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After having a facelift, what is the likelihood that skin necrosis will cause...

Q:

After having a facelift, what is the likelihood that skin necrosis will cause permanent scarring?  The area affected is about 1/2 inch wide and about 1 1/4 inches long, just in front of the ear.

A:

Certainly, skin loss or necrosis can cause scarring.  Time will tell.  If it does result in a significant scar, a revision may be in order but in most cases I would advise waiting for that for about one year.  It is impossible to say for sure without seeing the problem. 

A:

Usually small patches of marginal skin in this area can heal quite well.  The best thing to do is let it heal conservatively.

Steven G. Wallach, M.D. - View Other Answers by this Doctor
New York, NY

A:

There is no question you will have a scar, however it is impossible to know how bad or good it will be.  The best advice we can give you is to be patient; the most important step right now is to allow your wound to heal. If you end up with a bad scar, you may be able to have a revision. Usually it is better to wait until your scar is mature (meaning soft and with the same color of the rest of your skin); this process can take from 9 to 18 months.

Again, patience is very important, what you will see early it is not what you will see at one year. Having a second opinion consultation (with a board certified plastic surgeon, ASAPS member even better) will give you some piece of mind.

Good luck.

Victor M. Perez, M.D. - View Other Answers by this Doctor
Overland, KS

A:

You should let it heal.  The area may look thinner and reddened.  Over time the surgeon will most likely be able to lift the skin again and remove that area.  Be patient.

A:

It depends on how well you heal, the color of the skin, etc.  Usually this type of full thickness skin loss will result in some visibility, usually a whitish scar which is more noticeable in a darker skin.  If the scarring is significant, it can be revised by excising the scar, mobilizing the cheek flaps and closing.

 

 

A:

Your own surgeon is in the best position to advise you based on an understanding of your clinical course and what the contributing factors were.  However, although skin necrosis is rare after a facelift, it tends to heal with a much better scar than one would anticipate from the appearance early on.

Richard A. Baxter, M.D. - View Other Answers by this Doctor
Mountlake Terrace, WA

A:

 Although it is very unusual, skin necrosis can occur as a complication of facelift surgery.  This is  usually as a result of excessive swelling which may be secondary to hematoma or infection but could happen naturally as a result of tissue response to trauma from the surgery itself.  Skin necrosis will in turn, almost always, lead to permanent scarring.  The resultant scar often depends on the severity of the necrosis in the first place.  More superficial necrosis will usually leave less severe scarring.  It is important to point out the problem to your surgeon early in the process, if he/she is not aware of it already, because your surgeon may be able to positively alter the course of the resultant scar. 

A:

If you have skin necrosis in front of the ear, it will unfortunately cause permanent scarring.  This will improve with time and may eventually become fairly invisible. 

Massage, time, and lasers can all help.  Over time if enough looseness re-develops you might be able to have the scar excised and the skin advanced back to the ear as if it never happened, but this would take a few years to develop.

 

Richard P. Rand, M.D. - View Other Answers by this Doctor
Bellevue, WA

A:

The likelihood of skin slough after a facelift is minimal but greatly increased in smokers.  Scars mature over time so if this is recent then scar gels or creams may help to improve the end result.  Also we all scar and heal differently.  Scar maturation can take a year or more.  Scars also tend to contract so once the scar becomes smaller it may be possible, under a local in the doctor's office, to remove it.

A:

Skin necrosis after a facelift is extremely rare, unless the patient is a smoker or if a hematoma or blood collection under the skin has occurred.  The problem is correctable after the area has had debris removed.  Skin grafts are not usually needed.

James A. Yates, M.D., FACS - View Other Answers by this Doctor
Camp Hill, PA

A:

Scarring results vary between individuals.  It takes about a full year for a scar to mature. Working on the scar intensively through various methods (moisture, massage, silicone bandaging, possibly laser) with close interaction with your plastic surgeon will help optimize results.  If the scar is unsatisfactory in appearance, ultimately it probably may be revised just under some local anesthesia. The key is staying in touch with your plastic surgeon to navigate you through the healing process.

Michele A. Shermak, M.D. - View Other Answers by this Doctor
Lutherville Timonium, MD

A:

Once you have a scar, you will always have a scar. The trick is to make is as imperceptible as possible. There are a variety of techniques to improve on the appearance of a scar, ranging from lasers, steroid injections, tattooing and surgical revision.

A:

 A facelift usually will not cause skin loss, unless you are a smoker.  Otherwise the likelihood of skin necrosis is very low.

A:

The area of skin necrosis will leave a permanent scar.  It will probably be whiter, shiner, and lower than the surrounding scar.  6-12 months after the wound has completely healed, it may be able to be revised by again advancing the facial skin towards the ear, because the skin should be looser.  To allow closure, the skin may need to be stretched prior to the surgery if it is sufficiently loose. 

If you use nicotine in any form, including the patch, or are around second hand smoke, you should stop these, because there is a very good chance that you will again have skin loss.

O'Neil Engeron, M.D. - View Other Answers by this Doctor
Houma, LA

A:

The scar in front of the ear will fade over the next 1-2 years.  I recommend you consult a plastic surgeon who is certified by the American Board of Plastic Surgery and is an ASAPS member (www.surgery.org) to evaluate whether a scar revision may help reduce the appearance of the scar.  This kind of minor surgery typically can take place after the scar is soft and is white in color. That occurs after 16-18 months.

A:

It is possible that skin necrosis will cause permanent scarring.  However scarring may not be as big as the necrosis because as the wound heals it will become smaller than the necrotic area.

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A. Hossein Nezami, M.D., J.D. - View Other Answers by this Doctor
Jacksonville, FL

A:

These healing problems do occur from time to time, but facial scars are generally easier to treat than scars in other areas.  Follow your surgeon's instructions for wound care until the area is completely healed.  The area will be quite pink at that point.  Then ask about applying silicone gel sheeting to the area.  It is a thin clear or flesh colored sheet with adhesive backing.  This treatment helps fade the pigmentation more quickly and keeps the scarred area flat.  Usually it is worn twelve hours a day for three to six months.  I have seen impressive results.  Best of luck.

A:

Full-thickness injuries, or necrosis, following a facelift are not common in non-smokers or unless there was an untreated expanding hematoma.  Your plastic surgeon can help reassure you as to the depth of injury.  Expectant, conservative management is usually best.  Scar maturation can take some time (greater than one year).  A superficial injury, however, can heal very well.  Hopefully you are a non-smoker.  If you do smoke, please stop.

A:

The likelihood of skin necrosis following a facelift is relatively rare occurring anywhere between  .5 - 3% of the time depending on what type of facelift you have had.  It is more common in patients who are smokers and patients who have had a bleeding problem (hematoma) after the procedure.  The larger the area of skin loss, the more likely that there will be a significant scar.  For the most part, skin loss is rare and when it occurs, it is usually in a small area and scarring is minimal.

In your situation, there may be visible scarring because of the size and location of the skin loss.  My recommendation would be to follow your surgeon's advice.  This is usually to allow the area to heal on its own, use moisturizer and sun block to prevent pigmentation from sun exposure.  It is common to wait at least 3-6 months or longer to allow the scar to mature (soften, flatten, fade) before considering treatment.  Treatment may be nothing,  laser therapy or surgery.

Scott A. Greenberg, M.D., FACS - View Other Answers by this Doctor
Winter Park, FL

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