Significant tightness one year post-op facelift. What can I do and will this end?

Question

Hello, I had a deep plane facelift, coronal brow lift, and lower lid blepharoplasty nearly one year ago. I know everyone is different, but, for me, the healing process has been extremely painful and slow. I still feel like I have a tight vice around my neck and have pain and swelling along the incision sites. Everything feels extremely tight and I believe it looks this way as well. My quality of life has suffered tremendously. My question is: What can I do and will this end?

Yasin Kursad Varsak, MD · Answer

Hello, facelift surgery is typically a painless procedure. Particularly, after a year has passed, experiencing pain is not a common occurrence. Swelling may occur in the early stages, but it is unlikely to persist after a year. The majority of my practice consists of facelift patients, and most of them experience a sensation of tightness in the first few months. However, over time, this tightness tends to diminish, and complaints about tightness after a year are rare. Your pain threshold may be low, or you may perceive tightness and pain differently from others. Don't worry, as this is likely to continue because the healing process for soft tissues can sometimes take over a year; we see this in rhinoplasty patients as well. Unless there is an active infection, we do not expect swelling or pain at the surgical sites. During the surgery, cutting small nerve endings while lifting the skin flap can lead to localized numbness, but constant pain is not a commonly described condition. I recommend discussing these described conditions with your doctor for proper management. Remember, time heals everything, and this rule applies in surgery as well.

Alan Gonzalez, MD, FACS · Answer

Hello @Hindsight98, thank you for your question. It's always important to remember that healing is a unique process for each individual patient and it can take some time for results to be fully visible. You should definitely consult with the surgeon who performed your procedure as he would best be able to provide detailed information on what may help you in terms of the tightness and numbness still present after 12 months post-op. Best wishes!

Alan Gonzalez MD. American Society of Plastic Surgery Member (ASPS),International Federation for Adipose Therapeutics and Science Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Alan Gonzalez MD. American Society of Plastic Surgery Member (ASPS),International Federation for Adipose Therapeutics and Science Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Paul Fortes, MD · Answer

At one year post-op your recovery is nearing completion.  How an individual experiences any surgical recovery is unique to that person, but your experience in feeling extremely tight at the one year mark is not typical.  More typically, patients experience tightness and numbness of the face early in the recovery, and both of these things get better over time.  My advice is to express these concerns to your plastic surgeon, as only  he or she knows exactly what was done at the time of your surgery.  More surgery at this time is unlikely to be of benefit.  Instead, swelling and tight internal or external scars can be treated with corticosteroid injections to "soften" the scars, relieve the tightness, and reduce the residual swelling.  Ask your surgeon if he or she recommends this course of action for you.  Best of luck!

Amer Nassar, MD · Answer

Patients who are having tightness, particularly around the neck area, 1 year out, that is affecting their quality of life, likely suffer from from a permanent suture that was placed from ear to ear, tunneled in the neck. As this suture is likely permanent in nature based off the timeline, one would need surgery to remove it and relieve the tightness.Please consult with a Plastic Surgeon in your area that is comfortable dealing with revision facelifts for evaluation and possible treatment.
Kind Regards,
Amer Nassar, MDPlastic and Reconstructive Surgeon

Mats Hagstrom, MD (license on probation) · Answer

This response was dictated.
I apologize for any potential. Grammatical errors.
The procedures you had are permanent, reversible, and there is no way to alleviate your concerns.
Accepting that this is the new you and moving forward is your best option.
Unless it’s an aesthetic issue plastic surgeons really aren’t going to be of much use for you.
Without including before, and after pictures, we can’t begin to make an assessment.
I have no idea if your procedure was done well or not so well. Likewise, I have no idea if you’re a good candidate for the operations in the first place.
In a nutshell, your concerns are not a surgical problem.
The fact that plastic surgery cost them does not make your current discomfort and regret something that has a surgical solution.
I wish I could be more optimistic, but the time to be critical of plastic surgeons and making good choices is before having the procedure.
Most patients get accustomed to permanent changes after surgery within a few months.
Certain issues may linger on for longer.
I’ve had the same procedure you had except I did not have eyelid surgery.
For the most part, I appreciated the outcome, and the numbness and tightness Only bothered me occasionally.
I found the more I thought about it the worse it got so I tend to ignore it and move forward.
That seems to help with accepting permanent change. Focus on the future and the positive aspects of the procedure.
I’m sure there must be at least some.
Best,
Mats Hagstrom, MD

James Hoyt, MD (retired) · Answer

Experiencing significant tightness one-year post-op after a facelift can be concerning, but it's essential to understand that some degree of tightness or sensation changes can persist for an extended period after surgery. Here are some factors to consider and steps you can take:
1.	Consult Your Surgeon: If you're experiencing persistent tightness or discomfort one year after your facelift, it's crucial to consult with your plastic surgeon. They can evaluate your condition, assess the underlying causes of the tightness, and determine if any further treatment or intervention is necessary.
2.	Scar Tissue Formation: Tightness after a facelift can be attributed to the formation of scar tissue beneath the skin's surface. This scar tissue is a natural part of the healing process and can cause sensations of tightness or stiffness in the treated areas. Massaging the affected areas as directed by your plastic surgeon may help soften scar tissue and improve comfort over time.
3.	Range of Motion Exercises: Your plastic surgeon or a physical therapist may recommend gentle range of motion exercises to improve flexibility and reduce tightness in the facial muscles and tissues. These exercises can help promote circulation, relieve tension, and enhance overall comfort.
4.	Moisturize and Hydrate: Keeping your skin well-moisturized and hydrated can help improve skin elasticity and reduce sensations of tightness or dryness. Use a gentle moisturizer suitable for your skin type and avoid harsh skincare products that may exacerbate irritation or sensitivity.
5.	Consider Non-Surgical Treatments: Depending on the underlying cause of the tightness and your specific concerns, your plastic surgeon may recommend non-surgical treatments such as laser therapy, radiofrequency treatments, or injectable fillers to address residual tightness, improve skin texture, or enhance facial contouring.
6.	Be Patient: Healing from a facelift is a gradual process, and it's not uncommon for residual tightness or sensation changes to persist for several months or even up to a year after surgery. Be patient with your body's natural healing process and give yourself time to fully recover.
7.	Maintain Healthy Lifestyle Habits: Practicing good skincare, staying hydrated, eating a balanced diet, avoiding smoking, and protecting your skin from sun damage can all contribute to optimal healing and skin health.
8.	Seek Emotional Support: Dealing with ongoing discomfort or changes in appearance can be emotionally challenging. Seek support from loved ones, join online support groups, or consider speaking with a therapist or counselor if you're experiencing emotional distress related to your postoperative experience.
It's important to communicate openly with your plastic surgeon about any concerns or discomfort you're experiencing, as they can provide recommendations and interventions to address your specific needs and promote optimal healing after a facelift.

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