Follow up. Is this fat necrosis? (Photo)

5 weeks post facelift & fat transfer surgery. Ridges have not changed in weeks. Opened for aspiration, but solid. I have 6 large HARD bumps in lower cheeks and neck that have not changed with massage, heat, or aspiration. From what I have read I am beginning to think it may be fat necrosis, if so what is the next procedure to resolve it? My PS scares me when he says, he has not seen this and it is just the way I am healing. He is trying, but I am worried that I should be taking action.

Doctor Answers 7

Unusual bumps post fat grafting and facelift

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Thank you for sharing your story and pictures with us.

It is very unusual but it could be fat-related if fat grafting was done; could be excessive fat, fat necrosis, inflammatory fluid seen with healing, etc.  Keep in touch with your plastic surgeon and it should improve over time.

Hope this helps!

Best regards,

Dr. Marc DuPere, Toronto Aesthetic Plastic Surgeon

Toronto Plastic Surgeon
4.8 out of 5 stars 71 reviews

Unusual swelling after a facelift.

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The situation is certainly unusual. I personally don't do a lot of concurrent fat grafting with a facelift but the asymmetry suggests there may be fat necrosis or some fluid accumulation on the worse side.

Fat necrosis?

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Not sure, but it could be swelling or maybe fat necrosis. Light massage sometimes helps. Also light ultrasound massage may help. Best to review with your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Facelift lumps

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While it is true that a certain degree of lumpiness or firmness in areas is common after a facelift, what you seem to be describing falls outside of this range. It sounds like fat necrosis, but it could also be a pocket of fluid, or inflammatory scar of some sort, all of which are extremely uncommon after a facelift with fat grafting.
Right now you are only five weeks after the procedure. Relatively speaking, still early. During this time, the tissues are still healing, and can be influenced by multiple factors such as ultrasound, aggressive massage, potentially trying to break up what ever collection it is with a cannula or probe, very judicious steroid injections, etc.
In my opinion, now is the time to act, rather than wait this one out. I would fear that if you waited several months, that things would "set in "in the very soft and pliable tissues of the face, which could be even more difficult to address down the line.
I would visit with your surgeon again and discuss all of the above options. Based on your physical exam and what was done at the time of surgery, maybe none are indicated. May be simply waiting and massage is the right answer. However, you need to discuss this further with your plastic surgeon to make sure that you are fully involved in this process and understand the decision making here.
Best of luck!
Dr. Subbio
Board-Certified Plastic Surgeon
Newtown Square/Philadelphia, PA

Christian Subbio, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 74 reviews

Hard to know

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Could be fat necrosis or soft tissue swelling.
I would consider some ultrasound, dilute kenalog injections and massage.
It would be useful to know how much and where your doc injected the fat grafts.
Were they directly into these swollen areas?

Facial lumps

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It is difficult to tell if this is fat necrosis, not knowing if this is where fat was injected. It may just be scar and/or old blood that is resolving. At this point, conservative care  (massage, heat) are the best options, if it doesnt resolve by 12 weeks, then I would consider surgiacal exploration and revision

best of luck

5 weeks following Facelift

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It is unusual to have this sort of irregularity following facelift.  By the looks of your photos you appear to have persistent soft tissue swelling.  The good news it that with time this will likely resolve and the end result will be nice.  Be sure to stay in close contact with you surgeon and give it time.  Best regards

Sean R. Weiss, MD, FACS
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

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