Introduction Parotid gland sialocele is an uncommon but challenging complication following rhytidectomy, particularly with deep plane dissection beneath the superficial musculoaponeurotic system (SMAS). Literature describing its optimal management remains limited. Iatrogenic violation of the parotid capsule can result in postoperative sialocele formation, presenting with fluctuant swelling in the early postoperative period. While traditional management includes aspiration, compression, and anticholinergics, recent reports have highlighted the role of botulinum toxin A as a minimally invasive and effective treatment. Methods We present a case of parotid sialocele following a deep plane facelift, detailing clinical presentation, diagnostic considerations, and the management employed. A literature review was conducted to identify current therapeutic strategies for parotid sialocele following rhytidectomy, including conservative, pharmacologic, and surgical options. Results Our patient achieved complete resolution following a multimodal approach involving serial aspiration and targeted botulinum toxin A injection. Literature review demonstrated success rates of 70–100% with botulinum toxin A, using doses ranging from 10 to 100 units. Preventive measures such as SMAS or platysma coverage and selective botulinum toxin A injection into exposed glandular tissue further reduced recurrence. We present a step-wise management algorithm for this rare complication. Conclusions Parotid sialocele following rhytidectomy is rare but amenable to non-surgical management. We propose a practical algorithm integrating conservative measures and early botulinum toxin A use to optimise outcomes and minimise morbidity.