Reduction malarplasty (RMP) to reshape the facial contour is one of the most popular aesthetic surgical procedures in Asia. Here we report a case of intracerebral hematoma (ICH) after RMP. A 31-year-old woman was referred to our hospital following RMP. On arrival at our emergency room, she presented with deep drowsy mentality and right hemiparesis. Computed tomographic scan demonstrated an ICH. We conducted stereotactic aspiration of the blood clots. Because of increased ICH after the operation, the patient underwent craniotomy and hematoma evacuation. After removal of hematoma, intraoperatively a defect of the middle cranial fossa dura, a skull base bony defect, and a bony fragment were noticed. We think that these lesions have been caused by aggressive manipulation of surgical instruments. To our knowledge, ICH after RMP was not reported. The radiologic features of this case and suggested mechanism of the complication are described.