In short. The commonest early complication of any lift: what one-sided pressure and swelling mean, why you call rather than wait for morning, and what theatre involves.
Key points
- The instruction that belongs in every plan is a telephone number that answers at night, and permission to use it.
- A patient who notices one side swelling more than the other, or pain that is worsening rather than easing, should call the same hour.
- Being told it is nothing is a good outcome and costs a telephone call.
A collection of blood under the skin, called a hematoma, is the commonest early complication of any lift, and it is the reason the first night after this operation is not simply a night of sleep. The distinction that matters is simple: most of the first night is uncomfortable and expected, and a small proportion of it is a problem that needs theatre. Learning which is which before the operation is more useful than being reassured that both are unlikely.
What it looks like
A hematoma is pressure. Swelling that is worse on one side, swelling that keeps growing after the point at which it should be settling, pain that is not controlled by what you have been given, and skin that looks tight or tense rather than merely bruised. It is often described by patients as the sensation that something is building up rather than something that is sore. Compare one side with the other. A face is symmetrical, and a difference that is increasing is the finding that matters, not the absolute amount of swelling.
Call, do not wait
The instruction that belongs in every plan is a telephone number that answers at night, and permission to use it. A patient who notices one side swelling more than the other, or pain that is worsening rather than easing, should call the same hour. Being told it is nothing is a good outcome and costs a telephone call. Being told it is nothing in the morning, when it was not nothing, costs something that cannot be reversed. Ask who to call before the operation, and write the number down.
What returning to theatre involves
Evacuating a collection is a short operation in which the blood is released and the wound is closed again, usually under a brief anaesthetic. It is not a repeat of the lift. When it is done early, the recovery is usually unremarkable and the result is what it would have been. The reason this page exists is that the outcome depends far more on how quickly the patient is seen than on how well the evacuation is performed, and the patient is the one who decides how quickly.
Call the same hour if
- One side of the face or neck is swelling more than the other, particularly if it is increasing.
- Pain is worsening rather than easing, or is not controlled by the medication you were given.
- The skin over the swelling looks tense, shiny or darker than the other side.
Prevention is planned rather than hoped for. Blood pressure is controlled before the operation, drugs that affect bleeding are reviewed with whoever prescribed them, drains are used where the surgeon judges they help, the head is kept up, and the first night is observed. Smoking is stopped, because it is a risk factor that belongs to the patient and there is no reason to carry it. None of this removes the risk of a collection. It changes whether one is recognised in time, and that is the part that decides the result.
Frequently asked questions
What does a hematoma feel like?
It is a collection of blood under the skin, and it announces itself as pressure and swelling that are worse on one side and worse than expected, often with pain that is not controlled by what you were given. The skin may look tense, tight or bruised far beyond the other side. It is not usually subtle, and the honest rule is that anything that feels wrong enough to think about is worth a telephone call that night.
Why not wait until the morning appointment?
Because the tissue under pressure is tissue that is not being supplied properly, and hours matter. A collection evacuated early is usually a straightforward problem with an uncomplicated recovery. The same collection left overnight can compromise the skin over it, and skin that has been lost is a result that no later operation recovers. This is the one complication where being an inconvenience at night is the correct behaviour.
How is it prevented?
Pressure is controlled before the operation, drugs that affect bleeding are reviewed with the prescriber, drains are used where the surgeon judges them useful, the head is kept elevated and the first night is observed rather than assumed. None of that removes the risk. It changes how quickly a problem is recognised, which is the part that determines the outcome.
Risks & Limitations
- A deep plane lift is a longer operation under a longer anaesthetic. The branches of the nerve that move the face are closer to the dissection: weakness is usually temporary, and not always.
- A collection of blood under the skin is the commonest early complication and the reason the first night matters. One-sided swelling, increasing pressure or pain that is worsening should be reported the same hour, not in the morning.
- Skin at the incision edge can heal poorly or be lost, and the risk rises with smoking and with previous surgery. Scars are permanent and mature over a year or more.
- Swelling at this depth settles more slowly than after a skin-based lift. Three months is too early to judge, and a revision considered before twelve months should be examined very carefully.
When to Seek Care
- Swelling on one side of the face or neck that is increasing, pain that is worsening rather than easing, or a collection of blood under the skin — telephone the team the same hour, day or night.
- Any loss of movement rather than feeling: a brow that will not lift, an eye that does not close fully, or a smile that is asymmetric — report it immediately.
- Fever, spreading redness, warmth or discharge around an incision, or a wound that opens.
- Difficulty breathing, chest pain or a calf that is swollen and tender — seek emergency care at once.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — facelift and deep plane technique guidance
- National Institute for Health and Care Excellence (NICE, UK) — guidance on surgical safety and shared decision making
- Cochrane Library — systematic reviews in facial rejuvenation and wound care
- British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) — patient information on facial surgery
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.