Swelling and bruising after Facelift: how to distinguish normal healing from signs of prolonged recovery

Swelling and bruising after Facelift are mostly normal and resolve naturally over time. However, hematoma (a collection of blood from internal bleeding) is reported as the most common complication of this surgery that may require revision surgery. We explain the distinction between normal healing progression and signs that warrant prompt contact with your surgeon.

The most common complication is "hematoma"

In reports summarizing short-term complications after Facelift, hematoma (accumulation of blood clots) is considered the most frequent complication requiring surgical intervention. A comparative analysis of research from 2001 to 2013 noted that the frequency of hematoma increased by approximately 1.8%[1]. Similarly, other reports also identify hematoma as the most common complication, with reported frequencies ranging from 0.2% to 8%[2].

Characteristics of people prone to hematoma

Risk factors that increase hematoma risk include being male, having a history of high blood pressure, and having a constitution where blood does not clot easily[1][2]. If any of these apply to you, it is advisable to receive a detailed explanation of these risks before surgery.

"Expanding swelling" is a sign to contact the clinic, not a wait-and-see situation

"Expanding hematoma," in which one side suddenly becomes significantly more swollen, may lead to obstruction of blood flow or worsening of inflammation, and is considered a condition that should be managed immediately with revision surgery[2]. In cases of small hematoma, it may sometimes be possible to manage it with a needle aspiration procedure[2].

Methods to reduce bleeding are also being researched

There are reports that mixing tranexamic acid with local anesthetic and infiltrating it has reduced intraoperative blood loss[3]Tranexamic acid is used throughout the field of plastic surgery to control bleeding, and there are systematic reviews that have organized its effectiveness.[4]Randomized controlled trials have examined the effect of placing drains (tubes for fluid drainage), but they have not demonstrated an effect in preventing swelling itself.[5].

Follow-up observation is conducted at intervals of several months.

In before-after cases of surgical techniques using internal suturing (quilting sutures), the typical course shows discharge on the day after surgery, wearing a compression garment, and then follow-up at 1 week, 1 month, 3 months, and 6 months.[6]Delayed changes such as skin depressions or seromas, and fluid leakage, are findings that emerge during this follow-up observation.[6].

Signs that warrant contact other than swelling

If new difficulty moving the face appears, it is a sign to suspect nerve involvement rather than swelling. Systematic reviews of nerve injury after Facelift are available, and it is positioned as a complication to be assessed separately from swelling.[7]Fever, warmth and redness around the wound, or a sudden increase in bloody drainage also require contact as signs of infection or circulatory compromise.

The boundary between normal recovery and changes requiring contact

Gradual reduction of swelling and bruising is a normal course. On the other hand, if only one side suddenly swells, difficulty with movement appears, or fever develops, these are signs of deviation from the normal healing process. Those who match risk factors for hematoma (male, high blood pressure, easy bleeding tendency) may benefit from confirming specifically how to distinguish these signs before surgery.