Hematoma and nerve paralysis in incisional facelift—how do they vary by surgical technique?

The most common complication in incisional facelift is hematoma (blood accumulation under the skin). An analysis pooling 11,300 cases reported hematoma in 1.1% and overall complications in 1.8%[1]. When broken down by surgical technique, both hematoma and temporary nerve paralysis show variation in the figures, but the differences remain under a few percentage points[2]. Therefore, when choosing a surgical technique, it is more useful to consider how to respond if a complication occurs rather than which technique is more dangerous.

How often do complications occur?

The overall rate does not reach 2%. An analysis of 11,300 cases reported overall complications at 1.8%, with hematoma at 1.1% and infection at 0.3%[1].

However, these are figures pooled across all surgical techniques[1]. If you want to know the figures for the specific method you will undergo, you need to consult analyses broken down by surgical technique.

How do nerve paralysis rates differ by surgical technique?

Rates are slightly higher with methods that address deeper layers. In a meta-analysis of 183 studies, temporary nerve injury occurred in 1.85% with the high-SMAS elevation technique and 1.52% with the composite method[2]. Compared with the SMAS plication method, a statistically significant difference appeared only in these two (odds ratio 2.71 and 2.22, both p<0.05)[2].

The actual frequency does not reach 2%. The deeper methods should not be avoided; rather, these figures serve as data to compare against the magnitude of lift obtained.

Which surgical technique increases hematoma?

Deep-plane dissection and SMAS partial excision with suturing. In the same analysis, major hematoma occurred in 1.22% with deep-plane technique (odds ratio 1.67, p<0.05) and 1.92% with SMAS partial excision suturing (odds ratio 2.65, p<0.01), significantly more than with plication[2].

Hematoma can develop after leaving the operating room. It is reassuring to ask about the timing of discharge and how to reach the clinic on the day of surgery.

Does paralysis persist? Are there measures to prevent it?

No difference between techniques has been found in permanent nerve injury. The meta-analysis of 183 studies reported no significant difference between surgical techniques regarding permanent nerve injury[2]. Medical literature notes that SMAS partial excision with suturing may reduce the risk of nerve injury compared with the plication-only method[3].

Hematoma has clear preventable factors. Textbooks state that hematoma is the most common complication in Facelift procedures, and postoperative hypertension is the greatest risk factor.[3]Preventive measures including blood pressure management have also been analyzed and summarized.[4]If you tend to have high blood pressure, please discuss preoperative management beforehand.

Pitfalls when comparing numbers

Ranking is not yet established. A research protocol registered in 2025 describes the analysis of 183 studies as a descriptive summary rather than a comparative analysis of surgical techniques, and states that ranking analysis will be performed going forward.[5].

A review comparing SMAS handling methods with Deep Plane[6]and prospective studies tracking both approaches[7]are also underway. Consider the current numbers as interim results. It is worth asking about the source of evidence for explanations such as 'newer surgical techniques have fewer complications.'

Four things to confirm at your consultation

First, whether the SMAS is folded, partially excised, or lifted at a deeper plane.[2]Second, the frequency of hematoma at that facility and how it is managed if it occurs.[1]Third, how your blood pressure will be managed.[3]Fourth, how long temporary nerve paralysis, if it occurs, is expected to take to resolve.[2].

The range of surgical options available varies depending on the degree of sagging (skin laxity), skin thickness, and the condition of the neck. Complication statistics are population averages and do not indicate what will happen to you. At your consultation, confirm the depth to which sagging extends and your blood pressure status, then decide together which surgical technique to use and what to prioritize.