Facelift Risks Explained: Hematoma, DVT, Nerve Injury & How to Avoid Complications

Patients often search:

• “Is facelift surgery safe?”
• “What can go wrong with a facelift?”
• “How common are complications?”

The reality:

• Serious complications are uncommon in expert hands
• But risk is never zero

The goal is not to eliminate risk entirely—it is to systematically reduce it at every stage:

• Preoperative planning
• Intraoperative technique
• Postoperative care

Learn more about facelift recovery timeline, facelift swelling stages, what a facelift fixes, and the best age for facelift surgery to make an informed decision about your procedure.

Cutaneous flap necrosis is an uncommon but clinically significant complication, typically associated with compromised vascular perfusion to elevated skin flaps. The risk is increased in patients with a history of smoking, vascular disease, or excessive tension on wound closure.

The pathophysiology involves disruption of the subdermal plexus and inadequate perfusion, which may result in partial- or full-thickness tissue loss, most commonly in the postauricular or preauricular regions.

Preventative strategies are centered on:

• Preservation of vascular integrity during flap elevation
• Avoidance of excessive tension through deep structural repositioning rather than skin tightening alone
• Meticulous, multi-layered closure techniques (typically 3–4 layers) to distribute tension evenly
• Preoperative patient optimization, including strict smoking cessation
• These principles underscore the importance of respecting both anatomical vascular networks and biomechanical forces during closure.

Wound dehiscence, or separation of the surgical incision, is a multifactorial complication influenced by mechanical tension, tissue perfusion, and patient-related factors such as nutritional status.

In facelift surgery, optimal wound healing is achieved through:

• Layered closure techniques, typically involving deep structural sutures followed by dermal and subcuticular approximation
• Tension redistribution, ensuring that skin closure is not the primary load-bearing layer
• Meticulous surgical technique, minimizing tissue trauma

In addition, perioperative nutritional optimization plays a critical role. Adequate protein intake is essential for collagen synthesis and tissue repair. Supplementation with formulations containing arginine, glutamine, and β-hydroxy β-methylbutyrate (HMB)—such as Juven—may further support wound healing and reduce the risk of dehiscence.

This integrative approach reflects an understanding that surgical outcomes are influenced not only by technique, but also by the biological environment of healing.

Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), represent rare but potentially life-threatening complications following aesthetic surgery, including rhytidectomy (facelift). Although the overall incidence of VTE in facelift procedures is low, its consequences necessitate a rigorous emphasis on prevention, early recognition, and risk stratification.

Incidence and Clinical Context

The reported incidence of VTE following facelift surgery remains low across the literature. Early survey data demonstrated an overall DVT incidence of approximately 0.35%, with a disproportionately higher occurrence in patients undergoing procedures under general anesthesia. In this cohort, while less than half of procedures were performed under general anesthesia, the majority of thromboembolic events were associated with its use.

• More contemporary data evaluating facelift procedures performed under local anesthesia with sedation (MAC or oral anxiolysis) report significantly lower rates of VTE, with incidences as low as 0.017% in large series. Additional institutional reports have demonstrated no observed VTE events in smaller cohorts, further supporting the low baseline risk in properly selected patients.

Role of Anesthesia Type

While anesthesia type alone is not an independent determinant of VTE, multiple observations suggest that facelifts performed under local anesthesia or MAC-style sedation may be associated with a lower thromboembolic risk compared to general anesthesia. This relationship is likely multifactorial rather than causal.

Procedures performed under general anesthesia are often associated with:

• Longer operative times
• Reduced intraoperative and immediate postoperative mobility
• Greater physiologic perturbation
• Increased likelihood of combined or more extensive procedures

In contrast, procedures performed under local anesthesia or MAC sedation typically involve:

• Shorter operative duration
• Earlier ambulation
• Reduced systemic physiologic stress
• Careful patient selection

These factors collectively contribute to a lower overall VTE risk profile, rather than the anesthesia modality itself being the sole driver.

About the Author

Dr. Emmanuel De La Cruz, MD is a double board-certified plastic surgeon in Houston, Texas, certified by the American Board of Plastic Surgery and the American Board of Surgery. He specializes in advanced facial rejuvenation procedures, including deep plane facelift, ponytail facelift (endoscopic facelift), neck lift, eyelid surgery, and facial fat transfer.

He has trained with internationally recognized leaders in facial surgery, including Chia Chi Kao in Beverly Hills and Giovanni Botti in Italy, allowing him to offer both minimally invasive and structural facelift techniques tailored to each patient.

In addition to his surgical expertise, Dr. De La Cruz is a portrait sculptor and painter, bringing an artistic understanding of facial balance, proportion, and harmony to his work. His approach focuses on achieving natural, refined, and undetectable results in facial rejuvenation.