1 week after facelift & upper lower eyelids. I have necrosis, but doctor is doing nothing. Should I get second opinion? (photo)

If this is standard protocol I'm ok with that but should I get a second opinion?I have had a facelift and upper lower eyelids. I have necrosis. I am one week out. My Dr. Board certified PS has looked at the area and scrubbed it and there is still blood flow to the areas. He is doing nothing.

Doctor Answers 8

Healing after facelift

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Bruising and swelling are normal after facelift. Skin necrosis is rare, but needs to be diagnosed and treated in person. Follow up with your surgeon or an experienced, board certified facial plastic surgeon. Good Luck!

San Diego Facial Plastic Surgeon

Possible necrosis after face lift

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If your surgeon can see blood flow to the area, there may be no necrosis.
Necrosis is death of the skin - it has no blood flow.
Necrosis can develop over time. If concerned, removing sutures may help.
Otherwise the area is observed until it heals or dies. 
Your photos also show a small tissue separation under the eyelid, eyelid sutures ready to be removed and what looks like a small bunching of eyelid skin. None are of concern now.
See your surgeon as often as needed - when concerned I see patients at least once a week. 
I see no need for a second opinion for now.

Bruising or Necrosis after Facelift

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It is hard to give advice based on photographs alone, but you do not appear to have actual necrosis in the photographs. I do see the purplish or bluish color to the skin in front of your ear, but that can be due to various things, such as simply postoperative bruising, or possibly having an underlying hematoma, or possibly an early sign of what will later be necrosis. Keeping close followup with your surgeon is important, as he or she can assess which of these is the most likely cause, and treat you accordingly. If it is bruising, Arnica or Bromelain can help. If it is a hematoma, then this should be drained. If it is low blood flow to the area (what causes necrosis), then often the best thing to do early on is *not* operate on the area. In this situation, hyperbaric oxygen treatments may be beneficial. If there is excessive tension on the skin, your surgeon may release some of the stitches to give the skin "a break". Again, keep close followup with your surgeon so that the area can be reassessed and treatment plan modified as needed. Patients can have this type of appearance early on and go on to heal without skin loss or necrosis. Even when it is early signs of skin loss, the actual area lost is not necessarily as big as the discolored area. Hopefully you don't smoke anyway, but in case you do, make sure you avoid smoking during the healing process.

Anita Patel, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 12 reviews

Healing issues are the responsibility of your own surgeon.

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I'm not really certain your going to have necrosis in front of your ear but this is a situation that should be carefully monitored by your own surgeon. At the moment I don't see any advantage in a second opinion.

Do I have necrosis

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As I look at your photos I think that the eyelid incisions look good. There's slight crusting but no evidence of necrosis that I can see. It is more difficult to tell as far as the cheek is concerned. The opinion of your surgeon at this time is the most important. If there is significant decreased blood flow to the area one option you may ask him to consider may be hyperbaric oxygen. This can be difficult to find and expensive but it is one way of increasing oxygen flow to areas of compromised bloodflow.

Do I have necrosis after a facelift?

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From the pictures you have provided, it is difficult to determine whether or not you have necrosis. It's very possible that you have standard bruising and swelling. If your plastic surgeon has confirmed that the tissue has good perfusion then I would continue to be compliant with his post-operative instructions and keep in close contact with him to ensure that you are healing normally.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon

Is a second opinion needed?

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If blood supply has been verified than the skin is not necrotic(dead). The face has a  very good blood supply and should heal up just fine without intervention at a week post op. You should continue to follow closely with your surgeon to monitor the areas. Thanks for the question.

You don't have necrosis.

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Necrosis means dead tissue. You have some fairly typical scabbing and incomplete incisional healing in the lower eyelid. Your surgeon has verified capillary refill, indicating ongoing blood flow. Dead (necrotic) tissue does not have blood flow nor does it bleed.

If your tissues exhibited ischemia in the first few hours after surgery, there are a number of maneuvers than can be considered. These do not apply one week after surgery.

I hope you are not smoking, using nicotine of any kind (patch, spray, gum, or e-cigarette), or are exposed to second-hand smoke. Any of those CAN cause late necrosis, but only if tissues are compromised in their circulation from the early post-op period.

Please feel free to get a second opinion, but I'm concerned about the source of the misinformation that led you to think you might have necrosis in the first place (friend? online research? doctor who is not an ABPS-certified plastic surgeon?)

You trusted your choice of surgeon to operate on your face and eyelids! Please trust his judgement now, as I see no reason to question him at all. He is allowing your tissues to heal and I'm sure he gave you some instructions and limitations. Follow them.

Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 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.