The Importance of Knowing Complications No surgery is risk-free. Facelift, despite being a safe procedure when well executed, has potential complications that every surgeon must know deeply — not to fear, but to prevent, identify early and treat properly. The [Modern Face philosophy has as its first pillar Maximum Safety. This doesn’t mean absence of risks, but rather minimization through refined technique, adequate patient selection and rigorous protocols.
“The difference between an experienced surgeon and an inexperienced one isn’t that one has complications and the other doesn’t — it’s how each prevents, recognizes and manages them.”
- — Dr. Robério Brandão
Complications Overview
Complication Incidence Severity Prevention
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Hematoma: The Most Common Complication Hematoma is blood accumulation in the dissection space. It’s the most frequent complication of facelift, occurring in 2-8% of cases in the literature.
Risk Factors
- • Male gender (2-3x more common)
- • Arterial hypertension
- • Use of anticoagulants/NSAIDs
- • Cough, vomiting, effort in post-op
- • Inadequate hemostatic technique
Prevention
- • BP <140/90 in perioperative period
- • Suspend ASA/NSAIDs 7-10 days before
- • Meticulous hemostasis
- • Drains when indicated
- • Prophylactic antiemetics
Hematoma Management
Small Hematoma (<50ml)
Observation, gentle compression, BP control. Usually resolves with spontaneous absorption.
Large/Expanding Hematoma
SURGICAL EMERGENCY. Return to operating room for drainage and hemostasis. Delay increases skin necrosis risk.
Nerve Injury: The Greatest Fear
Facial nerve injury is the greatest fear of patients and surgeons. Fortunately, permanent injury is rare in experienced hands (<1%). Temporary weakness from neuropraxia is more common but resolves.
Branches at Risk
Marginal Mandibular Branch
Most vulnerable. Innervates lower lip depressors. Injury causes smile asymmetry. Crosses mandible ~2cm posterior to angle.
Temporal (Frontal) Branch
Risk in browlift. Innervates frontalis muscle. Injury causes inability to raise eyebrow. Crosses zygomatic arch.
Buccal Branch
Multiple anastomoses - isolated injury rarely causes permanent deficit. Innervates perioral musculature.
Great Auricular
Sensory (not motor). Injury causes earlobe numbness. Very superficial in cervical region - easy to injure if inattentive.
💡 Modern Face Advantage
The Endomidface technique works in the subperiosteal plane, BELOW the facial nerve branches. This virtually eliminates the risk of injury to motor branches during midface dissection.
Skin Necrosis
Skin necrosis is rare (<1%) but devastating when it occurs. Results from ischemia due to excessive tension, compressive hematoma or vascular compromise.
⚠️ Risk Factors
- • Smoking (main factor)
- • Excessive closure tension
- • Undrained hematoma
- • Poorly controlled diabetes
- • Very superficial dissection
- • Reoperation (previous scar)
✅ Prevention
- • Cease smoking 4-6 weeks
- • Close skin WITHOUT tension
- • Tension on SMAS, not skin
- • Drain hematomas promptly
- • Adequate dissection plane
Summary: Prevention Pillars
Rigorous Patient Selection
Identify and modify risk factors. Refuse when indicated. 2.
Deep Anatomical Knowledge
Know where structures at risk are. Don’t improvise. 3.
Meticulous Technique
Hemostasis, correct planes, tension-free closure. 4.
Close Follow-up
Early identification allows intervention before complication worsens.
Frequently Asked Questions
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Related Articles
Deep Neck Guide
Learn about advanced neck rejuvenation techniques and safety.
Hematoma Prevention
Specific strategies to minimize the most common complication.
Nerve Protection
Deep dive into anatomical landmarks for safe facial dissection.
For surgeons: Learn more about the [Endomidface technique and our training programs.
Learn Maximum Safety Techniques
The mentorship programs emphasize complication prevention and management when they occur.
View Mentorship Programs