Does this look like skin necrosis? (Photo)

Question

had a facelift with erbium laser 4 days ago and am concerned about the black/discoloured areas near both ears.

Jonathan Zelken, MD · Answer

These pictures are concerning for blood supply compromise. Excellent wound care can help. Also, loose dressings, antimicrobials, and pain control will help. If you are a smoker, it's absolutely critical that you avoid cigarettes of course, and alternatives as well. Sometimes, application of "nitro paste" or hyperbaric oxygen can reverse some of the damage. Fortunately, this often heals very well.

Jessica Kulak, MD · Answer

It is important to see your surgeon and discuss your concerns.  The diagnosis of skin necrosis is more clear with an in person evaluation.  From the picture there appears to be a small area of discoloration, which can represent bruising or skin compromise.  Skin compromise isn't often full thickness and can still heal well in most people. There is more more to the evaluation than can be seen on the picture.  Best of luck!

Evan Ransom, MD, FACS · Answer

Thank you for the question and the photos. I routinely perform laser resurfacing with facelift and neck lift surgery. However, when doing so, the surgeon must be aware of the depth of the laser penetration and the thickness of the flap/skin where the laser is being fired. It looks like you have at least one or two areas of full skin thickness burns. These will most likely heal over time, but will require careful attention and special dressings/ointments. While I can't make an exact diagnosis in one photo, this does look concerning and you need to see your surgeon as soon as possible.

Ben Lee, MD · Answer

It is certainly possible to conservatively laser resurface in conjunction with a facelifting, but care and close follow-up are essential. Along those lines, I would bring this to the attention of your surgeon. It may be perfectly fine (hard to make that judgement from pictures), but your surgeon is the most qualified to judge and would certainly want to know about it.

Kenneth D. Steinsapir, MD · Answer

These are facelift flaps with compromised circulation. If you are smoking at all, you should immediately stop right now.  Smoking, diabetes and certain other systemic diseases affect the function of the capillaries that are needed to carry oxygen to the far reaches of these skin flaps.  My advise to you and your surgeon is to be very conservative is any debriding of this tissue.  Surprisingly many areas that look funky actually to perk up and heal remarkably well.  Call your surgeon immediately and talk to them about conservative wound care to maximize recovery of these tissues. Like I said, if you smoke, stop right now. Some surgeons advocate hyperbaric oxygen for this.  I do not think that the evidence that it helps is so good but you can discuss this with your surgeon.  Please post in 3 weeks and let us know how you did.

Paul J. Leahy, MD · Answer

Congratulations on having your procedure. The skin on your left cheek does look a little irritated, but not frankly skin necrosis. I would see your surgeon regularly this week to be sure all is well. Best wishes

John Mesa, MD · Answer

Patients with questions and concerns about their facelift healing process should address those concerns with the surgeon that performed the operation, ideally during a follow up consultation.

Babar Sultan, MD · Answer

It is difficult to make a determination without seeing you in person however it appears that you do have some skin compromise. With excellent wound care and follow up, this typically heals well. Recommend calling your surgeon for follow up.

All the best!

All the best!

Amy S. Bekanich, MD · Answer

Hi - For sure you  need to have someone take a look at things.  Pictures can be very deceiving with shadows and such.  Bruising can look like necrosis in a photo.  That diagnosis can only be definitively made with an in-office visit.  And if it does end up being necrosis try not be too discouraged.  There is a lot of variability in how things will settle.  Your plastic surgeon will have a number of strategies for how to  go forward.  Fingers crossed for you.
All the best - Dr. Bekanich

Timothy A. Janiga, MD, FACS · Answer

I would make sure you have follow-up with your plastic surgeon and they can evaluate you in person.  You also had a facelift and so this can complicate the situation in regards to blood flow to the skin.  Take care.Timothy A. Janiga MD, FACS

Does this look like skin necrosis? (Photo)

Answers (12)

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