Does massage really help get rid of lumps? What else can I do? (Photo)

Question

I have lumps after a facelift with fat transfer performed 4 weeks ago. I know, I know, it's early. But I have a large lump on my cheek that makes me look deformed. I have to make public appearances! Is there any truth that massage will help them go away? My surgeon says she can liposuction them out, but I'm very fearful of the consequences of that. Not sure she has ever done it before.

John Michael Thomassen, MD · Answer

Sometimes these lumps represent fluid collections that can be aspirated with a small needle.  This can sometimes relieve the issue.  If not, you may consider a revision in the office to remove the offending tissue directly and correct the contour irregularity.

Mark Hamilton, MD · Answer

Thank you for sending images. So sorry to hear this has occurred. Some lumpiness is common for the first several weeks to months after a facelift. It is important to rule out that this is not fluid which can be drained off. If truly lumps from the healing process, massage, scar fading creams and time will help these resolve. Because this is so visible, utilizing injections would give a more immediate result. This includes injecting 5-F or steroids. I would recommend consulting with your surgeon to discuss your options, particularly in office injections.Hope that helps-

Afshin Parhiscar, MD · Answer

Dear dissolawyerI’m sorry you are having difficulties after your procedure. If your surgeon feels that enough time has gone by and is planning liposuction, I would bring up the option of off-label use of kybella. There is a high likelihood that much of the lumps will resorb without intervention. You also want to make sure it’s not small hematomas. Once the area is soft and your surgeon feels it’s fat and not other tissue, then can be dissolved with kybella. Early liposuction is likely to lead to secondary deformity, hematoma and unwanted asymmetry.  Be patient and follow your surgeons instructions .

Ben Lee, MD · Answer

I know that it's hard to believe, but yes, massage has a role to play in contour irregularities after facelift. The lymphatic drainage patterns are disturbed afterwards and need to be re-established. Manually helping the tissue fluid out of the area with massage can aid greatly in improving the post-operative swelling that you have, and there are massage therapists who specialize in postoperative massage. In any case, the facial tissues are very forgiving and any early abnormalities eventually improve. I know you do a lot of public appearances, but the timeline really is 6 months until full recovery, although most of that recovery occurs months before that.

John Mesa, MD · Answer

at 4 weeks post op, there is usually still significant swelling and asymmetries of the face in a percentage of the patients. The final results of a facelift won't be seen at least until 3 months post surgery. Patients with questions and concerns about their facelift  healing process should address those concerns with the surgeon that performed the operation, ideally during a follow up consultation.

Kanit Wittayavanichai, MD · Answer

Hello dissolawyer. There are several reasons of causing lumps. First, irregular skin plane dissection. Second, from liposuction while in facelift surgery. Next, fat injection but getting clot. Last, blood clotting inside or several reasons mixing. I suggest that you massage and wait for 3 months. If it’s still there, you may get small cannula liposuction. I hope this is helpful. / Dr.Kanit W. Thailand

Curtis Wong, MD · Answer

your surgeon knows what is causing it and is best equipped to help you smooth it out as much as possible.  Massaging certainly can help if its mostly fat but if its from the plication, it won't be as effective.  The injections suggested by others can help if swelling or excess fat... but if from the plication, it will not help with that.  So your surgeon really is best equipped to help you through this and provide the reassurances you need that your ending will be a happy one.  Your surgeon should also be sharing your desire for the best outcome possible so I would assume your surgeon would be providing you detailed instructions on what you can do to help expedite this process.

Babar Sultan, MD · Answer

When one separates the different layers of the face/neck, the initial healing response has some scarring which can result in lumps and bumps. Time, massage, and occasional steroid injections will help those resolve. It is important to rule out a fluid collection.

All the best!

All the best!

Jessica Kulak, MD · Answer

You are still early in your postoperative healing.  Some of the lumpy appearance will improve on its own over time as the tissue heals and swelling resolves. Message at this point in your recovery often will help smooth some of the irregularities. You should followup with your Plastic surgeon before you start anything that hasn't been recommended in your post op instructions.  Sometimes, steroid injections can soften firm lumps after surgery that are related to inflammation.  You should followup with your plastic surgeon for guidance and together you can decide if further intervention is needed down the line, but it is mostly likely too early in your recovery to make that determination.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos (at 4 weeks post op), the lumps may require some intervention.  Follow up with your facelift surgeon, hand held ultrasound can help.  The issue is with the unreliable nature of fat when used for facial shaping.  
 I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
  The more invasive type facelifts can have minor lumps and bumps for up to 12 months which is why the minimally, invasive face-lift has gained popularity due to it's limited dissection and rapid recovery.  Only so much can be done to decrease the bumps (massage, ultrasound and liposuction (if this is an isolated clump of injected fat), the rest will take time to resolve.
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Finally, the reality is that there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Board certification by "any" specific board alone is not an implied guarantee of results. I have been a board certified facial plastic surgeon with The American Board of Facial  Plastic and Reconstructive Surgery since 1993.  There are several boards that certify plastic and or cosmetic surgeons (summarized below):
The American Board of Facial Plastic and Reconstructive Surgery for facial plastic surgeons that specialize in plastic surgery of the face, head and neck area.
The American Board of Plastic Surgery for plastic surgeons performing plastic, reconstructive, (some also perform hand and back surgery).
The American Board of Cosmetic Surgery for cosmetic surgeons performing cosmetic surgery of the face and or body.
You can google each specific board to learn more about them and the specialty they represent.  
 In my experience and humble opinion, board certification by any board (and you can see that since there are at least 3 such certifying boards, no one board can "claim" ownership or superiority in Plastic Surgery..doing so is more "hype" and "marketing" than fact), so logically there must be some other way to find the surgeon that's "right" for you.
**Medical Boards of each state keep records of safety and or malpractice issues with all doctors, including any plastic & cometic surgeon.
**Avoid price as an initial determination of how your select your plastic and cosmetic surgeon.  If it sounds too good to be true it probably is.
**Do rely on reputation, experience and of course a "sound aesthetic judgement" on what will or will not make you more naturally attractive.
**Finally, always follow that little voice in your head that says this is the right place or perhaps you might want another opinion.
Hope this helps.

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