Parotid gland leakage from facelift has gotten worse. What is my next course of action?

Question

Been 2 weeks since facelift and parodit gland leakage. Has progressively getting worse Taking ropanul have drain in and compression I missing work i need this to end asap have been conservative and no results What my next course of action

Marc DuPéré, MD · Answer

Thank you for your question as it will help many patients.Parotid fistula is very rare but can occur with deeper plane types of facelift.  Most resolves without surgery.Apply pressure over the parotid area when eatingAim for liquids and
soft foods - Avoid solid foodWhen eating soft
foods, choose those that do not require a lot of chewing such as mashed
potatoes, scrambled eggs, milk shakes, oatmeal, etc.No chewing gumsFacelift compression garment can help if they apply a slight pressure over the parotidAim for a bland diet- no
sour, tart, extra spices. A bland diet decreases the risk of saliva collections Needle aspiration might be indicated a few times.If all persists, a small drain can be inserted for several days.Hope this helps!

Best regards,Dr. Marc DuPere, Toronto Aesthetic Plastic Surgeon

Jeffrey D. Wagner, MD · Answer

Be patient.  These usually resolve over a few days or weeks with pressure and bland diet and elevation.  Ask your surgeon about botox injections to decrease salivary output.  I would generally not recommend surgery until several weeks of conservative measures have failed.

James Bonaparte, MD, MSc, FRCSC · Answer

Sorry to hear about your difficulty. As others have mentioned, this is a problem that will stop, but patience is the key. I give  my patients the following advice if this very rare event happens. 1) When eating, put pressure on the site of leakage over your parotid gland, firm pressure2) See your surgeon regularly to assess the amount3) consider Botox to reduce saliva production.typically, after a few weeks #1 will stop it.

Christian Subbio, MD · Answer

Like others, I would advise patience. I realize this is easier said than done, but to try to jump to some intervention is premature at this point. And, could potentially make things worse. Like others have mentioned, in addition to the medications which dry secretions, drains, compressions, bland diet, and Botox are the mainstays of treatment. Keep in close contact with your plastic surgeon, wear your garments, and statistics say that this should in all likelihood get better with time.Best of luck!

Dr. Subbio
Board-Certified Plastic Surgeon
Newtown Square/Philadelphia, PA

Dr. Subbio
Board-Certified Plastic Surgeon
Newtown Square/Philadelphia, PA

Kevin M. Robertson, MD, FACS · Answer

The key is to stay conservative in your treatments and decisions.  Don't jump in with a repeat procedure too rapidly.  I would push for botox treatments at this point, to add to your current therapy with bland diet and compression

David Gilpin, MD · Answer

Thank you for your question.  I am so sorry that you are having this issue.  The good news is that this will resolve with time.  If your surgeon has put a compression dressing, be sure to wear this as often as they recommend.  With conservative management, this frustrating issue will resolve.  Also, be sure to eat a bland diet, which will help the salivary flow to slow down.  Be sure to follow up and discuss your concerns with your surgeon.  I hope that this helps!-David Gilpin

Stephen Prendiville, MD · Answer

This rare, but annoying compication usually heals spontaneously with conservative measures.  However, use of Botox can minimize salivary productio and speed up the process

Andres Bustillo, MD, FACS · Answer

This should eventually stop. Continue with compression dressing as this is the most important. Consider botox  treatment so that parotid deceased production of saliva.

Brian K. Machida, MD, FACS · Answer

I'm not sure why the problem is not subsiding. Parotid surgery for tumors leaves the gland open with multiple cut surfaces and the skin flap is just closed on top of it with a drain which is taken out after a few days. Is your surgeon certain that it is saliva? It sounds puzzling and a reexploration might be needed to take a look. I'm not sure a sialogram would show anything but that's the only study which might.

Vincent N. Zubowicz, MD · Answer

It is highly unlikely that the parotid duct was damaged during facelift. More than likely the surface of the parotid can "sweat" and accumulate. A small drain can be placed. This is a rare complication but usually fixes itself in short order.