Bad scar around ear, too tight skin, pixie ear, loose skin under chin, stretchmarks. Advice for improvement? (Photo)

Hello,
Sorry to hear that you are experiencing this trouble following your facelift.  You probably need to wait for at least a year for the skin to relax and settle before pursuing any additional treatments.  You may need to have more of a deep plane approach to decrease tension on the skin flaps, but is hope for improvement of this issue.  Good luck.

It's not too early or late to start treating the scars. I recommend researching and considering PRP (to repair), CO2 fractional laser (to resurface), vbeam (to treat the red/pink), topical silicone, and possibly kenalogue injection. These can be performed in combination and repeated until the desired improvement is achieved. Scar revision may be beneficial for portions of the scar. The best way to proceed will be to see and be evaluated by a surgeon or physician who has experience with these treatments. 

A personal evaluation would be necessary to create a customized treatment plan for you, but the far majority of revision facelifts that I perform shortly after a prior facelift need a deep plane technique for proper correction. Releasing the ligaments that hold the cheek allows for a better lift. This then allows for the removal of the excess skin and scar tissue. This also allows for skin closure to be performed under little to no tension which helps prevent issues with healing and scar formation. If the ligament is not released, the lift is compromised and it would be very difficult to close the incisions without tension. I personally don't see why you would need to wait a whole year. I am comfortable performing revision facelifts once all the healing appears to have occurred which usually only takes 4-6 months. Good luck.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Thank you for your question and for attaching photos. This is obviously not the final result any patient or surgeon would like. Fortunately, this is fairly uncommon. I am not sure if you are a smoker or not, but many times this is the reason for slow wound healing and scars like this. At times, it is genetics and just bad luck. I would suggest waiting a full year for any revision and you are almost there. You probably need to have the whole procedure redone to get the best results. If you are indeed a smoker, you must quit at least 2 months before a revision or you will be back in the same boat or worse. I wish you the best.

I think it's fairly obvious that your procedure will require a revision.  Generally speaking, 12 months is required before consideration of a revision should be entertained.  It is important to understand that a revision facelift will improve the scars around the ears and hairline, but will not completely eliminate the scars extending down to the sternocleidomastoid muscle.  These will need to be revised separately and at a later date.  A scar revision alone without mobilization of the SMAS may place undue tension on the skin and result in equally bad scars.  See a Facial Plastic Surgeon or Plastic Surgeon who is comfortable with this kind of facelift revision, make sure that you eliminate any use of nicotine that may or may not have contributed to this problem, and take the time for adequate recuperation.  

Thank you for your question.  I am so sorry that you are having these issues after your surgery.  Thank you for your pictures, as well.  At this point, I would not recommend undergoing a secondary/revision procedure.  I would wait for a full year, and also consider having a steroid injection placed into these incision lines.  I am hopeful that with time, these will soften and their appearance will improve.  In the future, I am hopeful that as your skin loosens, you will be able to undergo a revision facelift at which time these incision lines can be removed and your earlobe repaired. I would consult with a board certified facial plastic or plastic surgeon who has experience in facelifting for an in-person examination, as well.  I hope that this helps, -David Gilpin

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

I am sorry that this occurred to you. At this point I would not recommend surgery. There is no skin laxity that would allow the scarred skin to be removed and new skin advanced. You would likely get the same result as you have now. I would visit a reputable dermatologist that has a good array of lasers that can help improve the scars in addition to kenalog/5FU injections to the scars. Good luck, many of these get much better with time.

Hi. The best option to discuss with your surgeon is to re do the Face Lift and add a Neck lift. The scar on the left is wide and while waiting longer and treating the area with steroid injections will improve, this combined with the loose neck skin and fullness loans it self for re-operation. The neck lift component will allow the facial skin to be lifted more extensively and I would combine this with a High SMAS flap that will take pressure off the skin and allow tension free re-draping of the facial skin.

 Fortunately for many patients this is not a common problem. When I see this type of results it indicates poor planning or too tight of a closure. Your solution now would be injecting of either Kenalog to try to improve the scarring and under certain circumstances using 5FU(an anti cancer drug). I have seen many results that looked worse than yours and improve dramatically.   In this case patience  is a virtue. I would do nothing earlier than nine months to 12 months  as far as surgery. Injecting Kenalog along with the 5FU can start within a few months.