Noticing Pulled Up "Muscle" Cords After SMAS, Will It Improve? (photo)

  If there was a permanent suture used, this may need to be removed.  However, tissues and sutures, even if permanent, always relax to some degree.  The tissues cannot be held indefinitely in place in the facelift.  Therefore, this works to your advantage in a situation like this.  If the band or curtain or rope persists for a year, filler or fat grafting for camouflage is a reasonable alternative.  Kenneth Hughes, MD Los Angeles, CA

Final Healing Following SMAS Facelift is Progressive Over Many Months

Although 6 months have passed it is likely that it will improve at least somewhat over the next 6 months. The type of swelling typical of the photo you showed is often due to induration (chronic edema) which may be due to the fact that this is where most of the SMAS plication or suturing took place. Without seeing your operative note it would be impossible to tell, but a good question for your plastic surgeon. If it does not resolve by a year post op then it is likely do to another reason such as the vector used to suspend the SMAS.

There are many predictable portions of the healing process that ALL PATIENTS EXPERIENCE. Although both doctor and patients would like to not have this happen, it is part of the healing process. These Side effects refer to what you will be experiencing from the facelift healing process: Here are some of the common things you will experience. The common side effects include: swelling which is maximum 2-3 days later, bruising (highly variable), numbness which takes several months to resolve,  tightness takes several days to months to resolve, discomfort chewing (technique dependent), discomfort (generally mild with this surgery, nausea (variable) and in some patients emotional lability in some. Although most of the visible edema resolves in 2-3 weeks in mini-lifts and 3-4 weeks in traditional facelift approaches, residual firmness (edema you feel but don’t see) can linger for several months. Skin suppleness also takes a while to return as does scar maturation. I tell my patients it takes up to a year for final resolution of the healing process. In my experience, the above rough time table is usually delayed in smokers, when multiple procedures are performed together and when resurfacing procedures are done at the same time as the lift. The same is true if complications occur such as infection, hematoma, skin loss or compromise, etc

Those areas should continue to resolve over time. They most likely represent directional vectors; that is, areas that were cut and lifted from the smas layer. Often massaging those areas can help or you may need some fillers to mask over those areas. Fat augmentation or sculptra can often correct those areas.