The most common complication occurs twice as frequently in men, as in women. The complication is bleeding that requires intervention and takes place in four percent of patients. Inadequate pain control, hypertension, coughing, or straining in the postoperative period may all predispose to this.
Incision breakdown is most commonly associated with a history of smoking, peripheral vascular disease, connective tissue problems. Opening most commonly occurs behind the ear, and if confined to this location presents no severe long term problems.
Loss of fat, secondary to necrosis (death) from devascularization (loss of blood supply) most commonly from too superficial a dissection, especially in a smoker may lead to firm spots just under the skin. The same technical folly may be responsible for the more devastating complication of skin loss. This, in most cases will heal without surgical intervention, albeit not without time, inconvenience, and in some cases, a noticeable scar.
Injury to the nerves that move the facial muscles happens in 1 percent of cases not involving deep dissection, and in up to 4 percent of cases involving a deeper (sub-SMAS) dissection. Fortunately, the most commonly injured branches are not as important as the branches injured less frequently and as a result injury is often without overt symptoms, and is only evident on detailed analysis. If there is a deficit, it will resolve on its own in the great majority of cases. More devastating injuries may require reconstructive face lift surgery.
Infection is rare in well vascularized tissue such as the face; it happens less than 1% of the time and is treated adequately with antibiotic therapy in the great majority of cases.
Hair loss may be due to inappropriately beveled incisions, superficial undermining, excessive tension on the closure, and many times idiopathically (without any known cause). Where the complication produces a clinically significant problem, multiple techniques exist to help the situation.
Hyperpigmentation (an increase in the coloration of bruised areas) is an uncommon, but recognized complication.
Asymmetry may be the consequence of an uneven pull on skin flaps from one side to the other. If significantly obvious, the problem may require surgical revision.
Pixie ear deformity (and earlobe that is drawn down and completely attached to the cheek) results from improper closure placing excessive traction on the lower part of the earlobe and is not an overly difficult problem to correct.
Parotid gland cysts (mistakenly referred to by some clinicians as fistulae, result from exposed parotid gland communication with the sub-flap space. The cysts that thus result are self-limiting, and more of a nuisance than anything else.
Wind-blown appearance is a result of too tight of a pull along a horizontal vector, resulting in distorted facies. Although this was far more common in the past, some well known actors, and prominent public figures can be seen to have had their faces pulled too tight yielding an unnatural, operated-upon procedure.
How long do the results of a face lift hold up? Is one type of rhytidectomy better than another? Do the benefits of any particular rhytidoplasty outweigh another?
The results of a properly performed, and surgically sound, operation will typically last up to a decade. The face lift surgery obviously cannot halt the aging process, and to a certain degree just give the illusion of setting back the hands of time. Aging then takes over once again, but not to the same degree, or at the same rate. This is because some of the skin was removed, and some of the underlying tissue repositioned, at times more superior than in youth. This allows for less tissue to be acted upon by gravity. Beware of miracle cure operations that promise lasting results with less face lift surgery. Such procedures may be more profitable to the “surgeon” performing them, more surgeries may be done because they do not take as long, but the patient will generally be back to square one within six months, plus a few “minimally invasive” incisions, and minus some had-earned capital.