Bruising or Hematoma After Facelift?

I had a facelift on 4/13. All seemed fine, then about 4 days ago, I developed a very dark bruise or hemotoma on my left cheek. There's no pain, but should I be concerned or is this part of the normal healing process? Thanks.

Doctor Answers 60

Please see your surgeon!

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Dear JPierce

Some times patients are very considerate of their busy surgeon's: "I didn't want to bother you so I am waiting for my one week appointment." Please be aware that this hematoma potentially constitutes a threat to the facial skin over the area of the bruise. If you have not seen your doctor and you are reading this, I urge you to pick up your phone and call your surgeon. I assure you, your surgeon wants to hear from you. He or she will want to see you immediately to confirm that the circulation in the facial flap is not being compromised by the hematoma. If so, there are interventions that can be performed right in the office by your surgeon to help preserve the facial skin. Less serious hematomas can simply be observed but don't make this call on your own. Please stop reading this website, and pick up your phone and call your surgeon.

Please let the RealSelf community how things went.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Some bruising, some skin loss, and a possible hematoma

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It's difficult to know without examining you, but from your photo you certainly have some skin loss and some bruising, and my guess is a small hematoma as well. I would see your surgeon ASAP as I am sure he would want to treat this in some manner, be it local wound care or drainage of the hematoma. In most cases, the good news is that after proper wound care and time, it should heal well and look acceptable compared to your other side.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Looks like small hematoma with a little skin loss.

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Hi.   From the one picture and from the timing, I think you have a hematoma that should be looked at right away, because it could affect the result.  I cannot tell you what treatment you need (most commonly, the blood clot is removed under anesthesia), but see you surgeon right away!

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

See your surgeon

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While one photo clearly does not tell the whole story, I do think that you should see your surgeon for advice. It appears that the skin at the top, just in front of the ear, is looking compromised. Topical antibiotics, or other treatment may enhance your outcome.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.7 out of 5 stars 37 reviews

Suspicious Bruising Should Be Checked

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I can't say for certain. Distinguishing between bruising and a hematoma is something that requires a personal exam, and I encourage anyone in this situation to immediately contact the surgeon's office. Patients are often worried about having too many questions for their surgeons after surgery, yet, I can reassure you that plastic surgeons expect them. More than that, we want you to communicate your concerns as early as possible, so we can take whatever steps are needed to correct the issue. Best of luck to you.

Marc DuPéré, MD
Toronto Plastic Surgeon
4.8 out of 5 stars 71 reviews

Bruising after facelift

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It is not uncommon to have the bruising manifest more at 3-5 days postop, but the dusky color in the skin in this picture can be an indictation of decreased blood flow. In this situation I would certainly recommend seeing the surgeon that performed the procedure so they can better evaluate the skin, checking for capillary refill, for example.

Dr. Donath 

Alexander Donath, MD, FACS
Cincinnati Facial Plastic Surgeon
4.7 out of 5 stars 45 reviews

Minimizing Bruising and Swelling Post Facelift

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I think one of the most important things is to have the patient stop Aspirin, Advil, Motrin, and fish oils pre-operatively as well as atraumatic technique on behalf of the surgeon. I also add platelet rich plasma (PRP) which is an autologous internal glue to help minimize bruising and swelling in my patients. Bruising and swelling is not uncommon, however, if you have a hematoma that is significantly different. It needs to be acted upon and evacuated immediately. This is something that is based upon the diagnosis made by the surgeon, however, it is an uncommon occurrence with proper pre-operative, intraoperative, and post operative care.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Hematoma? Only Your Surgeon Can Tell

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I agree with other posters that the 1st thing you should do is go and see your surgeon for any concerns. Secondly, although bruising is present, a hematoma does not appear to be present in this photograph. Lastly, the dark appearance of the skin beneath your sideburn suggests a small amount of skin flap necrosis. Although your surgeon is likely to take a very conservative approach with this issue, an absorbant dressing known as Polymem(3M) may be helpful. Treatment with Polymem is as follows: Apply and change at least 2 times per day and avoid use of petroleum jelly.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Cause for concern

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Of course you should be addressing these concerns to your own surgeon. From your photos, there appears to be an area of dark skin above your ear where your sideburns should be. If it is black, this is not normal. Your skin of the cheek area in front of your ear is quite dark and could very well indicate a hematoma or at least significant bruising that could compromise the viability and healing of the overlying skin. You should have your surgeon look at this as soon as possible since remedies can be performed to limit the injury to the skin. It is not possible to make a definitive diagnosis by just a single photo. If you cannot see your surgeon or he doesn't give you a good explanation, seek a second opinion from a reputable plastic surgeon.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Face Lift Bruising, Bleeding, or Hematoma

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Any bruising, bleeding, or hematoma after face lift surgery should be immediately be known by the plastic surgeon.

While a certain degree of bruising or bleeding from the incision / stitches is expected, a collection of blood (hematoma) underneath the skin should be treated right away. Hematomas are generally drained, or observed if very small. Hematomas after face lift surgery are more common in men and patients with high blood pressure. Blood thinners, aspirin, ibuprofen, and herbal medications should also be avoided with any cosmetic surgery. Your facial plastic surgeon will guide you on pre and postoperative care for your cosmetic procedure.

Don't delay, and contact your face lift surgeon ASAP.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.