Bruising After a Facelift or Rhinoplasty: How to Bruise Less

By Adam Bryce Weinfeld, MD · Board-certified plastic surgeon · Austin, Texas · Updated November 1, 2026

Does oozing cause bruising after a facelift or rhinoplasty?

Yes. Oozing leads to bruising. When there is bruising underneath the skin, that’s blood that has collected underneath the skin from the process of surgery.

There’s going to be bleeding during surgery; we know that. That bleeding, and a little bit collected under the skin, leads to bruising. It can also lead to swelling, because blood underneath the skin, outside of the blood vessels, is actually inflammatory. And because it’s inflammatory and inflames nerves, it can also increase pain.

We’re not talking about life-threatening bleeding, but we are talking about recovery-threatening bleeding. Just a couple of extra drops of blood underneath the surface of the skin can mean a little more bruising than would be desirable, and a longer recovery.

Why bruising matters after facial surgery

Patients are concerned about a lot of things when it comes to recovery, especially recovery in the face: rhinoplasties, comprehensive cervicofacial rejuvenation (surgery of the face and neck, such as facelifts and neck lifts) and other procedures around the eyes. Bruising can delay the healing process, the recovery process and especially the process of social reintegration.

People want to get back to work and back to social engagements without evidence of surgery as soon as possible. Bruising is one of the telltale marks of having had surgery, in addition to swelling. So the name of the game is to reduce the amount of blood that collects underneath the skin, during surgery and also after surgery, during the recovery.

Why does a little blood matter more in the face and nose?

It’s particularly important in surgery of the face. Noses and faces, because a small amount of blood has a bigger impact. It’s a tighter space, a smaller space.

What controls bruising after facial surgery?

Three factors, or pillars, control it: the patient, anesthesia and surgical technique. To control bruising, we have to know the contributing factors that lead to bleeding.

All surgeries have bleeding. We want to control it and minimize it as much as possible, so you’ve got to understand those factors. There are patient factors, there are technique factors, and there are anesthesia factors.

What can you do before surgery to bruise less?

Tell your surgeon about alcohol, every supplement and every medication you take. Some patient factors are things we can modify.

Alcohol

Drinking alcohol, especially excessive amounts, within two weeks of surgery can potentially affect the ability of the liver to make the proteins that help create useful clotting during surgery. Those proteins help minimize bleeding and minimize the oozing that leads to bruising.

Supplements: turmeric and fish oil

Supplements that people take can have a big impact. So you need to tell your doctor what supplements you’re taking before surgery. We generally ask patients to stop at least two weeks before.

There are two supplements a lot of people take because they think they’re good for health. They may very well be good for their health, but they’re not good for it if what they want is a great facial plastic surgery recovery.

• Turmeric is very well understood to cause a little bit of a decrease in our body’s ability to create clots, and therefore it can lead to oozing.
• Fish oils are good for the heart for a variety of different reasons. Fish oils also affect the formation of normal, healthy, important clotting during surgery, at a microscopic, microvascular level, that’s important to decrease oozing.

There’s a whole host of them, and it is important to be aware of them. The most common ones are listed below.

Medications: aspirin and SSRIs

Some medications we can ask a patient to stop if we have medical clearance to do so, like aspirin. Some people take it for heart health, but many people who take it don’t have to. We like patients to stop it two weeks before surgery.

Another common one is SSRIs: mood-regulating medications like Prozac and others in that family. Those medications are well established to affect platelet function. Platelets are the tiny blood cells that help form the important clots that prevent bleeding, and therefore bruising, with surgery.

So I talk to my patients: we know this can cause a little extra bruising and may affect your recovery, but we need to have an honest conversation about whether it’s advisable for you to stop. If you stop this, is it going to really wreck your life? Is it going to make you depressed, or change your motivation level or your enjoyment of life?

If it’s not advisable, we acknowledge that some medications people have to continue to take, and we have other ways of controlling bruising and bleeding. But if someone says, “I only take it because it helps me sleep, I have mild anxiety, and I’ve gone off of it before,” then it ain’t an issue, and we have them stop. That’s about two weeks, and sometimes a month, beforehand, for patient-specific reasons. For more on the medications around surgery, see facelift and rhinoplasty medications for pain, nausea and swelling.

Common supplements and over-the-counter medications to stop before surgery

These are the most common ones we ask patients not to use, generally for at least two weeks before surgery. It’s not a complete list, so tell your surgeon everything you take.

Supplements

• Fish oil and other omega-3 supplements
• Turmeric (curcumin)
• Vitamin E
• Ginkgo biloba
• Garlic supplements
• Ginger supplements
• Ginseng
• Feverfew
• Dong quai
• St. John’s wort
• Green tea extract
• Saw palmetto

Over-the-counter medications

• Aspirin and products that contain it, such as Bayer, Bufferin, Ecotrin, Excedrin and Alka-Seltzer
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)
• Bismuth subsalicylate (Pepto-Bismol), which contains a salicylate related to aspirin
• Cold, flu and nighttime pain products that contain aspirin, ibuprofen or naproxen, such as Advil PM. Check the label.

Why do some people bruise more than others?

Genetic variation. Some patients just ooze a little bit more, and some a little bit less.

There’s a range of how our platelets and our coagulation cascade proteins (the proteins that make blood clot) function. There are microscopic differences that have to do with genetic variations, and those are things we can’t necessarily control. But it is important to know if someone has a disorder like hemophilia, or even a hemophilia trait, or has a relative with hemophilia or von Willebrand disease.

This is basic screening, done with some very simple questions:

• Do you bleed a lot when you’ve lost teeth? What’s dental work like?
• When you nick yourself shaving your underarms, your legs or your beard, does it stop bleeding in a normal period of time? Or does it take half an hour, an hour, to stop oozing?

These are important indicators that tell us we may need to order some labs, to get more information about how your blood functions when it needs to clot.

How does anesthesia affect bruising?

Through blood pressure. A low-normal, steady blood pressure during surgery, a smooth wake-up and nausea prevention all help limit oozing. Anesthesia factors cover the perioperative experience (the time around surgery) and how we can regulate it.

Clonidine for anxious patients

Some patients undergoing facial surgery tend to be very anxious, and their blood pressure pops when they get anxious, which we know will happen around surgery. We give them clonidine, a blood pressure medication that has a really wonderful effect on the way people’s blood pressure responds to stress. It can also make people feel less anxious, so it affects blood pressure in two different ways. It also helps with pain control afterward.

Patients take it either as a patch or as pills, depending on the specifics of their clinical scenario. Usually, when a patient is going to undergo facial surgery, we’ve noted high blood pressures and there’s no reason not to do it, we have them put the patch on the morning of the day before surgery. It starts to really kick in by the time we do surgery. They wear it for a week, and it really helps.

Steady beats perfect: blood pressure during surgery

Blood pressure during surgery is really important too. We work with a very tight, small group of anesthesia providers who are really excellent, and there are some we specifically request for our facial procedures because blood pressure management during surgery is so important. See also general anesthesia vs. IV sedation for a facelift.

We seek a low normal: in the normal range, low normal or just below normal for these facial procedures, because that helps decrease oozing. In some patients, you can’t keep what would be ideal. Then what’s more important is a consistent blood pressure.

If we had an ideal of, let’s say, 110 over 65 or 70, but we just can’t keep it there, I’d much rather have a 120 over 80 than a pressure bouncing back and forth between 110 over 65 and 130 over 90, because we’re trying to chase something we’re never going to catch.

A smooth wake-up and nausea prevention

One of the most important skills is waking a patient up without abrupt motions, like retching or gagging. That causes a temporary increase in venous pressure through a Valsalva maneuver (straining against a closed airway), plus clenching and a general increase in blood pressure, and that can force blood underneath the skin when we’ve just operated. So we want an anesthesia provider who makes the wake-up a very smooth transition, without that retch, that clench or biting on the breathing tube. We have hand-selected the ones who do this really, really well.

Postoperative nausea control starts even before the operating room, with medications to prevent nausea. Those are supplemented by the medications our anesthesia providers give during surgery, and by the way they use their anesthesia cocktail: gases, propofol, ketamine, Precedex, a mixture tailored to the patient that gives the best anesthesia with the lowest exposure to medications that cause nausea, such as narcotics and even some of the gases. See also the link between nausea and bruising in rhinoplasty.

Why do we care about nausea? Because the last thing we want is someone to wake up and throw up. Throwing up creates a lot of pressure: back pressure, venous pressure and sudden motions. That can create oozing and bleeding under the skin: more bruising, more swelling, more discomfort. We want you to get back to your life as soon as possible.

How does surgical technique reduce bruising in a facelift or rhinoplasty?

In a rhinoplasty, by dissecting in the right plane, shaping bone with a piezotome, using epinephrine and IV TXA, and obliterating dead space. In a facelift, by careful dissection under magnification, bipolar cautery, TXA and a steady blood pressure. Here we’ve got to look at the man in the mirror: what can I contribute to make your healing and your recovery the best it can be? This is all about technique. Experience leads to technique, customized to the patient.

Dissect in the right plane

In rhinoplasty, we dissect as deep as we can, adjacent to the cartilage and bone: in most people, the subperichondrial plane (just under the perichondrium, the thin lining over cartilage) and the subperiosteal plane (just under the periosteum, the lining over bone). If it’s a boundary between layers, it bleeds a little bit less.

Some patients’ anatomy just doesn’t permit it. In rare patients, say a thick-skinned patient with really flimsy, floppy cartilage, you have to leave some of that perichondrium on. But the better we’re able to achieve that dissection, the less bruising we will have.

Piezo osteotomies

Another factor is the choice of tools. I use a piezotome (an ultrasonic bone instrument) for most of my osteotomies, the controlled bone cuts in a rhinoplasty. Not all of them; sometimes I still use an osteotome. You don’t want to be rigid in your thinking and your technique.

A piezotome can cut, move and reduce bone in a very precise way while minimizing collateral damage to the soft tissues and the blood supply within them. That helps decrease bleeding, because you’re not injuring the stuff that bleeds. Bone, especially in the nose, doesn’t bleed that much. It’s the soft tissue around it, like the overlying skin and the underlying mucosa.

Epinephrine and IV TXA

Something else helps limit the bruising by limiting the oozing. I inject a mixture of anesthetic medications with a sequential increase in the amount of epinephrine, which clamps down on the blood vessels. The patient also gets IV TXA (tranexamic acid), which also helps reduce bleeding. Re-dosing the local anesthesia with epinephrine gets us through the phase where the initial bleeding can occur.

Obliterating dead space

Dead space is a surgical term for a potential space: a space that’s not occupied by anything. It exists in a surgical plane, a space created between two tissues that used to be joined together. In a rhinoplasty, we lift the skin off the cartilage and bone to modify them, which brings the shape we see through the skin. That creates a lot of dead space.

That dead space can fill with blood. That blood can create bruising. It can also become fibrotic, replaced with collagen, and that can distort the appearance. It can rob the patient of the beauty we were trying to achieve. So we need to control dead space. I like to say obliterate, because it’s a fancy word. Who doesn’t like fancy words?

How I control dead space after rhinoplasty:

• Surgical taping
• Cushions under the splint that help squeeze the skin down
• Bolstering or quilting sutures under the surface, such as the supratip stitch
• Repairing the scroll ligaments
• Transcutaneous sutures (through the skin) that bring the layers together, removed at seven days

In a facelift or neck lift

In a deep plane facelift or neck lift, I decrease oozing with:

• Careful dissection of the skin and deep planes under loupe magnification (surgical magnifying lenses)
• Bipolar electric cautery, a precise cautery that seals small blood vessels
• Intravenous TXA, plus topical TXA as needed
• Rigorous maintenance of a stable blood pressure in the low range of normal
• A gentle wake-up without bucking or retching, and nausea control
• In the neck, direct dissection and direct excision with scissors instead of liposuction

How long does bruising last after a facelift or rhinoplasty?

Bruising usually peaks at about 4 to 7 days. After a rhinoplasty, patients usually feel comfortable socially or going back to work at about 7 or 8 days. After a facelift, it’s more likely 10 to 14 days.

I have facelift outliers who go back to work between 5 and 8 days. As early as 5 days is a significant outlier, but I’ve had people go back at 7, 8 and 10 days. For more on what the first days feel like, see rhinoplasty recovery: pressure, discomfort and getting social.

What helps bruising after surgery?

• Head elevation is good.
• Arnica or bromelain: we start these 3 days before surgery.
• Cold compresses after a rhinoplasty: I don’t love them, because the condensation can make the splint come off. If patients are very careful and hold them on the cheeks and over the eyes, not near the splint, I’m OK with that.
• No cool packs on facelift skin: they can decrease blood supply, which can lead to necrosis of the skin (tissue loss) and decreased healing.
• Makeup: OK on the central face, away from the incisions, almost immediately, and certainly by 2 or 3 days. In the areas of the incisions, it’s between 7 and 14 days, whenever there’s no more crusting.

We see patients frequently, so we can clear them as needed.

Frequently asked questions

How long before surgery should I stop turmeric and fish oil?

Dr. Weinfeld generally asks patients to stop supplements at least two weeks before surgery. Turmeric is well understood to decrease the body’s ability to create clots a little, and fish oils affect normal, healthy clotting at a microscopic, microvascular level. Both may be good for your health, but not for a great facial plastic surgery recovery. Tell your surgeon every supplement you take.

Should I stop my SSRI before a facelift or rhinoplasty?

Not without your prescribing doctor. SSRIs affect platelet function and can cause a little extra bruising, so Dr. Weinfeld has an honest conversation with each patient about whether stopping is advisable. If it isn’t, the patient keeps taking it and bruising is controlled in other ways. If it is, he has them stop about two weeks, sometimes a month, beforehand. Never stop a prescribed medication without your prescribing doctor.

Can I use ice or cold compresses after a facelift or rhinoplasty?

It depends on the surgery. After a rhinoplasty, Dr. Weinfeld doesn’t love cold compresses, because the condensation can make the splint come off. They’re OK if patients are very careful and hold them on the cheeks and over the eyes, not near the splint. After a facelift, he doesn’t want cool packs on the skin, because they can decrease blood supply and lead to skin necrosis and decreased healing. Head elevation is good.

When can I wear makeup after a facelift or rhinoplasty?

Makeup is OK on the central face, away from the incisions, almost immediately, and certainly by 2 or 3 days after surgery. Over the incisions, it’s usually between 7 and 14 days, once there’s no more crusting. Dr. Weinfeld sees patients frequently after a facelift or rhinoplasty, so he can clear each patient for makeup as soon as they’re ready.

Will I have black eyes after rhinoplasty?

Usually not all the way across. Some rare rhinoplasty patients get no bruising under the eyes. Many have a little in the lower corners of their eyes, and sometimes it reaches halfway across the lower eye region. Bruising all the way across is rare, and when it happens, it’s usually because the patient got nauseated and threw up. That’s one reason nausea prevention is a big part of the plan.

What is a clonidine patch, and why use it before facial surgery?

Clonidine is a blood pressure medication that blunts the way blood pressure responds to stress. It can also ease anxiety and help with pain control afterward. For anxious patients whose blood pressure pops, or patients with high blood pressures, Dr. Weinfeld has them put the patch on the morning of the day before surgery, so it is working by surgery, and wear it for about a week.

This article is for education only and is not medical advice. Individual results vary. Never stop a prescribed medication without your prescribing doctor. Written by Dr. Adam Weinfeld from his video and dictated answers; edited and formatted with AI assistance. Watch the full video on YouTube.