context: BACKGROUND: Facelift (rhytidectomy) is a prominent technique for facial rejuvenation with 126 713 performed in the United States in 2014. Current literature on facelift complications is inconclusive and derives from retrospective studies. OBJECTIVES: This study reports the incidence and risk factors of major complications following facelift in a large, prospective, multi-center database. It compares complications of facelifts done alone or in combination with other cosmetic surgical procedures. METHODS: A prospective cohort of @entity0 undergoing facelift between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major complications, defined as complications requiring emergency room (ER) visit, hospital admission, or reoperation within 30 days of the procedure. Univariate and multivariate analysis evaluated risk factors including age, gender, BMI, smoking, @entity1 , combined procedures, and type of surgical facility. RESULTS: Of the 129 007 @entity0 enrolled in CosmetAssure, 11 300 (8.8%) underwent facelifts. Facelift cohort had more males (8.8%), @entity1 (2.7%), elderly (mean age 59.2 years) and @entity2 (38.5%) induviduals, but fewer smokers (4.8%). Combined procedures accounted for 57.4% of facelifts. Facelifts had a 1.8% complication rate, similar to the rate of 2% associated to other cosmetic surgeries. @entity4 (1.1%) and @entity3 (0.3%) were most common. Combined procedures had up to 3.7% complication rate compared to 1.5% in facelifts alone. Male gender (relative risk 3.9) and type of facility (relative risk 2.6) were independent predictors of @entity4 . Combined procedures (relative risk 3.5) and BMI >=  25 (relative risk 2.8) increased @entity3 risk. CONCLUSIONS: Rhytidectomy is a very safe procedure in the hands of board-certified plastic surgeons. @entity4 and @entity3 are the most common major complications. Male gender, BMI >=  25, and combined procedures are independent risk factors. LEVEL OF EVIDENCE 2: Risk.
  