How to Avoid Facelift Regrets — Zetith Clinic Explains the Causes of Complications and How to Prevent Them

• Whether the attending physician is a certified specialist of the Japan Society of Plastic and Reconstructive Surgery or the Japan Society of Aesthetic Surgery
• Whether they offer advanced surgical techniques involving the SMAS layer
• Whether pre-operative blood pressure and medication checks are thoroughly conducted
• Whether a clear protocol for post-operative hematoma and infection management is in place
• Whether there are abundant case photos showing natural-looking results

Complication and Revision Rate Data for Facelift from Published Literature

While a facelift (rhytidectomy) is a procedure requiring advanced technical skill, a substantial body of clinical data has accumulated regarding its safety when performed appropriately. At Zetith Clinic, we are committed to presenting scientific evidence honestly — including negative data — so that patients can make informed treatment decisions. Below, we introduce key figures derived from peer-reviewed publications.

① Overall Complication Rates for Facelift

A large-scale analysis published in 2020, "Contemporary Analysis of Rhytidectomy," examined complication in detail among 13,346 facelift patients (mean age 60.07 years; 90.3% female). The overall complication rate was 5.19%, with the following breakdown:

• Hematoma: 1.97% (the most common surgical complication)
• Infection: 0.89%
• Seroma: 0.62%

Multivariate analysis in the same study identified male sex (odds ratio 1.69), obesity (BMI >30, odds ratio 1.73), and general anesthesia (odds ratio 1.73) as factors that significantly increase complication risk. The study also noted that 22% of patients underwent concurrent blepharoplasty, indicating that combined procedures are common.

A 2021 review article, "Facelift Complications: A Review," conducted a cross-database analysis and reported an expanding hematoma rate of 1.8% by meta-analysis. It also highlighted the important finding that approximately 90% of hematomas occur within 24 hours postoperatively, underscoring the critical importance of close monitoring immediately after surgery.

② Factors Influencing Hematoma Risk and Preventive Measures

Hematoma is the complication requiring the greatest vigilance in facelift surgery. A 2007 paper, "Complications of Superficial Plane Cervicofacial Rhytidectomy" (178 cases), demonstrated that hematoma risk increases markedly when preoperative systolic blood pressure exceeds 150/100 mmHg. It also reported a striking contrast: the hematoma rate was 4.8% in groups using tumescent solution containing epinephrine, compared to 0% in groups without it.

The 2021 review similarly reported that patients with a systolic blood pressure exceeding 150 mmHg faced a 3.6-fold relative risk of hematoma, while male patients faced a 2.8-fold increased risk, reaffirming that preoperative blood pressure control and patient sex are critically important risk factors. A Phase 2 RCT also showed that fibrin glue use substantially reduced postoperative drainage from 26.8 mL to 11.5 mL, and lowered hematoma rates in male patients from 3.4% to 0.4%; however, the evidence for hematoma reduction with fibrin glue remains insufficient, and further validation is awaited.

③ Relationship Between Surgical Technique (SMAS Management) and Complication Risk

The 2019 study "Rhytidectomy Complication Rates by SMAS Technique" is a noteworthy large-scale data comparison examining how complication rates vary depending on the method used to address the SMAS (superficial musculoaponeurotic system). Rates of transient facial nerve injury differed by technique and were reported as follows:

• SMAS plication (n=5,081): 0.69%
• SMASectomy (n=3,454): 0.84%
• SMAS flap (n=17,247): 0.79%
• High lateral SMAS (n=1,300): 1.85% (OR 2.71 vs. SMAS plication)
• Deep plane (n=1,597): 0.69%
• Composite (n=858): 1.52% (OR 2.22 vs. SMAS plication)

While high lateral SMAS and composite techniques were associated with statistically higher rates of nerve injury, the study concluded that all such injuries were "transient," with limited long-term clinical impact. Regarding large hematoma rates, differences by technique were also observed: SMASectomy had the highest rate at 1.92%, while SMAS plication had the lowest at 0.73%. The SMAS flap technique was also noted to have a comparatively higher skin necrosis rate of 1.57% (OR 2.29). These data demonstrate that surgical technique selection directly affects the risk profile, reinforcing the importance of thorough preoperative discussion with the treating physician.

④ Incision Design and Patient Satisfaction

"Facelift Without Temporal Incision" (225 cases) examined the complication profile of facelift performed without a temporal incision. Only 2.2% of patients expressed dissatisfaction with scarring, and the hematoma rate was 3.6% (including needle aspiration and surgical intervention) — comparable to the literature average of 3.8%. Facial nerve injury rates were reported as below 2% across multiple publications, though some reports (such as the Little report) cited values as high as 8%, indicating variability depending on the surgeon and technique. Notably, deep vein thrombosis (DVT) was identified in 2 cases, both of which were asymptomatic. The risk of distal thrombus progressing to pulmonary embolism is approximately 2%, highlighting that postoperative systemic management cannot be overlooked.

Making the "Right Choice" Based on the Data

Summarizing the published data above, the overall complication rate for facelift falls broadly within the 5–6% range, with hematoma (approximately 2%) being the most frequent complication. While infection and nerve injury rates are relatively low, they are not zero. Crucially, many of these risks are closely associated with factors that can be identified and managed in advance — including blood pressure, body weight, smoking status, and choice of surgical technique.

Understanding these figures is not meant to cause anxiety, but to empower patients to choose "the right timing, technique, and clinic for their own situation." At Zetith Clinic, we carefully evaluate these risk factors during the consultation stage and propose a safe, individualized plan tailored to each patient.

References

1. Kim JH, et al. "Contemporary Analysis of Rhytidectomy." Aesthetic Surgery Journal, 2020. A large-scale retrospective analysis of 13,346 cases examining overall complication rates and risk factors using multivariate analysis.
2. Pitanguy I, et al. "Complications of Superficial Plane Cervicofacial Rhytidectomy." Aesthetic Plastic Surgery, 2007. Analysis of 178 cases examining the relationship between tumescent solution composition, blood pressure management, and hematoma risk.
3. Gupta V, et al. "Rhytidectomy Complication Rates by SMAS Technique." Plastic and Reconstructive Surgery, 2019. A comparative analysis of complication rates by surgical technique across multiple SMAS approaches (totaling approximately 30,000+ cases).
4. Sherris DA, et al. "Facelift Complications: A Review." Facial Plastic Surgery Clinics of North America, 2021. A comprehensive review integrating meta-analyses from 2001–2013 and the TOPS database, examining hematoma, infection, and the effects of fibrin glue.
5. "Facelift Without Temporal Incision." Year of publication not stated. Evaluation of complication profile and patient satisfaction in 225 cases using a technique omitting the temporal incision.