I am 4 1/2 weeks after bottom facelift surgery and have an open infected wound in front of one ear. Advice?

Question

After surgery it looked dark like a scab. Dr. removed that and now it is pink and raw looking with an infection. It is indented and the size of a dime. Will I need a procedure to fix this? It looks like it will leave a horrible scar :(

Brian K. Machida, MD, FACS · Answer

You are describing skin necrosis.  You need to follow with your surgeon for proper wound care until it heals.  Work with your doctor to attain optimal healing.

Jason Emer, MD · Answer

This is difficult to answer without pictures. I recommend getting a formal evaluation with a cosmetic dermatologist for after care. I recommend Silagen + Bioshield to promote healing. Any scarring can be improved with lasers and microneedling/prp. See an expert. Best, Dr. Emer

Michael I. Echavez, MD · Answer

It sounds as if you may have had a bit of skin necrosis in front of your ear after your lower facelift procedure.  Once the scab is removed, it is normal for the area to appear pink and raw.  This will take several months to heal and it will improve.  Once it has healed fully, if there is any visible abnormality, this can frequently be treated with a minor scar revision.  Your surgeon should be able to monitor your progress and determine if any further procedures are necessary.

John R. Burroughs, MD · Answer

The critical thing is to stay in touch with your surgeon.  They know the specifics of your case the best.  They can advise you on the best treatment.  This can happen sometimes and if it leaves a bothersome scar can be revised.  I would recommend using vaseline or a medicated balm on the area (e.g. SkinCeuticals Hydrabalm) as moist wounds tend to heal better than dry ones.  Don't pick at it.  If a discharge develops get on some oral antibiotics.  Best regards.

Robert E. Zaworski, MD (retired) · Answer

The scar can easily be revised if needed.  Follow up with your surgeon for wound care instructions and antibiotics. Keep the area clean and follow up with your surgeon as recommended.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  It sounds like you had some skin slough due to tissue injury but you should discuss this with and continue to be followed by your facelift surgeon.  Sadly, this is one of the unwanted "side effects" with the more aggressive, invasive type facelifts.... especially over the past 15 years where the hectic pace of literally does not allow for the proper degree of post-op recovery and activity restriction.  This is one of the main reasons that the minimally, invasive SMAS facelifts are gaining popularity (discussed below).   The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
  In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 In my experience when evaluating the face, it's key to determine the following:  Are the cheeks, chin and lips the ideal aesthetic shape?  Are "jowls" present and is there excess fat and skin in the face and neck.  Once these factors are determined, the proper aesthetic plan can be determined to make the face balanced, (for women) feminine and more naturally youthful and beautiful (while for men creating a more chiseled, angular and handsome face). Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  If the front portion of the cheeks is either concave or flat, they can be augmented and shaped with a dermal filler or by using silastic cheek implants (permanent enhancement) to create full, round cheeks that will feminize the entire face.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 'Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.

Daniel Straka, MD - Account Suspended · Answer

I'm sorry to hear about your problem. Unfortunately, it sounds like you may have developed a small area of necrosis (dead tissue) due to lack of adequate blood supply.  Although this is uncommon, it is a known complication from a facelift surgery, typically at the edges of the incision where the flap of skin does not get as much blood flow. A lack of blood flow to the area also increases the risk of infection. If it truly appears infected topical nesporin (triple antibiotic) is recommended and also oral antibiotics.  A culture of the wound may also be helpful to determine the organism.  If there is a true infection then I wouldn't recommend additional procedures at this time to address scarring. Infection should be treated adequately first and then there may be revisional procedures to improve the scar. There are many options but could include laser treatments, surgical scar revision, filler injection, PRP, etc. Depressed scars are typically more difficult to treat than elevated scars. Regardless, treating scars is a long process that typically requires multiple interventions over a period of time. Bottom line is, if there is an infection, make sure that is cleared before beginning the road to scar treatments. Hope this is helpful.

I am 4 1/2 weeks after bottom facelift surgery and have an open infected wound in front of one ear. Advice?

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