Facelift Risks and Complications in Sydney: An Surgeon’s Honest Guide

Every patient who walks into my consulting rooms deserves the same thing: a clear, honest picture of what facelift surgery involves, including the risks. The conversation I have with patients about facelift risks and complications in Sydney is usually the longest part of the consultation, and that is by design. A facelift is a significant operation, and the decision to proceed should not be rushed.

What follows is essentially that same consultation, only on the page. Read it through, and you’ll have a sense of where the real risks of facelift surgery sit, how everyday side effects look different from the genuine complications, and the practical steps both surgeon and patient can take to lower the odds of trouble.

Risk in facial surgery cannot be eliminated. It can, however, be substantially reduced through three things: choosing the right surgeon, using the right technique in the right setting, and preparing your body properly. The aim of this guide is to help you assess all three.

Why a frank conversation about facelift risk matters

Australia changed the way cosmetic surgery is regulated in July 2023, when AHPRA introduced a new cosmetic surgery framework with stricter advertising rules, mandatory referrals from a GP, and a 7-day cooling-off period for patients undergoing major cosmetic procedures. These changes were a direct response to high-profile patient harm cases.

One of the clearest distinctions in the new framework is between a Specialist Plastic Surgeon (FRACS) and a cosmetic doctor or cosmetic surgeon. A Specialist Plastic Surgeon is a doctor who has completed at least 12 years of medical and surgical training, including a fellowship in plastic surgery with the Royal Australasian College of Surgeons. A cosmetic surgeon, by contrast, is not a recognised specialist title in Australia, and the training requirements are very different.

This matters for risk. The single biggest variable in facelift safety is the surgeon performing the operation. Published complication rates differ significantly depending on surgeon training, case volume, and the setting in which the surgery is performed. If you take only one thing from this article, take that.

Common, expected side effects (not complications)

It helps to start by separating the two. A side effect is something that is expected to happen and resolves on its own. A complication is an adverse event that requires intervention or carries the risk of a lasting consequence. Confusing the two creates unnecessary anxiety.

These are the side effects that almost every facelift patient experiences:

• Bruising and swelling. Both peak around days 3 to 5 after surgery and fade noticeably by week 2 to 3. Most patients return to social settings between weeks 3 and 4.
• Tightness and numbness. A pulled, tight feeling around the cheeks, jawline and neck is normal as the deeper tissues heal. Numbness around the ears and lower face usually resolves over 3 to 6 months.
• Mood changes during early recovery. Many patients describe a brief low mood in the first 1 to 2 weeks. This is a normal physiological response to the anaesthetic, the swelling, and seeing yourself looking very different in the mirror. It is not a complication, and it lifts as the swelling settles.
• Mild discomfort. Most patients report less pain than they expected, usually managed with simple oral analgesia rather than strong opioids.

If you would like a more detailed walk-through of what to expect day by day, our recovery after deep plane facelift blog covers the timeline in depth.

Genuine complications and how each is minimised

These are the complications I discuss with every facelift patient before surgery. Each one is uncommon, but each one matters.

Hematoma

A hematoma is a collection of blood under the skin, and it is the most common serious complication of facelift surgery. Published series report incidence rates of approximately 1 to 5%, depending on the technique used and the patient’s individual risk profile. Men have a slightly higher rate than women, largely because of differences in skin and beard blood supply.

Most hematomas show up in the first 24 hours, with one side of the face or neck swelling rapidly, pain increasing, and a sense of pressure building. If we catch it early, the fix is straightforward: a quick trip back to theatre to drain the blood and find where it came from.

How do I get the hematoma rate down? Mostly by being fussy about blood pressure during the operation and the hours after it. A hemostatic net can be useful for compressing smaller bleeders. Drains go in when I think the patient will benefit from one. And tranexamic acid is a clotting helper I use routinely in selected cases. None of this is dramatic, but the cumulative effect on hematoma rates compared with older techniques is real.

Facial nerve injury

This is the complication patients fear most, and rightly so. The facial nerve controls the muscles of facial expression, and damage to it can leave one side of the face weak. Happily, long-term nerve injury after a facelift isn’t something we see often. With experienced surgeons, the published numbers fall well under 1 percent, and whatever weakness does crop up tends to settle on its own.

Temporary weakness is much more common, particularly in the muscles around the eye and lower lip. It happens because nerves can be stretched or briefly stunned during dissection, even when they are never cut. In almost every case, function returns over weeks to months as the nerve recovers. Permanent injury is most often associated with surgeons who do not have a deep working knowledge of facial nerve anatomy. The deep plane facelift technique requires precise anatomical understanding because the dissection happens immediately above the layer in which the nerve branches travel.

Skin necrosis and wound healing problems

Skin necrosis means an area of skin loses its blood supply and does not heal. It is uncommon, but it is one of the complications most strongly tied to factors the patient can control.

Smoking is the single biggest risk factor. Nicotine constricts the small blood vessels that supply the skin flap during healing, and the effect is significant. For this reason, I require all facelift patients to be completely nicotine-free for at least 6 weeks before surgery and 6 weeks afterwards. This includes cigarettes, vapes, nicotine patches, gum and lozenges. There are no exceptions, because the consequences of smoking through a facelift can be permanent and disfiguring. Other risk factors include uncontrolled diabetes, peripheral vascular disease, certain medications, and a history of radiation to the face or neck.

Visible or widened scarring

Every facelift involves incisions, and every incision leaves a scar. The aim is to place the scars where they are least visible, usually within the hairline above and behind the ear, around the natural contour of the ear itself, and in the groove behind it. With careful incision design and good healing, most facelift scars become very difficult to see at conversational distance over the months that follow.

Some patients heal with hypertrophic or keloid scarring, where the scar is raised, red and noticeable. This is more common in patients with a personal or family history of keloid formation, and it is something I screen for at consultation. When the risk is identified, we discuss preventive strategies including silicone, taping, and, in some cases, steroid injection.

For a more detailed breakdown of scar placement and care, please see our blog: Does facelift surgery leave scars.

Asymmetry and unsatisfactory results

No human face is perfectly symmetrical, and surgery cannot create symmetry that was never there. Most patients have noticeable differences between the two sides before surgery; what changes is whether they have looked closely enough to see them. After a facelift, both sides will have improved, but small asymmetries usually remain.

True unsatisfactory results, where the outcome falls short of what was reasonable to expect, are uncommon when expectations are properly aligned at consultation. When concerns do arise, I prefer to wait at least 6 to 12 months before considering any revision, because tissue settling continues for that long. Our blog on when to ask for a second opinion after facelift surgery walks through the decision in detail.

Pixie ear and earlobe distortion

“Pixie ear” refers to an earlobe tugged down and forward by the weight of lifted skin, leaving it stretched and stuck against the cheek. It tends to appear after facelifts that rely on skin tension alone, without proper support of the deeper layers. A modern facelift gets around this by securing the deeper tissues, either the SMAS or a deep plane composite flap, to the underlying bone and fascia. With no tension on the closure, the earlobe sits where it should.

Hairline distortion

Lifting skin up and out during a facelift will shift the hairline unless the incisions are mapped against the natural hairline first. You can end up with a temporal hairline sitting too high or a sideburn pushed out of place. Trichophytic incisions, angled so that hair eventually grows up through the scar, help camouflage any line crossing hair-bearing skin. For patients with thin temporal hair or a high starting hairline, I sometimes prefer to keep the incision in front of the temporal hairline rather than behind it, trading a fine visible line for keeping the hairline where it belongs.

Numbness and altered sensation

Almost every facelift patient experiences some numbness in the first weeks and months after surgery, particularly around the cheeks, the front of the ear, and the earlobe, because the small sensory nerves that supply the skin are unavoidably stretched during the lift. In most patients, sensation returns gradually over 3 to 6 months. A small permanent area of reduced sensation, usually around the earlobe, is occasionally left behind. Patients almost never find this bothersome, but it is something I make sure every patient knows about before surgery.

Anaesthetic risk

Modern general anaesthesia, when administered by a specialist anaesthetist in an accredited hospital, is very safe. Serious anaesthetic events in healthy patients undergoing elective surgery are rare. Every facelift I perform is in a fully accredited private hospital with a specialist anaesthetist who reviews the patient’s full medical history before the operation. This is one of the reasons I do not perform facelift surgery in office-based settings: the level of monitoring and the access to emergency support in a hospital are not replicable in a consulting room.

Risk factors patients control

Some of the most powerful risk-reducing steps happen before you ever see the inside of an operating theatre. These are the factors I ask every patient to address in the weeks before surgery:

• Smoking and nicotine in any form. Cigarettes, vapes, patches, gum and lozenges. Nicotine is the problem, regardless of the delivery method.
• Uncontrolled high blood pressure. This is one of the strongest predictors of post-operative hematoma. Blood pressure must be well controlled before surgery, and we work with your GP if needed.
• Certain blood thinners and supplements. Aspirin, fish oil, vitamin E, anti-inflammatory medications and some herbal supplements (including ginkgo and garlic capsules) increase bleeding risk. We provide a complete list of what to stop, and when, at consultation.
• Recreational drug use. Cocaine in particular causes major blood pressure and cardiovascular problems and is an absolute contraindication to facelift surgery in the lead-up to the operation.
• Poor nutrition. Patients who have lost a large amount of weight rapidly, particularly on GLP-1 medications such as Ozempic, sometimes need a nutrition plan in the weeks before surgery to support healing.
• Body mass index extremes. Both very low and very high BMI carry their own risks. We discuss this individually at consultation.

Risk factors the surgeon controls

On my side of the table, the most important variables are:

• Specialist Plastic Surgeon FRACS qualification with ongoing training in modern facelift technique. AHPRA registration as a specialist plastic surgeon (mine is MED0001151603) can be verified directly through the AHPRA register.
• Deep plane technique performed with full anatomical respect for the facial nerve. This requires a clear three-dimensional understanding of where each branch of the nerve travels in each layer.
• Operating in an accredited private hospital with full surgical and anaesthetic support, never in an office-based setting.
• Specialist anaesthetist. A doctor who has completed full specialist training in anaesthesia, not a sedationist or non-specialist medical practitioner administering sedation.
• Conservative case selection. There is an old surgical truth: the operation you do not perform never has a complication. Knowing when not to operate matters as much as knowing how to operate.
• Modern adjuncts. Hemostatic net where appropriate, careful blood pressure control, tranexamic acid in selected cases, and drains where indicated rather than routinely.

How to spot warning signs after surgery

The vast majority of facelift recoveries are uneventful. On the rare occasion something goes wrong, the warning signs usually appear early, and quick action is what saves the result. Get in touch with our practice straight away if you notice any of the following:

• Rapid one-sided swelling or increasing pain. This can suggest a hematoma and needs assessment within hours, not days.
• Inability to move part of your face. Particularly the eyebrow, the corner of the mouth or the eyelid, days after surgery. This needs urgent review.
• Fever, increasing redness around incisions, or pus. These can suggest infection, which is uncommon but treatable when caught early.
• Sudden change in vision or severe one-sided headache. Rare, but always worth a same-day call.

My patients are given direct contact details for the practice and an after-hours number, and I would always rather be called about something minor than miss something significant.

Frequently asked questions

How safe is facelift surgery?

Facelift surgery is considered very safe in the right setting: a Specialist Plastic Surgeon FRACS operating in an accredited private hospital. Modern published series put serious complication rates well under 5%, and the issues that do arise are usually minor and settle over time. More than anything else, the surgeon’s credentials and the operating environment shape your personal level of risk.

What is the most common complication of a facelift?

Hematoma, which is blood pooling under the skin, sits at the top of the list for serious facelift complications. The rate runs roughly 1 to 5% depending on the technique and the patient, and men carry a slightly higher risk. It typically shows itself within the first day, and dealing with it is usually uncomplicated if it’s picked up early.

Can a facelift damage facial nerves?

Permanent facial nerve injury after a facelift is rare, occurring in well under 1% of cases when performed by a qualified Specialist Plastic Surgeon. Temporary nerve weakness is more common and almost always resolves within weeks to months. Surgeon experience and a deep working knowledge of facial nerve anatomy are the key protective factors.

Is a deep plane facelift riskier than an SMAS facelift?

A deep plane facelift is not riskier than an SMAS facelift in experienced hands, and published evidence shows comparable complication rates with longer-lasting results. Surgeon experience with the specific technique is the more important variable. The deep plane approach is technically more demanding, which is why surgeon selection matters.

What can I do to reduce my facelift risks?

The four most impactful things you can do are stop all nicotine for at least 6 weeks before surgery, control your blood pressure, optimise your nutrition, and choose a Specialist Plastic Surgeon FRACS. A complete pre-operative checklist, including which medications and supplements to stop and when, is provided at consultation.

How do I know if my facelift recovery is normal?

Normal facelift recovery includes bruising, swelling, tightness and mild discomfort that improve steadily over the first 2 to 3 weeks. Warning signs that need urgent surgeon contact include rapid one-sided swelling, severe pain, fever, or weakness in part of the face. Practice contact details, including an after-hours number, are provided to every patient at discharge.

Why choose Dr Hunt for Facelift in Sydney

Choosing the right surgeon is the single most powerful step you can take to reduce facelift risk. Dr Jeremy Hunt has performed facelift surgery in Sydney for over 25 years as a Specialist Plastic Surgeon FRACS, operating exclusively in accredited private hospitals with specialist anaesthetists.

Dr Jeremy Hunt is a Specialist Plastic Surgeon (FRACS) based in Sydney, with consulting rooms in Woollahra (175 Edgecliff Road, Woollahra NSW 2027) and Wollongong (Suite 6, 174 Gipps Road, Gwynneville NSW 2500). He has over 25 years of experience in aesthetic and reconstructive plastic surgery, with particular expertise in deep plane facelift, mini facelift, jowl lift, neck lift and complementary facial rejuvenation procedures.

Dr Hunt holds Fellowship of the Royal Australasian College of Surgeons in Plastic Surgery (FRACS) and is registered as a Specialist Plastic Surgeon by the Australian Health Practitioner Regulation Agency (AHPRA), registration number MED0001151603. He is an active member of the Australian Society of Plastic Surgeons (ASPS), the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), and the Royal Australasian College of Surgeons.

All facelift surgery with Dr Hunt is performed in fully accredited private hospitals with specialist anaesthetists, never in office-based settings. Dr Hunt sees patients from across Sydney, including Double Bay, Woollahra, Bondi Junction, the Eastern Suburbs and the wider Sydney metropolitan area, as well as from Wollongong and the Illawarra.

To discuss whether facelift surgery is right for you, you can request a consultation with Dr Hunt at his Sydney or Wollongong practice using the form on this page or by calling our team. Please note that under the AHPRA cosmetic surgery framework, a 7-day cooling-off period applies between consultation and surgery, and a referral from your GP is required before booking any major cosmetic procedure.

Further reading

• Facelift Surgery in Sydney (procedure page)
• Deep Plane Facelift in Sydney
• Does Facelift Surgery Leave Scars?
• When to Ask for a Second Opinion After Facelift Surgery
• Recovery After Deep Plane Facelift

Medical references

• AHPRA Cosmetic Surgery Hub: Australian regulatory framework for cosmetic surgery, including the specialist plastic surgeon distinction.
• Healthdirect Australia: Facelift Surgery: Australian government-backed plain-language overview of facelift procedures and risks.
• Therapeutic Goods Administration (TGA): Cosmetic procedures: TGA information on regulated medical devices and products used in cosmetic procedures.
• Johns Hopkins Medicine: Facelift: Authoritative academic-medical reference on facelift complications and definitions.
• American Society of Plastic Surgeons: Facelift Safety: Plastic surgery society reference on risk consent and informed decision-making.
• PMC: Limited incision facelifts safety meta-analysis: Peer-reviewed complication-rate data from modern facelift series.

Disclaimer: Any surgical or invasive procedure carries risks. The information in this article is general in nature and is not intended as medical advice for any individual. Before proceeding with surgery, you should seek a second opinion from an appropriately qualified health practitioner. A referral from your GP and a 7-day cooling-off period are required for major cosmetic procedures under the AHPRA cosmetic surgery framework. Individual results vary.

MED0001151603 – Dr Jeremy Hunt, Specialist Plastic Surgeon, AHPRA registration. This website contains imagery that is only suitable for audiences 18+.