What could cause these white spots around my staples? (photo)

Question

I had a facelift 5 days ago. This area itches. I don't know if the itching is caused by the spots are spots caused by scratching These spots Cannot be felt and are on only one side. I am to go back to the dr in 3 days to Have staples removed

Christian Subbio, MD · Answer

It appears that the skin behind your ear is reacting to something.  Most likely antibiotic ointment, or antibiotic gauze which has an oil-like base and could be clogging up the glands.  See what your surgeon says.  After physical exam has determined that this is some sort of reaction, discontinuing the offending agent, unroofing some of the larger collections, and potentially steroid creams may be of some help.  Regardless, this should not compromise your ultimate outcome.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Vincent N. Zubowicz, MD · Answer

The area you demonstrate usually is left with poor blood supply after a facelift. Separation of the epidermis appears to be occurring is a function of this. Your surgeon may want to have specific treatment for the area in might even consider antibiotics.

Justin C. Cohen, MD, FACS · Answer

Thanks for including your picture. It looks very much like an allergic or irritant-related reaction. Occasionally, an antibiotic ointment like Neomycin can cause this to happen.  You should definitely see your surgeon for a thorough exam. Infection is always a possibility. I doubt this will impact your final result however. Good luck!

Marc DuPéré, MD · Answer

Thank you for your picture.You should see your plastic surgeon as this might be signs of low oxygen to your skin "flap". Avoid nicotine completely and minimize caffeine.You may ask your plastic surgeon if he performs PRP - platelet-rich plasma injection.Hope this helps!

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

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

Alyson Wells, MD, FACS · Answer

Thank you for including the photograph!  It appears that there is generalized irritation from contact with the dressing or a topical ointment such as Bacitracin, along with clogging of the skin pores in the area from the ointment (or ointment-soaked gauze dressing).  Since your facelift was very recent, I am confident you are in close contact with your plastic surgeon and the office.  The appearance of this area in the photo warrants an immediate call to your plastic surgeon and seeing your plastic surgeon as soon as possible to make sure that the likely ointment reaction is improving with removal of the offending agent, and that this does not progress to infection due to compromise of the normal barrier function of the skin.  Best wishes for a speedy resolution to your situation and for a beautiful final result!

Michael N. Desvigne, MD, FACS · Answer

A
little hard to tell by the photo but these look like little papules consistent
with milia.  Milia are small accumulations of laminated keratin material
that can occur after using antibacterial ointment and sometimes Vaseline.
 The area can become sensitive and irritated due to the excessively
moisture.  Sometimes the redness can be confused with an infection. If
there is increasing pain, and swelling and or drainage, this is more consistent
with an infection and typically requires systemic antibiotic therapy.
 Otherwise Discontinuing the ointment or Vaseline or decreasing the
frequency of applications usually is sufficient to allow the area to dry become
less irritated and heal.

Remus Repta, MD · Answer

Thank you for the question and photos.  There is some type of irritation occurring.  This could be a combination of the stress of the skin from the surgery or from a topical medication you're using.  The area is red enough that it warrants evaluation by your plastic surgeon sooner rather than later.All the best,Dr. Remus Repta

Michael E. Kelly, MD · Answer

moisture and/or ointment can cause these milia. In addition to having your surgeon clean and open them, a mild hydrocortisone cream can be helpful.Rest assured, these will resolve with timebest of luck

Keith Denkler, MD · Answer

This could be related to the topical antibiotic (neosporin) and the moisture behind the ear.Generally the white areas need to opened and expressed to prevent an infection.More check-ups by your doctor will be needed.

Vincent D. Lepore, MD (retired) · Answer

From your photo, it appears you may have developed milia (a clog of the eccrine duct of the sweat glands).  This can occur after any truama, including surgery, and also can be associated with an allergic reaction to a topical dressing or antibiotic.  Let your surgeon know about this.  The situation should resolve if the irritant is removed.  Your surgeon may want to de-roof the larger pustules.  But with local care this should resolve.  Best wishes, Dr. Lepore.

What could cause these white spots around my staples? (photo)

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