10 Months Post Facelift. Still Have Depressions on Lower Face. Similiar to SMAS Facelift That Was Performed? (photo)

Some differences in the recovery and healing between sides of the face are common after facelift. However, after 10 months, it generally will be evening out. I tell all of my patients to do gentle massage and warm compresses. There are various hand-held devices (massagers, ultrasound, etc.) marketed for swelling reduction. Some of these will help, others will not. However, just using your hand and a little lotion is equally effective. Lastly, for persistent swelling or a small ball of scar tissue ("pea"), injections of a steroid can be helpful. For depressions, fillers or fat grafts are helpful -- though I would recommend waiting until 1 year.

Generally speaking, it can take 6 to 12 months to completely heal after a facelift procedure. I would strongly recommend speaking with your surgeon or his/her clinical team to discuss your concerns further.

The depressions that you see are a taught SMAS flap from the facelift that was performed. The odds of this improving over the next 2 months, when all scars are final, is very slim. The soft tissue redundancy near the right side of the mouth can be soft tissue laxity left from the surgery, but this is hard to tell without seeing you clinically. Swelling does not appear to be the main problem as the lions share of healing is complete in 6 months.  Long-end-short, you could have fillers or fat grafting placed to correct the contour deformities. However, the best, natural and long lasting results would be achieved with a revision facelift. I am sorry that this is the answer I have to give you, but it is the most candid and accurate.

Be healthy and be well,

James M. Ridgway, MD, FACS

Facelift post op with depressions at 10 months will probably not resolve ane I need to feel this to recommend treatment .

The swelling you are experiencing can be seen after handiling of the SMAS.  It can last for up to a year. At this point massage may help a little. You may require fat grafting to correct the contour irregularities. All the best.

Without a photograph it is impossible to see exactly what it is that is bothering you. Regardless, no matter what it is not going to be improved with massage or ultrasonic treatment. Express specifically your concerns with your surgeon. If you are dissatisfied with the answer get another opinion.

     It is possible that there may be some improvement with massage and time.  The depressions can be filled with filler or fat if you wanted to consider that in the future.  The pea that you describe could be almost anything, but this may improve with massage and time as well.  Kenneth Hughes, MD Los Angeles, CA

Contour irregularities following facelfit surgery are not uncommon.  In the early postop period they are usually related to tissue edema and swelling and improve as the swelling works its way out.  After 6 months or so, any additional improvement will be minimal.  Permanent irregularities are the result of deep soft tissue bunching or overlap.  These can be improved with measures such as steroid injections into the prominent areas, micro-liposuction or micro-fat grafting.

Mario J. Imola.  MD, DDS, FRCSC, FACS.

It is common to have irregularities that far out of surgery. There are many things I utilize in my facial surgery patients that help a lot. Massage is the first thing that works well as you have mentioned. Sometimes ultrasound treatments can help smooth things out. Another thing that helps could be lymphatic massage by a lymphatic massage specialist, but likely this far out it won't make too much of a difference. I only mention it because you said massage helps. I use this type of massage with a specialist in town but normally during the first few months after surgery. Finally, if you really truly have long lasting areas of irregularity you could have fat grafting to the areas to contour them.

Small contour irregularities such as these are not uncommon and tend to resolve with time.  After 10 months you can do some gentle massage, or discuss some ultrasound therapy with your surgeon.  Try not to be too concerned- these will likely soften and improve.