Complications in Facial Surgery: A Complete Guide for Patients | Dr. García Ceballos FCCP

Aesthetic facial surgery—whether rhinoplasty, a facelift, blepharoplasty, or mentoplasty—offers transformative and lasting results when performed with technical rigor and in an appropriate clinical setting. However, like any surgical procedure, it carries risks that every patient should be aware of before making an informed decision.

In this complete guide, Dr. José Ignacio García Ceballos FCCP, plastic, aesthetic and reconstructive surgeon at Mallorca Medical Group, explains in detail what are the most frequent complications in facial surgery, how they are prevented and how they are managed in case they occur. Honest and transparent information that makes the difference between a trustworthy clinic and one that simply promises.

“In facial plastic surgery, safety is not an add-on: it is the starting point. Every surgical decision – from preoperative planning to postoperative follow-up – is oriented to minimize risks and maximize natural and long-lasting results.”

– Dr. José Ignacio García Ceballos FCCP, Plastic Surgeon at Mallorca Medical Group

1. Why is it important to discuss complications in facial surgery?

Many aesthetic surgery clinics avoid openly addressing the risks of their procedures. At Mallorca Medical Group, we believe that transparency is an indispensable ethical pillar. A well-informed patient is a safer patient, with realistic expectations and a greater ability to collaborate in their recovery.

The frequency of complications in facial surgery is low when the procedure is performed by a certified plastic surgeon with specific training in facial surgery -such as Dr. García Ceballos, trained at the UZ VUB in Brussels (Belgium) and member of the Fellowship of the American College of Surgeons (FCCP)-. However, no surgical procedure is one hundred percent risk-free, and the best way to protect the patient is to explain every possible scenario.

It is important to distinguish between a plastic surgeon (a board-certified specialist in Plastic, Aesthetic and Reconstructive Surgery) and an otolaryngologist (ENT) who performs cosmetic rhinoplasty, or a general practitioner who performs facial procedures. Comprehensive training and surgical experience make a significant difference in the prevention and management of complications.

2. General complications common to all facial surgery

Regardless of the specific procedure, there are potential complications common to all surgical interventions performed under anesthesia:

• Postoperative hematoma: accumulation of blood under the skin. It is the most frequent complication in facelifts (incidence 1-8%). It is managed with early drainage when significant. Smoking, uncontrolled high blood pressure, and the use of anticoagulants are major risk factors.
• Infection: infrequent (<1%) in facial surgery when certified sterile protocols are used. It is prevented with perioperative antibiotic prophylaxis and appropriate postoperative care.
• Abnormal scarring: includes hypertrophic or keloid scars, more frequent in high phototypes (dark skin). Precise surgical technique and active postoperative follow-up minimize this risk.
• Sensory alterations: temporary paresthesia or hypoesthesia in operated areas, generally transient and resolving spontaneously within weeks or months.
• Anesthetic reactions: extremely rare with modern anesthesia administered by a qualified anesthesiologist in a certified operating room.

3. Specific complications by facial procedure

Each facial surgery intervention has its own risk profile. Understanding it is fundamental for informed decision-making:

Rhinoplasty (nose surgery): specific complications include prolonged edema (especially in thick skin), cartilage irregularities, residual nasal septum deviation, and in less frequent cases, skin necrosis (higher risk if previous fillers have been overused). Ultrasonic rhinoplasty, performed by Dr. García Ceballos, reduces bone trauma and intraoperative bleeding compared to conventional osteotomy techniques.

Facelift (rhytidectomy): facial nerve injury is the most feared complication, with an incidence in expert hands of less than 1% for permanent paresis. Skin necrosis due to ischemia affects more smokers. The Deep Plane technique, which works below the SMAS, offers more natural and lasting results with less skin tension.

Blepharoplasty (eyelid surgery): specific risks include iatrogenic ptosis (drooping of the upper eyelid), ectropion (eversion of the lower eyelid), and, in very rare cases, ocular complications. A prior ophthalmological evaluation is recommended for patients with dry eyes or previous alterations.

Mentoplasty and facial lipofilling: the risk of chin implant migration, asymmetry, and fat reabsorption in grafts are the most frequent complications, all of which can be minimized with precise technique and appropriate candidate selection.

4. Risk factors that the patient should be aware of

Candidate selection is as important as the surgical technique. These factors increase the risk of complications:

• Active smoking: compromises microcirculation and significantly increases the risk of skin necrosis. Total abstinence is recommended at least 4 weeks before and after any facial surgery.
• Uncontrolled high blood pressure: main risk factor for postoperative hematoma.
• Anticoagulant or antiplatelet medication: must be discontinued sufficiently in advance under medical supervision.
• Natural supplements with anticoagulant effect: high-dose omega-3, vitamin E, garlic, ginger, ginkgo biloba.
• History of keloids or abnormal scarring.
• Autoimmune diseases or connective tissue disorders affecting healing.
• Undiagnosed body dysmorphic disorder: preoperative psychological evaluation is essential in cases of doubt.

5. How Mallorca Medical Group minimizes risks

Patient safety is not just talk: it is an integral protocol that includes every stage of the surgical process:

• Exhaustive preoperative assessment: complete blood work, electrocardiogram, anesthetic evaluation, and standardized medical photography.
• Certified operating rooms with all state-of-the-art monitoring and anesthetic safety systems.
• Multidisciplinary team: specialized plastic surgeon, qualified anesthesiologist, and surgical nursing team with experience in aesthetic surgery.
• Detailed informed consent covering all specific risks of the procedure, with sufficient time for reflection.
• Active postoperative follow-up: scheduled reviews, direct availability of the medical team for any incidents, and action protocol for complications.
• International training of the surgeon: Dr. García Ceballos completed his advanced training in facial surgery at the UZ VUB in Brussels (Belgium), a European reference in highly complex facial surgery techniques.

6. When to see a doctor after facial surgery

It is normal to experience swelling, bruising, and some discomfort during the first few days of recovery. However, certain warning signs require immediate contact with the medical team:

• Intense pain that does not improve with usual analgesia or that progressively increases.
• Fever above 38°C that appears after the second postoperative day.
• Excessive redness, local heat, or purulent discharge at the incisions.
• Marked asymmetry that appears or increases in the first few days.
• Loss of motor sensation (difficulty moving the lip, eyelid, or forehead).
• Active bleeding that does not stop with compression.

At Mallorca Medical Group, all patients have a direct channel of contact with the medical team during the postoperative period. No doubt or concern is too small.

Frequently Asked Questions about Complications in Facial Surgery

Are serious complications frequent in facial surgery?

Serious complications are infrequent when surgery is performed by a qualified plastic surgeon in a facility with adequate resources. The incidence of major complications (such as permanent nerve damage or skin necrosis) in expert hands is less than 1%. Correct candidate selection and postoperative follow-up are crucial.

Does the type of clinic influence the risk of complications?

Yes, very significantly. Operating in a health-certified operating room, with a qualified anesthesiologist and a complete monitoring team, substantially reduces the risk of anesthetic and surgical complications. Clinics that perform procedures under superficial sedation without an anesthesiologist or in uncertified operating rooms take risks that the patient is often unaware of.

Can an ENT perform rhinoplasties with the same safety as a plastic surgeon?

An otolaryngologist’s training is primarily focused on functional surgery of the upper airway. A plastic, aesthetic, and reconstructive surgeon like Dr. García Ceballos has specific training in advanced aesthetic techniques, complication management, and a three-dimensional vision of facial anatomy, which offers significant advantages, especially in complex or secondary cases.

What should I do if I think I have a postoperative complication?

The first thing to do is contact the medical team that performed the intervention directly, without delay. Never apply treatments on your own or wait for the next scheduled review if you have warning symptoms. At Mallorca Medical Group, our patients have direct access to the medical team throughout the postoperative period.