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2 years after facelift and I still have firmness around incision site. Is this normal? (Photo)

Two years ago I had a full face lift with brow lift. I am still having firmness around the incision sight front of ears and down side of neck. I went to an ENT/Facial Plastic Surgeon last week (he did not do the surgery) and he said the way it was sutured was the cause of scarring beneath the skin and that reopening and cutting away the scar tissue might help. He did give me a shot of cortizone to help break up the scar tissue and told me to massage it. Is there ultrasound that might help too?

Doctor Answers (9)

Unhappy with face lift scar

+1
  • the problem is probably from over-tightening the skin at surgery,
  • I would suggest a scar revision - it most likely to help,
  • lasers chiefly fade pink scars,
  • ultrasound won't improve it. Best wishes.


Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Scar Tissue From Facelift Incision.

+1
It is unlikely that ultrasound will help. I would just seek one more opinion from another facial plastic surgeon and then proceed after you make an assessment based on all the information you receive.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Scar revision at 2 years is best

+1
I would recommend scar revision at 2 years.   While cortisone etc may offer some help there are the side effects that may make the scar more visible.   Laser may help?  Ultrasound is all but worthless.  Cnsider a scar revision with meticulous repair under no stress.  This should give a much better endpoint.  My Best,  Dr C

George Commons, MD
Palo Alto Plastic Surgeon
5.0 out of 5 stars 25 reviews

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Scar firmness after surgery

+1
After two years, it is unlikely that your scars are going to get better on their own.  Rather than continue with steroid injections, I would recommend either laser treatments or scar revision.  If your skin tightness has lessened a bit, your new scars might be better than the ones you now have. 

David Marcus, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 11 reviews

Facelift scars

+1
The results of scars after facelifts are usually good, but can vary.
Unsightly scars can result from excess tension on the skin wound without adequate deep support.  Less than ideal scars can be a product of the patient's skin and scarring type.  Facelifts done similarly on 2 different patients will usually yield different scarring.
Steroid injections performed in a conservative manner can help scars, but bad scars usually require excision with deep tissue support, and reclosure

Jonathan Sykes, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Steroid shots, massage and revision

+1
I would consider the sequence of steroid and massage, if that fails then consider scar revision. Best to you. 

Henry Mentz, MD
Houston Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Firmness around incision two years after facelift

+1
As has been previously stated, steroid injection can soften the scar tissue. It is unlikely at this point that there will be much change in the way that the incision looks or feels. It is possible that you may need a scar revision surgery in order to pull the scars out and then close the incision under no tension. Ultrasound may help, depending on the severity of the scar tissue formation.

Todd C. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Bad facelift scarring.

+1
Two years post-op means your scarring is as mature and completely healed as it can get, so the firmness you feel now will not get better as additional time goes by. Steroid injections can soften and flatten raised, firm scars, but will also stretch and widen them, which could end up being better, or a different kind of unsatisfactory.

Your ENT/facial plastic consultant was perhaps a bit hard on your facelift surgeon, but technique and tension do play a role in the degree of ultimate scarring. Genetics, however, have a major role in the degree of scarring, and genetics may be as much "fault" as your surgeon's technique.

One way to find out would be to perform scar excision and revision, with precise, non-tension closure using fine suture technique. Then you would know that the best possible scar will result. I'd also consider topical scar pads after 2-3 weeks of healing, should you consider scar revision.

Ultrasound treatment can soften scar tissue to a degree, but steroids or scar revision would be the two choices I would suggest. Ultrasound improvements are liable to be much less worthwhile for the time, effort, and money spent (even if "free").

Unfortunately, the location of the scars cannot be changed, which is why I hate the hairline scars down the neck/scalp junction. Rather, placing the incision behind the ear and then crossing the bare skin behind the ear high where the pinna conceals the scar, and then extending the incision into the scalp, avoids the visible (and as in your case, unsatisfactory) scarring that now prevents you from wearing your hair up in a French braid or ponytail. This is avoidable in the initial choice of incision placement.

And is why choice of facelift surgeon is critical, right down to the minutia of incision placement.

 Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 116 reviews

Facelift scarring

+1
In review of your photo it is hard to see scars. In general facial plastic surgery scars heal well. If there is firmness or elevation steroid infections work well 90% of time. Need to review scars in 6 weeks sometimes need 2 or 3 injections for resolution.

Mark Prysi, MD
Naples Plastic Surgeon
5.0 out of 5 stars 3 reviews

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.