Hard Swelling and Brusing on Lower Cheek After Face Lift Three Weeks Ago

Question

My wife had a face lift three weeks ago. After first week, returned to Dr's office, he noticed abnormal swelling on Lower cheek that was hard and bruised about 3cm x 4cm in size) it swelled out about an inch from the rest of her cheek. Was told to do nothing about it. Stated that the hematoma should go down and not to worry about it. My wife dosent want a picture taken, due to the size of the swelling. All I am asking if this is normal. Im just trying to get info and help her out...Thanks

Sam Naficy, MD, FACS · Answer

Each situation is unique and only your surgeon knows the specific details of your procedure and should be the person commenting on post-operative questions such as this

Young R. Cho, MD, PhD · Answer

Thank you for your question for sharing your concerns with us. Swelling and firmness in the tissues will return to normal as time passes by. Between the first and second week, much of your swelling and bruising will dissipate.  This will be prolonged in the setting of a hematoma.  Hematomas vary in presentation.  Large ones that may compromise the tissue viability or the surgical goals should be evacuated.  Smaller ones may be observed and can resolve on their own with time. Lymphatic massage maybe an option to help clear the swelling/bruising and firmness at a faster pace.  I would make sure that you continue to follow up with your plastic surgeon during this period of time.

Mike Majmundar, MD · Answer

Swelling and bruising is normal after a facelift and, on average, lasts about 14 days.  Of course, that is an average and there are people on either side of that number.  There are younger patients who only bruise for 5-7 days and there are older individuals who bruise and swell for 6 weeks but on average, 14 days is what most people get.The amount and duration of the swelling and bruising depends on several factors such as diet before the procedure, medications, herbal supplements, activity after the procedure, age (vessels are more fragile as one ages), the extent of the procedure, other concomitant procedures adding to the bruising, habits such as smoking, and envirnomental factors such as heat, excessive sneezing or coughing, etc.  You can help bruising by increasing your intake of pineapple, arnica montana, and papaya extract; all of these have been shown to minimize bruising formation.  To improve an existing bruise, consider lympatic massage by your surgeon's office, topical arnica montana, and topical vit K in addition to increasing intake of green leafy vegetables.  Hematomas, a collection of blood under the skin, even when cleared still leaves behind a residual amount of blood under the skin and can prolong the bruising period. If there is a small hematoma, you can let it resolve on its own but this will take about 6-8 weeks to resolve and may require some steroid injections afterwards.  In the end, bruising always goes away, but can be a nuisance when it doesn't resolve as expected.  Good Luck!

Lawrence Kass, MD · Answer

I vote that this is probably a hematoma, just like your doctor said, and that it will almost certainly resolve with time (think 3-6 months). I think you try not to worry, reassure your wife and that continued observation and patience is the answer.

David Shafer, MD, FACS · Answer

Uniform swelling and some bruising after facelift can be expected.  However, asymmetrical swelling or excessive bruising is unusual and must be investigated.  While hematomas usually occur in the first hours to days, it is possible to have a delayed hematoma.  Your surgeon can drain the fluid in the office.  However, if they are unsure of the diagnosis, then they can arrange for an ultrasound guided drainage. 

	 

	Good Luck.

Kenneth D. Steinsapir, MD · Answer

Bruises or, in medical speak, hematomas do occur after lower facelifts. When they are large and it is immediately after surgery, I will often explore the face, remove the clot, and cauterized the blood vessel responsible for the bruise. This can often be done in the office procedure room under local anesthesia. When the hematomas are small, it may not be worth this effort. Yes, the do resolve on their own. The issues is that it delays healing and it can be many weeks before all the blood elements are removed by the body. Being patient is tough but it sounds like your wife's surgeon my the right call for a small hematoma. It will get better.

Romy Ahluwalia, MD · Answer

It’s hard to say without a picture or examine, but it sounds like a small simple hematoma that should resolve with time

Philip Young, MD · Answer

Swelling at 3 weeks is not unusual. At this point you likely have around 40% of your healing. We usually tell people that they will have 60% of their healing / recovery complete by 6 weeks, 80-90% by 6 months. 100% can take as long as 2 years. This is based on wound healing studies and tensile breaking strength of a heal wound.

	This area is likely an old fluid / blood accumulation that has settle into this lump. A 3 weeks, it is possible that this fluid could be aspirated but likely it is hard and full of inflammatory tissue and collage build up. Steroid injections would be my first thought along with pressure dressings and judicious taping.

Shepherd G. Pryor, MD · Answer

A small amount of blood clot or hematoma is not an uncommon finding after a facelift. There is truly nothing to worry about at this point based on the size of what you are seeing besides giving it time and patience. All will be well once your wife is farther out from having a major procedure completed. I would not recommend reexploration AT ALL 3 weeks after surgery. She should do great. Cheers! Dr. Shep

Johan E. Brahme, MD · Answer

A firm area of swelling along with bruising indicates a hematoma. If this is small it may liquefy and respond to aspirations, however this seems a little too large, and if left alone can leave permanent deformities. I would ask your surgeon about evacuating the hematoma. This can sometimes be done with a very fine liposuction cannula, without having to re-open the entire surgical incision. Good luck.

Hard Swelling and Brusing on Lower Cheek After Face Lift Three Weeks Ago

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