Scabs getting wet yellow pits after facelift - Is this a normal healing variation? (photo)

Question

I had a lower facelift a little over 2 weeks ago. It is tender behind my ears with big scabs that are forming yellow pits. Is this a normal healing variation?

Zoran Potparic, MD · Answer

What you are experiencing is partial loss of skin in few areas along incisions. Conservative approach with wound care and patience is shown to be the best in this case. Crust and dead tissue should be allowed to separate spontaneously and secondary healing will take over. It may take 6-8 weeks for this to happen but it will. You may shower, wash your hair with regular shampoo, wash the face and apply antibiotic ointment over all incisions including crusts twice a day. Once wounds are healed you will experience scars that are larger in the areas of secondary healing, but that will also improve in time. In some cases secondary surgery, scar revision, may be needed but not sooner than 12-15 months after all is healed. Staying in touch with your surgeon is always the best option unless there are some major differences. Good luck.

Keshav Magge, MD · Answer

Thank you for your question.  It looks like you have some areas of skin ischemia/necrosis which will take time to heal.  They require local wound care, and they will heal eventually and the scars can be addressed in the future.  Best to speak to your plastic surgeon.

John Michael Thomassen, MD · Answer

Small areas of necrosis of the skin have developed behind your ears.  Follow up with your surgeon who will gently debride the areas.  These should eventually heal with a slightly wider scar in the back of the ear.  It may be revised after for a better scar if necessary.

Kenneth D. Steinsapir, MD · Answer

However, this is not uncommonly seen. This is tissue ischemia at the edge of the skin flap behind the ear. The skin is dark due to lack of circulation. This is focal skin necrosis. However, this is not considered a serious complication and the management for this and the "yellow pits" is straight forward. Mostly it represents a delay in healing from the facelift. The good news is that you will heal. Strange surgeons can tell you how they manage these. However, it is far better to see your personal surgeon to allow them to manage these. This area is hidden behind the ear and under the hair. With the help of your surgeon, these area heal beautifully.

Dana Goldberg, MD · Answer

This is not normal healing. You have skin necrosis, where some of the skin didn’t get enough blood flow and has died. Usually with proper wound care, this will heal within a few weeks. 
Sometimes this causes discoloration or thickening of the final scars, but this can often be treated.  It’s important to see your surgeon every few days to make sure you are caring for it properly and that it stays free from infection.

Marcelo Antunes, MD, FACS · Answer

Thank you for your question. The pictures are not really clear, but seem to show a scab behind the ear, the size of the dime. 
This is called epidermolysis and is a partial or total necrosis of the skin in that area. 
First, I’d like to reassure you that this is likely going to be ok. It probably will not going to negatively impact your results in the long term in a very significant way. 
This scabbing is related to tenuous blood supply to the skin in that area (that area is the end of the flap - where the blood supply to the skin come from the furthest). You will need to apply ointment in the area and this should resolve in 1-2 weeks if all goes well (which should). The area behind the ear heals well and even when you pull your hair up it probably won’t be very noticeable to others. 
That being said, I’d recommend you discuss this with your surgeon to make sure there are not additional concerns on his/her part.

John J. Martin, Jr., MD · Answer

The top of the incision behind the ear is where some patients will have some poor wound healing and subsequent scabbing.  As the scab falls off you will notice some yellowish discharge in the area as the skin starts to grow in.  Once the are heals it may have some lighter pigmentation but otherwise will often look pretty good. While it is healing it is a good idea to keep it moist with an antibiotic cream.  Also use some warm compresses to increase blood flow to the area.

Dallas Buchanan, MD · Answer

Thank you for your questions. The photos are not very clear but there is certainly some concerns there. It looks like there is some soft tissue necrosis of the skin and some loosening of the incision. This is not normal healing and I suspect it will get worse before it gets better and likely result in an open wound at some point that will require local wound care. Without question, you need to be evaluated and managed by your plastic surgeon as soon as possible. And for your sake, I hope you chose a plastic surgeon who is board certified by the American Board of Plastic Surgery! When things go great, it may not matter, but when things do not go great, you are going to need an expert on your side. Best of luck!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Gilbert Lee, MD · Answer

Thank you for your questions and photos. It looks like you may be developing a little bit of an ischemic area. I recommend that you follow up with your Plastic Surgeon. Although this isn't super uncommon, it needs to be followed closely to avoid infection and maximize your results. They will be able to follow you through this post operative period and address anything that may come up. Good luck!

Scabs getting wet yellow pits after facelift - Is this a normal healing variation? (photo)

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