Deep plane facelift risks | Dr. Walter Zamarian Jr.

At a glance: what are the risks of a deep plane facelift?

Like any surgery, a deep plane facelift can lead to bleeding and hematoma, infection, healing problems, changes in facial sensation or movement, and complications related to anesthesia or blood clots. Careful evaluation and follow-up reduce and manage these risks, but no measure eliminates them. Shortness of breath, chest pain, fainting or sudden neurological symptoms after surgery need emergency care right away.

Hematoma: the most common complication of a facelift; rapid swelling on one side needs immediate assessment.
Nerves: a review of 15,404 patients estimated pooled rates of 0.66% for motor and 0.39% for sensory nerve injury.
Prevention: control of blood pressure, medications, pain and nausea, along with surgical measures.
Hemostatic net: I use it in all my facelifts, without drains, and it does not replace follow-up.
Expectations: understanding the risks helps you decide, including to wait or not to have surgery.

My deep plane facelift guide explains the technique and the results we aim for. This article goes deeper into the risk conversation: how to read the studies, what information to bring to your consultation and which changes should not wait for your next appointment.

Safety starts with a conversation where you can ask anything

It can be hard to ask about complications when you are excited about improving your face. Still, it is one of the most important parts of the consultation. I do not take your concern as a lack of trust: I want to know what worries you so I can explain what needs to be clear before you decide.

Rather than simply answering whether surgery is safe, I prefer to discuss which operation we are considering and which precautions make sense for you. That conversation covers your facial examination, your health, previous treatments and the conditions you will have for recovery. It also includes the option of waiting or not having surgery at all.

Four topics that belong in your plan

Bleeding and fluid collections

Bleeding and fluid accumulation are among the complications listed by the ASPS [1]. I explain the planned follow-up and whom to contact if the volume of your face changes significantly: reporting the change is more useful than trying to work out its name on your own.

Movement and sensation

At the consultation, I ask about any differences you already notice when you smile or touch your face. Muscle movement and skin sensation are different things, and recording what was already there helps us talk about expectations and about any changes after surgery.

Skin, incisions and scars

Infection, skin loss, hair loss at the incisions and unfavorable scarring are among the risks described by the ASPS [1]. I show you where I plan the incisions and listen to your history of healing, without promising that every mark will disappear.

Anesthesia and general health

Planning does not stop at your face. I need to know about your medical conditions, treatments and any past experience with anesthesia. For a facelift, I use total intravenous anesthesia (TIVA), with assessment and monitoring by the anesthesiologist; a cosmetic operation does not skip that step.

What the nerve injury numbers say

A systematic review and meta-analysis published by Gandra and colleagues in 2025 included 67 publications and 15,404 patients. The pooled rates were 0.66% for motor nerve injury and 0.39% for sensory nerve injury; for permanent injury, 0.047% and 0.045%, respectively [2]. These are separate outcomes and should not be added together into a single rate.

These figures are not my personal complication rate, and they do not calculate the risk for one person having a deep plane facelift: they combine the procedures and criteria of the included studies. Nor do they mean that every patch of numbness during recovery is the injury measured in those studies. I use the data to inform our discussion, not to guarantee an outcome.

If you already have an area with less feeling or a difference in movement, tell me before surgery. At follow-up visits, I want to know where a change appeared and how it has evolved. A symptom described as temporary in the research should not be ignored or given a date by which it must go away.

Hematoma: prevention does not replace assessment

A hematoma is a collection of blood under the skin that causes swelling and pressure. According to Mayo Clinic, it is the most common complication of a facelift, usually forms within 24 hours, and prompt treatment protects the skin and other tissues [3]. You do not need to confirm the diagnosis at home before asking for help: significant pain, especially on one side, or rapidly increasing swelling needs immediate assessment.

A review by Stewart and colleagues analyzed 45 articles on hematoma prevention after facelift. Controlling pain, nausea and blood pressure significantly reduced hematoma formation; drains and compression dressings had no significant effect [4]. Prevention is a set of decisions, not a single dressing or device.

That study is not a prescription for changing your own treatment. At your evaluation, I need to know what you take and why it was prescribed; any change is coordinated with the doctors involved. Do not stop blood thinners, blood pressure medicine or other treatment without guidance.

What about the hemostatic net?

I use the hemostatic net in all my facelifts and do not use drains. Before surgery, I explain how it works and how it is removed. It does not replace follow-up visits or make any swelling automatically normal.

In a 2025 randomized trial, 160 women having a deep plane facelift were assigned to either the net or drains, 80 in each group. There was no significant difference in hematoma and seroma rates [5]. That does not show that either method eliminates bleeding, and the result should not be applied directly to men.

Information that can change your preparation

Tell us about smoking and other nicotine products, diabetes, high blood pressure, any history of blood clots or abnormal bleeding, and problems with previous surgery. Medications and supplements need to be listed as well. According to Mayo Clinic, smoking greatly raises the risk of poor wound healing, hematoma and skin loss, and poorly controlled diabetes or high blood pressure can also raise the risk of complications [3]. I routinely ask patients to stop smoking at least 2 weeks before and 2 weeks after surgery, ideally 4 and 4.

This list is not for deciding on your own whether you can have surgery: it organizes what we need to assess. If you take medication for diabetes or weight loss, bring the names, doses and any recent changes. My preoperative instructions explain how I prepare for this step.

Also tell us about fillers, previous facial surgery and complications, even if they happened years ago. If you do not have all the records, say what is missing: a known gap is better than guesswork.

Your plan has to work outside the clinic

Recovery requires arrangements that fit your life. Before booking, I want to discuss help at home, transport and attending follow-up visits. Having support does not remove risk, but it keeps a practical problem from surfacing only when you need care.

If you are traveling to Londrina, plan your stay around the agreed schedule, with room for changes: a booked flight does not replace medical clearance. My patient journey explains each stage of follow-up. The person staying with you should know the contacts and instructions; their role is to help report a change, not to diagnose it.

Changes that should not wait

Shortness of breath, chest pain or fainting after surgery need emergency care. Pain and swelling in one leg need urgent assessment; together with shortness of breath or chest pain, they are an emergency, because the clot can travel to the lungs [6].

Sudden changes in speech, vision or strength also need emergency care, even if they improve. Do not assume that new weakness is caused by the operation: Mayo Clinic advises seeking immediate care for any signs of stroke [7].

In the operated area, report rapid swelling, severe pain on one side or persistent bleeding right away. Fever, discharge, a wound that opens or significant worsening also need prompt assessment. If you cannot reach the team in time, go to an urgent care or emergency service. My postoperative instructions describe the warning signs.

Do not try to drain, squeeze or treat an area that has changed. 24-hour support by WhatsApp, with Isanna and me, is part of your care, but it does not replace emergency services or in-person examinations, especially after you return home.

Five questions to ask before booking

Which risks matter most for my health and the proposed surgery?
Do we need any information or assessment before setting a date?
How will I receive instructions about the medications I already take?
Where will I be assessed if something changes unexpectedly during recovery?
How will follow-up work if I need to stay longer or need additional care?

I prefer these questions to come up before surgery. Understanding a possible complication does not oblige you to accept it: the conversation is there to help you decide with better information.

Frequently asked questions

Does a deeper plane automatically mean more danger?

No. The name or depth of a technique is not enough to rank your risk. I discuss the proposed operation, your health, any combined procedures and the relevant limitations.

Does the net mean I can skip a follow-up visit?

No. The net does not replace follow-up. Keep your scheduled visits and let us know if you have trouble attending.

Is numbness the same as paralysis?

No. Changes in sensation and difficulty with movement are different problems, and the nerve injury research also keeps them apart [2]. Tell us what you notice so we can assess it.

Could I need another operation?

Yes. Some complications may require treatment or another operation, and we may also need to discuss an unsatisfactory result or an unfavorable scar [1][3]. It is important to understand this possibility before you decide.

Let’s talk about what worries you

You do not need to hide a concern to seem ready for surgery. Write to us on WhatsApp: Bruna, my AI assistant, handles the first contact and then puts you in touch with Isanna to arrange a consultation with me. If you are already recovering from surgery and notice an emergency sign, seek immediate care.

References

American Society of Plastic Surgeons. Facelift Risks and Safety.
Gandra G, Silva BS, Horta R. Facelift Surgery and Nerve Injury: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2025.
Mayo Clinic. Face-lift.
Stewart CM, Bassiri-Tehrani B, Jones HE, Nahai F. Evidence of Hematoma Prevention After Facelift. Aesthet Surg J. 2024.
Ismail M, Ghoraba S. Hemostatic Net Versus Surgical Drain After Deep Plane Facelift Surgery: A Prospective Randomized Controlled Trial. Aesthetic Plast Surg. 2025.
NHS. DVT (deep vein thrombosis).
Mayo Clinic. Stroke – Symptoms and causes.