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Can I have surgery to release skin adhesion to underlying structure of the face after facelift? (Photo)

2 .5 months post op. have internal scars (hematoma on my cheeks which was milked 14 times).now i have hard and soft lumps . the skin on my whole cheek area seems to be stuck to the underlying structures. looks lumpy if i smile.A dr told me at the 6 month mark may have to open flap and separate the skin mechanically. What is this surgery called? Could it stay forever attached to the underlying tissue (i do massage, ultrasound and kenalog)? also the soft lumps are not diminishing. could be fat?

Doctor Answers 16

Skin adhesions after a facelift

It is possible to have some skin irregularities after a facelift.  Most of these lumps and skin lines disappear without a trace within 6 month of the procedure.  On those extremely rare occasions when some irregularities persist, fat grafting might be a good alternative to additional surgery.  Ask you surgeon about his opinion on fat grafting at your 6 month follow up visit.

Best of luck!

New York Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

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Lumps After Facelift #facelift

I agree it is way too early. I would wait a minimum of 6 months. Usually these areas will resolve themselves with time and patience. This does happen and I have seen it before. It is very hard to be patient especially when it is your face. What your surgeon means is that later, if need be he is talking about elevating the skin and trying to re-drape it more smoothly if needed.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Lumps after facelift hematoma usually resolve with time

It sounds as though you are taking appropriate measures with massage, heat and ultrasound.  Next

Most irregularities beneath the skin caused by hematoma will resolve but this can often take 6 months.

Personally I would wait a year before considering any  surgical intervention if the lumps last that long.

I agree that steroid injections can cause atrophy and should be used judiciously.

Tincture of time

At 2.5 months out, it is way too early. I agree as below to give it a god 6 months or longer before considering having anything done.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Lump after facelift

You are still very early in the healing phase. The hematoma will slow things down on that side, and it would not be unusual to have some irregular areas.  With time these will improve.  Heat and massage are also helpful.  If this doesn't help,  you could try some ultrasound. I would wait at least 6 months before trying any surgical  intervention, and from the way you look now, doubt you will need it.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

Can I have surgery to release skin adhesion to underlying structure of the face after facelift?

Sometimes, the hardest thing a person can do is wait!  But, honestly, this may heal without noticeable lumps.  I don't know what type of facelift you had (mini vs more extensive), so the best advice to follow at this point, is your surgeon.  You are only 2.5 months post-op and the body has a wonderful ability to heal.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Be patient

I'm sorry to hear your surgery was complicated by a hematoma. Everything you describe are possible solutions, but I would suggest waiting up to a year if you can. It takes a long time for everything to heal and settle down. You may still get some improvement as the healing process evolves, scar tissue softens, muscles and nerves start working again, fat and old hematoma absorb, swelling goes away...
You wouldn't want to fix something now that was going to get better on its own anyway.
Also, there is no sure fire to fix your problem now, so why risk it.
Finally, anything that can be done will technically be easier on a surgeon the further out you are from the original surgery giving him/her a better chance at fixing things as best possible.

Armin Moshyedi, MD
Bethesda Plastic Surgeon
5.0 out of 5 stars 5 reviews

Facelift hematoma

Another way to have managed your result would have been to lift up the flap early, remove all blood and hope for smoother healing. This is a judgement call by the surgeon. I have treated a person like you whose doctor did the same as yours. She had scar tissues long term in the cheeks and it looked similar to what you look like now. I was able to lift her cheeks back up and smooth them out some but this was after her doctor tried three times surgically himself. I'd seek some local second opinions.

A hematoma may require a face lift revision

Thank you for your question about your face lift.

I am so sorry you had a hematoma after your face lift.
  1. It will take six months for the swelling to subside.
  2. After a hematoma, the swelling can persist indefinitely.
  3. The swelling causes the lumpiness.
  4. Your surgeon's advice sounds reasonable - you may need a revision to correct the internal scarring.
  5. Your massage and ultrasound sound a good plan for now but are unlikely to resolve things without surgery - but let's hope I'm wrong.
This surgery is generally called a face lift revision, or a redraping of the skin or a secondary face lift.

Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Give It Time, But Revision May Be Necessary

I'm sorry to read about your complications. Unfortunately after hematoma (collection of blood), some residual blood may be left after "milking" blood out, and so there is increased inflammation with scarring underneath the skin, resulting in the kind of unevenness that you have. I would expect some improvement over the course of a year, but if it is severe enough, reopening the incisions (revision facelift) should result in a smoother surface. If the soft lumps indeed are not getting smaller, then they could be fat that has been pushed into lumps by the forces of scar contraction underneath the skin, or perhaps they are secondary to fat grafts if those were performed at the time of your surgery. I would continue to consult with your surgeon, but if secondary surgery is recommended, consultation with another surgeon might give you additional perspective on the best approach. For now, continued conservative measures will likely give you considerable improvement — and hopefully complete resolution. Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.