Overall complication rates

CosmetAssure 2008-2013, 11,300 facelifts: major complications 1.8%; hematoma 1.1%, infection 0.3%; 1.5% for facelift alone vs up to 3.7% combined with other procedures (PMID 26578747).
Risk factors in that database: male sex (hematoma RR 3.9), facility type (RR 2.6), BMI 25 or more and combined procedures (infection RR 2.8 and 3.5) (PMID 26578747).
630 facelifts: 38 complications including 29 hematomas; risk higher in men, patients over 55 and BMI over 30 (PMID 22446820).
Deep-plane meta-analysis 2026, 45 studies, 10,784 patients: complications 6.6%; temporary nerve injury 1.2%; hematoma 1.8%; skin necrosis 0.1%; no permanent nerve injury (PMID 42576065).
SMAS technique review, 27 studies, 6,086 patients: temporary nerve injury 0.85%, skin necrosis 0.41% (PMID 38283861).
Limited incision facelifts, 4,451 patients: complications 3.2% (PMID 37950895).

Hematoma

Full evidence in the hemostatic net file; headline figures: 1.1% major (PMID 26578747), 4.2% in 1,078 lifts (PMID 11513508), 2.7% overall and 0.97% major after deep plane (PMID 41203255).

Facial nerve injury

1979: under 1% of rhytidectomies, over 80% recover within 6 months (PMID 515227).
Meta-analysis 2025, 67 studies, 15,404 patients: motor nerve injury 0.66%, sensory 0.39%; permanent motor 0.047% (PMID 40456989).
Systematic review 2025, 20 studies: injury 0.5%-5%; 70% full recovery within 6 months with conservative care; 10% persistent deficit (PMID 41273502).
Meta-analysis 2019, 183 studies: temporary injury highest with high lateral SMAS (1.85%) and composite (1.52%); permanent injury no different by technique (PMID 30768122).
AAFPRS survey 2026: transient injuries 1%-5%; depressor labii inferioris most affected (75.8%); higher with deep plane and frequent gland reduction (PMID 41251721).
Referral center, 25 post-facelift paralysis patients over 20 years: 8 explored, 6 repaired; about half of both surgical and nonsurgical groups regained normal function (PMID 38015890).
Complete hemifacial paralysis after facelift, 10 cases from 8 surgeons, associated with Bell's palsy (PMID 37897668).
Reoperative sub-SMAS facelift: temporary nerve injury 7.1% vs 2.2% in primary lifts (PMID 35511039).

Skin necrosis and smoking

83 rhytidectomies: smokers had more dermal occlusive vascular disease; skin slough associated with continued smoking after surgery (P = .006) (PMID 3952215).
407 facelifts with conservative undermining, 32.4% smokers: no skin slough (PMID 3952216).
Deep-plane facelift proposed as an alternative in smokers (PMID 21768564).
Meta-analysis of elective plastic surgery: smoking did not significantly raise total facelift complications (OR 3.36, CI 0.92-12.30) (PMID 29426809).
Hemostatic net did not raise ischemia or necrosis rates (PMID 23949130).

Infection

CosmetAssure infection rate 0.3% (PMID 26578747).
Evidence review of antibiotic prophylaxis, decolonization, hypothermia, BMI and smoking in facelift infection (PMID 25539351).

Telltale deformities

Pixie ear: identified in 5% of earlobe insets; flap tension pulls the lobe anteroinferiorly (PMID 39013675).
Cross-cheek depression ("joker line") after SMAS work (PMID 18971739).
Lateral sweep and hollow eyes as facelift sequelae (PMID 9774028).
Vertical sweep deformity (PMID 28006056).
Prevention and correction of the "face-lifted" appearance (PMID 11802570).

Longevity

42 secondary lifts after SMAS flap facelift: mean interval 11.9 years; 21.4% returned within 5 years (PMID 20224461).
Guyuron 1997: mean interval between primary and secondary facelift 8.48 years (PMID 9326793).
Secondary rhytidectomy review, 737 patients: presentation 9-12 years after primary (PMID 42382704).
Owsley satisfaction survey, 89 patients: 97.8% very good or better at 1 year; 68.5% at mean 12.6 years; 31% disappointed in some aspect (PMID 20224460).
Younger patients (under 50) rated longer-lasting improvement (PMID 22186515).
Rohrich 25-year observations: fuller necks relapsed more; opening midline bands reduced neck recurrence (PMID 27348643).
Delta facelift: repeat lift at mean 9.3 years in 9 of 283 (PMID 37619977).
Twins, full vs short scar: neck better with full incision at 5 years (PMID 26890507).

Patient-reported outcomes (FACE-Q)

FACE-Q facelift appearance scales and adverse effects checklist validated in 225 patients (PMID 24105086).
FACE-Q quality-of-life and early life impact scales validated in 702 participants (PMID 25626785).
53 facelift patients: satisfaction with decision 90.5; felt 6.9 years younger; neck (78.1) and under-chin (67.9) scored lowest (PMID 25909302).
Prospective multicenter, 36 patients: scores improved by 3 months and held at 6 and 12 months; felt 6 years younger (PMID 30488241).
200 high-SMAS facelifts (38% response): combination procedures and lipofilling raised satisfaction (PMID 28002252).
Neck FACE-Q meta-analysis, 9 studies, 847 patients: open platysmaplasty with liposuction 81.5 vs closed 77.5; closed without liposuction highest (86.6) in selected patients (PMID 42500364).

Objective age reduction

Apparent age by 10 blinded reviewers: mean reduction 5.23 years (PMID 29040425).
AI, 50 patients: neural networks estimated 4.3 years younger vs patients' own 6.7 years; age reduction correlated with satisfaction (PMID 34181603).
AI, 226 patients: 3.5 years younger at 3 months, 1.7 years at 12 months; no technique superior (PMID 36706713).
AI and observers, 48 Chinese patients: 3.75 and 4.51 years vs self-appraisal 7.3 (PMID 39085528).
AI, 200 patients from surgeon websites: frontal views 2.5-2.8 years; no deep plane vs SMAS difference (PMID 42775335).

Revision and secondary facelift

ABPS tracer data: secondary facelifts rose from 4% (2006-2014) to 18% (2015-2021) (PMID 38302713).
Secondary rhytidectomy review, 14 articles: thinner SMAS, fibrosis and scarred planes; complications 2.0%-21.1%; temporary nerve injury up to 11.9% (PMID 42382704).
Guyuron: secondary lift satisfaction 4.49 vs primary 3.97 (P < .06); more ancillary procedures (PMID 9326793).
Revision neck lift review, 188 cases (PMID 41673281).

Glossary

Major complication (CosmetAssure): complication requiring ER visit, admission or reoperation within 30 days (PMID 26578747).
Neuropraxia: temporary nerve conduction block that recovers (PMID 41273502).
Skin slough / necrosis: death of part of the skin flap (PMID 3952215).
Pixie ear: earlobe pulled down and forward onto the cheek (PMID 39013675).
FACE-Q: validated patient-reported outcome instrument for facial aesthetic procedures (PMID 24105086).
Apparent age: age assigned by observers from photographs (PMID 29040425).
Secondary facelift: second facelift after a prior one (PMID 42382704).

Papers

PMID	First author	Year	Journal	Title	Finding
26578747	Gupta V	2016	Aesthet Surg J	Preoperative Risk Factors and Complication Rates in Facelift: Analysis of 11,300 Patients.	CosmetAssure 11,300 facelifts: major complications 1.8% (landmark)
20224460	Friel MT	2010	Plast Reconstr Surg	The measure of face-lift patient satisfaction: the Owsley Facelift Satisfaction Survey with a long-term follow-up study.	Owsley survey: 97.8% at 1 year, 68.5% at 12.6 years (landmark)
30488241	Berger M	2019	Aesthetic Plast Surg	Assessing Improvement of Patient Satisfaction Following Facelift Surgery Using the FACE-Q Scales: A Prospective and Multicenter Study.	FACE-Q gains stable 3 to 12 months
22446820	Abboushi N	2012	Aesthet Surg J	Facelift complications and the risk of venous thromboembolism: a single center's experience.	630 facelifts: complication risk factors (landmark)
42576065	Koroma P	2026	Aesthetic Plast Surg	Deep Plane Facelifts: A Systematic Review and Meta-Analysis of Outcomes.	Deep plane meta-analysis 10,784 patients: complications 6.6%
38283861	Mortada H	2024	JPRAS Open	Evolution of Superficial Muscular Aponeurotic System Facelift Techniques: A Comprehensive Systematic Review of Complications and Outcomes.	SMAS techniques review: nerve injury 0.85%
37950895	Amador RO	2024	Aesthet Surg J	Limited Incision Facelifts: A Contemporary Review of Approaches and Complications.	Limited incision facelifts: complications 3.2%
11513508	Grover R	2001	Br J Plast Surg	The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts.	Hematoma 4.2% in 1,078 facelifts (landmark)
41203255	Azzi JL	2026	Facial Plast Surg Aesthet Med	Prevention of Hematoma in Patients Undergoing Facelift (Rhytidectomy): A Systematic Review and Meta-Analysis.	Deep plane hematoma 2.7%
515227	Baker DC	1979	Plast Reconstr Surg	Avoiding facial nerve injuries in rhytidectomy. Anatomical variations and pitfalls.	Nerve injury under 1%, 80% recover (landmark)
40456989	Gandra G	2025	Aesthetic Plast Surg	Facelift Surgery and Nerve Injury: A Systematic Review and Meta-Analysis.	Nerve injury meta-analysis: motor 0.66%, permanent 0.047%
41273502	Arianpour N	2025	Maxillofac Plast Reconstr Surg	Management and outcomes of facial nerve injury following rhytidectomy: a systematic review.	Nerve injury management review
30768122	Jacono AA	2019	Aesthet Surg J	A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques.	Complications by SMAS technique
41251721	Pak KY	2026	J Craniofac Surg	Evaluating Facelift Outcomes and Technique Trends in the United States.	AAFPRS survey: transient nerve injury 1%-5%
38015890	Kaufman Goldberg T	2024	Plast Reconstr Surg	Post-Face Lift Facial Paralysis: A 20-Year Experience.	Post-facelift paralysis referral series, 25 patients
37897668	Venditto CM	2024	Aesthet Surg J	Complete Hemifacial Paralysis Post-facelift: Making Sense of a Plastic Surgeon's Worst Nightmare.	Hemifacial paralysis after facelift, 10 cases
35511039	Chang KN	2022	Plast Reconstr Surg	Analysis of the Outcome of Reoperative Face Lifts Using Sub-SMAS Techniques.	Reoperative facelift nerve injury 7.1% vs 2.2%
3952215	Riefkohl R	1986	Plast Reconstr Surg	Association between cutaneous occlusive vascular disease, cigarette smoking, and skin slough after rhytidectomy.	Smoking, dermal vascular disease and skin slough (landmark)
3952216	Webster RC	1986	Plast Reconstr Surg	Cigarette smoking and face lift: conservative versus wide undermining.	Conservative undermining in smokers: no slough (landmark)
21768564	Parikh SS	2011	Arch Facial Plast Surg	Deep-plane face-lift as an alternative in the smoking patient.	Deep plane in smokers (landmark)
29426809	Theocharidis V	2018	J Plast Reconstr Aesthet Surg	Current evidence on the role of smoking in plastic surgery elective procedures: A systematic review and meta-analysis.	Smoking meta-analysis: facelift OR not significant
23949130	Auersvald A	2014	Aesthetic Plast Surg	Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients.	Net: no rise in ischemia or necrosis (landmark)
25539351	Dauwe PB	2015	Plast Reconstr Surg	Infection in face-lift surgery: an evidence-based approach to infection prevention.	Infection prevention review (landmark)
39013675	Vaccari S	2024	Surgery	The pixie ear: How to prevent and correct it-a review of the literature.	Pixie ear review: 5% of earlobe insets
18971739	Lambros V	2008	Plast Reconstr Surg	The cross-cheek depression: surgical cause and effect in the development of the "joker line" and its treatment.	Cross-cheek depression (landmark)
9774028	Hamra ST	1998	Plast Reconstr Surg	Frequent face lift sequelae: hollow eyes and the lateral sweep: cause and repair.	Hollow eyes and lateral sweep (landmark)
28006056	Jacono AA	2017	JAMA Facial Plast Surg	Vertical Sweep Deformity After Face-lift.	Vertical sweep deformity (landmark)
11802570	Hamra ST	2000	Facial Plast Surg	Prevention and correction of the "face-lifted" appearance.	Preventing the face-lifted look (landmark)
20224461	Sundine MJ	2010	Plast Reconstr Surg	Longevity of SMAS facial rejuvenation and support.	SMAS facelift lasts 12 years on average (landmark)
9326793	Guyuron B	1997	Plast Reconstr Surg	Secondary rhytidectomy.	Secondary rhytidectomy: 8.48-year interval (landmark)
42382704	Saad C	2026	JPRAS Open	Challenges and complications in secondary rhytidectomies, a systematic review.	Secondary rhytidectomy review, 737 patients
22186515	Liu TS	2012	Plast Reconstr Surg	Long-term results of face lift surgery: patient photographs compared with patient satisfaction ratings.	Younger patients rate longer results (landmark)
27348643	Rohrich RJ	2016	Plast Reconstr Surg	Long-Term Results in Face Lifting: Observational Results and Evolution of Technique.	Rohrich 25-year observations (landmark)
37619977	Grotting JC	2024	Aesthet Surg J	Superior Vector Plication of the Mobile Anterior Midface: The Delta Facelift.	Delta facelift repeat at 9.3 years
26890507	Antell DE	2016	Plast Reconstr Surg	A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins.	Twins: full incision better neck at 5 years (landmark)
24105086	Klassen AF	2014	Plast Reconstr Surg	Measuring outcomes that matter to face-lift patients: development and validation of FACE-Q appearance appraisal scales and adverse effects checklist for the lower face and neck.	FACE-Q facelift scales validated (landmark)
25626785	Klassen AF	2015	Plast Reconstr Surg	FACE-Q scales for health-related quality of life, early life impact, satisfaction with outcomes, and decision to have treatment: development and validation.	FACE-Q quality-of-life scales validated (landmark)
25909302	Sinno S	2015	Plast Reconstr Surg	Face-Lift Satisfaction Using the FACE-Q.	FACE-Q facelift satisfaction, 53 patients (landmark)
28002252	Kappos EA	2017	Plast Reconstr Surg	Validating Facial Aesthetic Surgery Results with the FACE-Q.	FACE-Q, 200 high-SMAS lifts (landmark)
42500364	Fiore G	2026	Aesthet Surg J Open Forum	A Systematic Review and Meta-Analysis of the Role of Open Platysmaplasty in Facelift and Necklift Surgery: Comparative Outcomes of Closed- vs Open-Neck Rejuvenation With Liposuction Using FACE-Q Scales.	Neck FACE-Q meta-analysis, 847 patients
29040425	Frautschi RS	2018	Aesthet Surg J	Apparent Age is a Reliable Assessment Tool in 20 Facelift Patients.	Apparent age reliable, 5.23 years (landmark)
34181603	Zhang BH	2021	Plast Reconstr Surg	Turning Back the Clock: Artificial Intelligence Recognition of Age Reduction after Face-Lift Surgery Correlates with Patient Satisfaction.	AI age reduction 4.3 years, correlates with satisfaction
36706713	Elliott ZT	2023	Am J Otolaryngol	Artificial intelligence for objectively measuring years regained after facial rejuvenation surgery.	AI 226 patients: 3.5 then 1.7 years
39085528	Du H	2024	Aesthetic Plast Surg	Age Reduction After Face-Lift Surgery in Chinese Population: An Outcome Study Using Artificial Intelligence and Objective Observer-Based Assessment.	AI in Chinese patients: 3.75 years
42775335	Tan SJ	2026	Plast Reconstr Surg Glob Open	Comparing Deep Plane and Superficial Musculoaponeurotic System Facelifts Using Artificial Intelligence-Based Age Estimation.	AI deep plane vs SMAS: no difference
38302713	Stein MJ	2024	Aesthetic Plast Surg	Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.	ABPS: secondary facelifts 4% to 18%
41673281	Şibar S	2026	Aesthetic Plast Surg	Revision Neck Lift Surgery: A Systematic Review of Indications, Techniques, and Outcomes.	Revision neck lift review

Open questions / controversies

Nerve injury rates range from 0.66% pooled (PMID 40456989) to 1%-5% transient in a surgeon survey (PMID 41251721), depending on definition and reporting.
Durability has no randomized evidence; figures come from secondary-lift intervals and surveys (PMID 20224461, PMID 20224460).
AI age estimates run 2-4 years lower than patients' own estimates (PMID 34181603, PMID 39085528).
Smoking: strong physiologic data (PMID 3952215) but no significant facelift effect in pooled analysis (PMID 29426809).

Facelift complications and outcomes

Overall complication rates

Hematoma

Facial nerve injury

Skin necrosis and smoking

Infection

Telltale deformities

Longevity

Patient-reported outcomes (FACE-Q)

Objective age reduction

Revision and secondary facelift

Glossary

Papers

Open questions / controversies

Papers cited on this page