Follow up. Is this fat necrosis? (Photo)

Question

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.

Christian Subbio, MD · Answer

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. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Vincent N. Zubowicz, MD · Answer

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.

Marc DuPéré, MD · Answer

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

Sean R. Weiss, MD, FACS · Answer

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

Michael E. Kelly, MD · Answer

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 revisionbest of luck

Follow up. Is this fat necrosis? (Photo)

Answers (7)

Answer: 5 weeks following Facelift

Answer: 5 weeks following Facelift

Answer: Facial lumps

Answer: Facial lumps

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Follow up. Is this fat necrosis? (Photo)

Answers (7)

Answer: 5 weeks following Facelift

Answer: 5 weeks following Facelift

Answer: Facial lumps

Answer: Facial lumps

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Recommended reading

Everything you need to know about Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.