Bruising or Hematoma After Facelift?

Dear JPierce
Some times patients are very considerate of their busy surgeon's: "I didn't want to bother you so I am waiting for my one week appointment." Please be aware that this hematoma potentially constitutes a threat to the facial skin over the area of the bruise. If you have not seen your doctor and you are reading this, I urge you to pick up your phone and call your surgeon. I assure you, your surgeon wants to hear from you. He or she will want to see you immediately to confirm that the circulation in the facial flap is not being compromised by the hematoma. If so, there are interventions that can be performed right in the office by your surgeon to help preserve the facial skin. Less serious hematomas can simply be observed but don't make this call on your own. Please stop reading this website, and pick up your phone and call your surgeon.
Please let the RealSelf community how things went.

It is not uncommon to have the bruising manifest more at 3-5 days postop, but the dusky color in the skin in this picture can be an indictation of decreased blood flow. In this situation I would certainly recommend seeing the surgeon that performed the procedure so they can better evaluate the skin, checking for capillary refill, for example.Best,Dr. Donath 

Although this one photo can not replace an in-person examination, I am concerned with a hematoma in your situation. Therefore, I hope that you can see your surgeon quickly for examination and appropriate management of your recovery. Hematoma formation is one of the most common complication after facelift with an incidence of 2-3%. If treated in a timely fashion, it usually does not cause lasting problems or aesthetic issues. In contrast, if one waits too long, skin loss, scaring, infection etc. can arise.

Bruising after a facelift is common, and even though they are uncommon, hematomas do occur. Based on the provided picture, the presence of a hematoma is difficult to say, but skin loss in front of the ear is definitely possible. Be sure to contact your surgeon right away for any postoperative concerns or questions.
All the best

This is really hard to comment on without  physical exam and touching the area. I would see your surgeon as soon as possible. If it is a hematoma it needs to be assessed and possibly addressed to prevent long term complications. Hope this helps.Best of luck,DrC

I can't say for certain. Distinguishing between bruising and a hematoma is something that requires a personal exam, and I encourage anyone in this situation to immediately contact the surgeon's office. Patients are often worried about having too many questions for their surgeons after surgery, yet, I can reassure you that plastic surgeons expect them. More than that, we want you to communicate your concerns as early as possible, so we can take whatever steps are needed to correct the issue. Best of luck to you.

Thank you for your question and for sharing your experience with us. From the photos, it may be difficult to discern whether you have a hematoma under the bruise.  Hematomas are usually a result of bleeding in the tissues that is significant enough to cause a visible mass or lump that may or may not need to be drained depending on the size and location. Occasionally, it can be due to a bleed in the artery that may result in a more rapid, expanding hematoma and is usually a cause for more emergent treatment. Spikes in blood pressure, or vasodilation with increased activity can cause a small hole or tear that was previously sealed to open and cause the bleed. I would follow-up with your surgeon immediately so they can evaluate whether the there is an underlying hematoma, whether it needs to be evacuated, and whether the overlying tissue is compromised. 

A hematoma or collection of blood is a
relatively rare complication that can occur in 5% or fewer of cases.
Symptoms and signs of hematoma include significantly worse pain, swelling or
bruising on one side of the face compared to the other. As long as it is
identified and treated appropriately, the long term result will not be affected
by this however. If left untreated, it can result in loss of the skin in
the area overlying the hematoma.Specific
concerns after surgery should be directed to your surgeon.

As you are post procedure, do seek the opinion of your operating plastic surgeon, they are on hand to ease any concerns both post and pre op.Haematoma rate is rare for facelifts, and in my clinic less than 1%. 

A hematoma is the most common significant complication of a facelift and should be addressed immediately. This is why I see my patients the next morning and possibly the 2nd day after surgery. Blood can be easily removed during these early phases. It's looks like you have a hematoma. See your surgeon immediately. 

Whenever anything develops unexpectedly, its important to follow up with your surgeon.  In some cases, minor drainage might be needed or in other cases, only observation is required.  Be sure to follow up with your surgeon.