Scar tissue or cysts??? Numerous hard ridges and lumps after Facelift & fat transfer with no improvement at week 5.

Question

I have developed numerous hard ridges in my cheeks and neck that have shown no improvement in the last 2 weeks. My face is so tight that I can not smile and opening my mouth is limited. I have tried massage and warm compresses with no results. My scar was reopened for needle aspiration and the bumps were solid and could not be drained. It sounded like the needle was hitting hard califications. The surgeon now thinks it is scar tissue, or hardened oil cysts. Do I need a second opinion?

Vincent N. Zubowicz, MD · Answer

Most patients with facelifts that do not include grafting of fat are very passable in appearance within two weeks of the operation. Injection of fat creates swelling is the body response to this material. It may take a number of weeks for this to subside.

Andrew Campbell, MD · Answer

A second opinion never hurts, but your problems may just go away on their own. If your nodules are firm, I personally would inject a small amount of dilute steroid in them. Otherwise, you are doing everything correctly. Hopefully over the next few weeks, things will normalize.Andrew Campbell, M.D.Facial Plastic SpecialistQuintessa Aesthetic Centers

Marc DuPéré, MD · Answer

Thank you for your question. It sounds to me you had a post-op hematoma (bleeding) which clotted (hence hard initially) when not evacuated post surgery. By 5 weeks, it should be amenable to aspiration. You should visit your plastic surgeon again.It is unlikely to be cysts, calcifications or thick scars so early post surgery.Hope this helps!

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

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

Andres Bustillo, MD, FACS · Answer

At 5 weeks after a facelift, it is normal to have some lumpiness. Without pictures, its difficult to know the size and shape. Also, when did they develop? These are important questions that would help to know the answers to help you.

Michael N. Desvigne, MD, FACS · Answer

Lumps and bumpiness
after surgery is quite common.  Most
frequently it is scar tissue that typically will remodel and soften over time.
If fat transfer was performed, it is is however possible to for oil cysts in
the area of fat transfer.  If the fat
cells do not ultimately survive then they die or necrose and can also cause
scar tissue that may be firm, lumpy and or bumpy.  Week 5 typically results are appreciated
however, if there is still significant swelling these results may not be as
easily noticed.

Michael E. Kelly, MD · Answer

Some lumps are normal at this point and will generally soften and resolve over time. But what you describe sounds more worrisome. Impossible to tell without examining you. But I would try massage for the next few weeks and see how things improve. I would not advocate any surgery for at least 3 months.hope this helps

William Marshall Guy, MD · Answer

Hello Persnickety,Without any photos (and really feeling the area), it is difficult to say exactly that this is.  It would by unlikely to be a cyst as to get to a noticeable size take a long time to develop.  Small blockages of oil glands tend to form very small little white heads called milia that improve with scrubbing or unroofing them.  This could represent some of the unevenness that develops right after surgery but improves with time (it represents how the different areas of the face swell and how that swelling goes away).  This is not usually firm though and is more of a visible issue.  If things had to be reopened it is possible you had developed a hematoma (blood collection) under the skin.  If that is the case then this area will soften up but it will take a little longer to heal than areas without a hematoma.  The other possibility is the fat grafting is taking unevenly.  This may improve with time but is more variable.  If liposuction was also performed and the cannula was not moved into different angles then these can be channels that formed.  This may not improve that much without further treatment.  As of right now time will continue to help.  You may benefit from injections of steroids to help soften these areas faster.  If you don't trust your surgeon (hopefully this isn't the case), then a second opinion may help.  But this soon after surgery there aren't many interventions that would be performed.  I'd recommend you continue to follow up closely with your surgeon and if you aren't pleased, seek a second opinion.

Keith Denkler, MD · Answer

You will likely need a second opinion.It sounds like there is a large amount of scarring.This will improve with time, but it sounds very scarred.Sounds good to start looking.

Vincent D. Lepore, MD (retired) · Answer

I'm sorry to hear you are having problems following your face lift.   Scars are typically at their worst at 4 to 6 weeks following a surgery and it is not unusual to have some areas of lumpiness following a face lift.  Gentle massage with a moisturizer may speed healing and softening of the affected areas.  Ask your surgeon if at this point they might consider a hydrocortizone injected into the worst areas.  But give things time to settle.  You are always free to get a second opinion and this might help ease your concerns.  Best wishes, Dr. Lepore.

Scar tissue or cysts??? Numerous hard ridges and lumps after Facelift & fat transfer with no improvement at week 5.

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