in the natural curves and folds of the ears and behind the hairline, to dramatically reduce scar visibility.
Keloid, or raised, scarring is different, however—some people are predisposed to this pattern of skin healing. In such cases, surgeons can take steps to thwart or minimize the overproduction of scar tissue. “If a patient has a family history or personal history of keloids, we can be proactive, with early steroids and other treatments,” Dr. Shafer explains.
Facelift recovery concern #4: post-op bleeding
“There are certain inherent characteristics that you just don’t know about each patient until you do the operation, and you can’t control them,” Dr. Rubinstein says. The potential for hematoma, or bleeding underneath the skin, is often one of them (the risk of hematoma is higher for men and those with high blood pressure).
Hematomas form when blood collects beneath the skin—typically in the neck or cheeks, in the case of facelifts. This happens most often within the first 24 to 48 hours after surgery and can be a surgical emergency—which is why some doctors like to keep facelift patients overnight.
They can also present weeks after surgery, though this is much rarer. If this is the case, “it would look like a bruised area,” Dr. Youn explains. If you spot one, you’ll want to call your surgeon right away; addressing it may require aspiration, or, in rare cases, a return trip to the OR, to stop the bleeding.
Related: 10 Doctors Give Their Best Facelift Advice, in 10 Words or Less
Facelift recovery concern #5: nerve injury
Otherwise known as a crooked smile, a motor nerve injury following a facelift is a serious complication—though also exceedingly rare.
“The one nerve that we all worry about and do our best to avoid is the marginal mandibular nerve,” Dr. Rubinstein says. This nerve runs along the lower jawline and is set so deep within the facial anatomy that, ideally, it won’t even be touched during facelift surgery. However, “there are some patients who have more superficial nerves than others,” Dr. Rubinstein explains. If a surgeon inadvertently nicks or cauterizes the nerve, “your mouth won’t move quite normally after surgery,” Dr. Youn explains.
“If you do get a motor nerve injury, it usually heals on its own,” Dr. Youn says, noting that it could take months to fully recover. Still, it’s something that should be flagged right away to your doctor; any mouth movement restriction or crookedness of the smile is considered to be an abnormal facelift complication and should be checked out right away.
