Should my scars look like this four weeks post facelift/necklift surgery? (photos)

Question

Had a lower facelift&necklift 4 weeks ago. Initially, wounds appeared to be healing well, but in last 2 weeks have become increasingly sore; pus seeping from area of the incision in front of 1 ear. At post-op check, nurse said the stitches were dissolvable . However, while some have disappeared, have quite few of what feels like plastic/nylon threads sticking out around bottom of the ears - not convinced these are dissovable. I will be going back to my surgeon but also hoping for advice here.

George Bitar, MD · Answer

Thank you for your question.  Your incisions do not look normal for 4 weeks Postop.  You are probably having a reaction to your sutures.  Removal should help your recovery.  Contact your surgeon to discuss this matter.

Ritchie Younger, MD · Answer

ALWAYS  best to make an assessment in person, but based on these photos you may have an issue that can be addressed to get you back on track for a great facelift result ! Either you may have a slight wound infection or you may have developed a mild allergy to topical application of a wound care product such as an antibiotic ointment.  If you do have some drainage, it should be swabbed and sent for a culture to see if there are any bacterial components to the redness you have. If there is minimal drainage  and redness along the incision lines you might consider it an allergy to topical antibiotic, and probably should change to another antibiotic ointment to apply to the incision line.  If there is a considerable amount of drainage, you may need to be started on an oral antibiotic, and follow up on  the culture results to confirm that  you are on the right antibiotic.  At four weeks you may think this is not the greatest early result, but with proper wound care your incisions still may become quite invisible.  Follow-up with your surgeon is the best way to optimize your eventual outcome !!

Lawrence Kass, MD · Answer

Thank you for the photos.  I do agree that it looks like there was a lot of tension on the posterior incisions and there also could be infection present.  The front incision on the right ear and the earlobe look good.  I do think you should see your doctor soon.  Good luck!

Afshin Parhiscar, MD · Answer

Dear EstherOnionsAlthough you should go see your surgeon as soon as possible, I dont see any evidence of infection here. I think that your surgeon used "dissolvable" sutures and they cause significant inflammation in some patients. In your case, the suture line is red and inflamed however the rest of surrounding skin does not appear involved. I think a thorough cleaning and removal of remaining parts of sutures followed by topical wound care will help immensely. then at 6 months, reassess your scars and decide whats next.

Toby Mayer, MD · Answer

You need to return to your surgeon since it sounds as though you have an infection if Pus is extruding from the wound.  The scar on that side is not acceptable and will eventually probably need to be revised.

Louis C. Cutolo, Jr., MD, FACS · Answer

I'm
sorry to read you're still experiencing these signs. Redness with drainage 4
weeks after the procedure certainly suggests an infection. It could also be
that you are having a "reaction" to the sutures that are dissolving. The
"plastic/nylon threads" that are sticking out of the bottom of the
ears may be dissolvable but may take a significant amount of time to disappear.
It is important to see your plastic surgeon. He knows exactly the type of
sutures that were placed. He may opt to start antibiotics and explore the wound
that is draining. The wounds will look better after the infection is cleared.
Best of luck for your recovery.

Gary L. Ross, MBChB, FRCS · Answer

I would consult with your PS. The nylon stitches you mention if clear may well be dissolvable. You have redness around the scar line and it is unclear whether you should have some antibiotics for this. When dissolvable stitches dissolve you can have some discharge but I would see your PS to make sure you have no collection/swelling and to assess the redness etc. I'm not sure what you are putting on the wounds and this could be affecting things. I would also make sure to use a gentle hair shampoo at this time and avoid hair colouring.

Todd C. Miller, MD · Answer

Hi EstherOnions, it appears that too much tension was placed on the closure behind the ear which creates a thickened scar. If you have pus draining from the incision region you need to be evaluated by your surgeon ASAP. It's possible that your body may be sensitive to the sutures that were used under the skin and they are not dissolving properly. Regardless, schedule follow up with your surgeon as soon as you can for evaluation.

Ron Hazani, MD, FACS · Answer

From you description and photos it's likely that you have a local wound infection. That can be managed with wound care and antibiotics. Scar revision with placement of the incisions inside the ear tragus and more closely to the post auricular sulcus can improve the long term appearence of your scars.

Stephen Weber MD, FACS · Answer

It does appear that you had a lot of tension placed on the skin incision. This has resulted in widening of the incisions and alot of redness. Drainage from facelift incisions is very rare and is usually a sign of infection. You should return to your surgeon ASAP. I do agree with you that your incisions have not healed as well as they should have. Once any infection is dealt with and you've healed, you can consider laser resurfacing or scar revision to blend and camouflage the incisions. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Should my scars look like this four weeks post facelift/necklift surgery? (photos)

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