What is the probability of skin necrosis if I want to do facelift surgery after head and neck radiotherapy?

High. Radiation causes a permanent vasculitis that impairs the circulation to the skin. If you undermine that skin as in a facelift, the skin may die from inadequate blood supply.One could consider other treatments, such as fat grafting to restore volume to the aging face. This may also improve the quality and texture of the skin appearance, as stem cells exert their effect.Consider non-invasive treatments that restore volume. Should any procedure be done, it would have to be a highly modified facelift with limited skin undermining. 

Is impossible to comment on your specific situation. However, radiation creates a progressive decrease in blood flow to the skin which influences wound healing. You should pursue a facelift only with a plastic surgeon familiar with the aesthetic operation as well as head and neck cancer.

Hello,There are too many variables to address your question with a big degree of reliability.  Things to consider are - location of the radiation, how long after your radiation treatment are you, how much radiation was provided, your age, underlying medical conditions...I can expound more but as you can see, there is no easy answer without more information from you.  

The risk of necrosis after radiation is high. I would not recommend a facelift for you. You will only be flirting with disaster

This is a very difficult question to answer without knowing where you were irradiated and when.  Very often after neck irradiation to eradicate disease in the lymph nodes, the neck can have a very firm, wood -like hardness.  If that's the case, I likely would not perform a face and neck lift at all due to the scarred tissue planes and lack of pliability of the tissues.  On the other hand, if you had cancer of the nasopharynx for example localized to that area, the neck and skin could have been spared.  You should check with your head and neck surgeon and radiation oncologist to be sure.  Best of luck.

Radiation therapy can cause microvascular changes in the area that was treated. These are likely permanent changes that can adversely impact the outcomes of facelift surgery.The effect it will have will depend upon:1) What kind of radiation you had/how deep it penetrated2) Total dose of radiation3) How long ago it was done4) Where the beam was focusedAll in all you do have a potentially increased risk of having issues with your facelift flap that can result in some scarring issues.  It does not mean that this will definitely happen, but the risk is higher.  The factors above will influence this as the type of facelift you are considering will as well.There is no study that can give you an exact percentage of increased risk of skin necrosis.  It would be very hard to get a large enough sample size in this type of a population to ascertain this information. 

There is no absolute yes or no answer in deciding on a facelift after having head and neck radiation. The most important factor is to be reasonable sure that the cancer has been treated and the chance of a recurrence is extremely unlikely. If it has been more than 5 years since the treatment, then it is generally considered cured with little chance of it coming back.That being said, radiation definitely will decrease the blood supply to the skin of the neck, although the severity does depend on the amount of radiation as well as individual patient factors. There is a higher risk of skin necrosis (scabbing with scarring and poor healing), however, I have operated on patients after radiation who have healed well. One important difference is that often after radiation, the fibrosis (wood-like feeling of the skin) causes the neck to be stiffer and there is not as much looseness. This can mean that the neck portion of the surgery may be less extensive with less risk of skin necrosis.If you and an experienced surgeon do decide to proceed with a facelift, it is extremely important to closely monitor you during the first 10 to 14 days after surgery for early signs of necrosis. If present, they can be improved with topical NitroPaste and/or hyperbaric oxygen therapy. However, it is essential to understand the potential risk before proceeding with surgery.

Thank you for your question. Yes you do have an increased risk of wound healing issues and/or skin necrosis. It would be helpful to know what area was radiated, if you had any previous surgery in the area and how much radiation damage you currently have. In some cases the surgery can be done with some improvement. It is important not to pull the skin too tight in these cases and to keep undermining of the skin at a minimum. Your plastic surgeon can discuss this is detail with you after a full consultation.

This is a complex question requiring consultation with a skilled plastic surgeon as well as your radiation oncologist. There are several factors that play into this including the timing and duration (dosage) of the radiation, the area targeted, the extent of the face lift dissection. Without question there are increased complications and morbidity when undermining skin as with a facelift in an area of radiation because of the decreased vascularity. There may however be alternatives in the degree of surgery, and the postop treatment.

It's impossible to give a statistic regarding the risk of skin necrosis. The risk clearly is higher on the radiated side than the irradiated side. Skin necrosis following a properly performed facelift is very, very uncommon. I agree with the recommendation of Dr. Seckel to visit with your radiation oncologist. They will know the type of radiation you were treated with and the dose delivered to your skin. Regardless, you want to consult with a plastic surgeon familiar with head and neck radiation effects. Both of you should carefully consider the information and recommendations of your radiation oncologist before making a decision to move forward with surgery. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon