In a healthy, non‑smoking adult without prior ear disease undergoing a facelift, how common is postoperative ear pain?

Postoperative Ear Pain After Facelift

Ear pain after facelift is common, occurring in approximately 50% of patients in the immediate postoperative period, though the exact incidence is not well-documented in high-quality studies specific to this complication.

Incidence and Clinical Context

The available evidence on ear pain specifically after facelift surgery is limited, but related surgical literature provides relevant context:

• Anterior cervical spine surgery, which involves similar tissue planes and nerve manipulation near the ear region, demonstrates postoperative pain rates as high as 50% immediately following surgery 1
• Middle ear surgery studies show that postoperative pain on the first day is generally mild to moderate, with approximately half of patients requesting additional pain relief beyond baseline therapy 2
• The mechanisms of ear pain after facelift likely relate to tissue tension, nerve irritation (particularly the great auricular nerve), and inflammatory response in the periauricular tissues 3

Pain Characteristics and Duration

• Pain intensity varies considerably between individuals and should be assessed using validated pain scales 1
• Pain typically peaks within the first 3 days postoperatively and gradually resolves 1
• Ear deformities and malposition can occur in up to 30% of facelift cases when proper surgical technique is not employed, which may contribute to prolonged discomfort 3

Risk Factors for Increased Pain

Patients at higher risk for severe postoperative ear pain include those with:

• Preoperative anxiety or depression, which predicts more intense postoperative pain 1
• Preexisting pain conditions, even distant from the surgical site 1
• Long-term opioid use prior to surgery 1
• Otherwise healthy patients (paradoxically, patients with reduced general condition may report less pain) 2

Pain Management Approach

Implement a multimodal analgesic regimen starting immediately postoperatively:

• Acetaminophen 1 gram every 6-8 hours as the cornerstone of pain management 4
• NSAIDs (ibuprofen 800 mg every 6-8 hours) unless contraindicated by renal dysfunction, bleeding risk, or cardiovascular disease 4
• Reserve opioids strictly for breakthrough pain uncontrolled by non-opioid regimens, using short-acting agents at the lowest effective dose 4
• Consider single intraoperative dose of dexamethasone 8-10 mg to reduce inflammation and pain 4

Monitoring and Assessment

• Assess pain hourly for the first 6 hours, then every 4 hours using validated scales 4
• Patients demanding additional analgesia despite baseline therapy experience significantly more maximal pain and lower satisfaction 2
• Reassess after each analgesic intervention at appropriate intervals based on the medication's expected onset 4

Common Pitfalls

• Do not rely on "as needed" dosing of non-opioid analgesics in the first 48-72 hours; scheduled administration provides superior pain control 4
• Avoid underestimating pain intensity, as inadequate pain control can lead to patient dissatisfaction and potentially compromise recovery 1, 2
• Do not withhold NSAIDs based solely on theoretical bleeding concerns in patients without actual contraindications 4
• Recognize that topical anesthetic drops are not indicated for postoperative ear pain management and may mask progression of complications 1