Tightness in scalp and face/neck 12 month after facelift. What can I do?

Question

12 months after brow, face and neck lift, my scalp, sides of face and neck, is so tight a frozen feeling as if it is contracted under the skin, it feels worse as time goes by. My facial skin is not tight. Sometimes a heat sensation around bottom of ears of neck. I feel lightheaded and disorientated inside my head with these tight sensations that I try to cope with constantly. After 12 months I am at wits end and are very concerned, please, any feed back will be so greatly appreciated

Brock Ridenour, MD · Answer

I'm sorry to hear that you are having a difficult time. I would describe your condition as a form of dysesthesia. Dysesthesia is an unpleasant abnormal sensation that can be either spontaneous or provoked by touch. Dysesthesia following face lift surgery is quite rare but the symptoms are disturbing to the patient. The cause of the condition is not clear, but likely involves injury to small sensory nerves in susceptible individuals.  As a rule, it will get better with time. Massage, strategic injections with Kenalog/5FU, and small doses of medications such as amitriptyline or carbamazepine can be helpful. Since your symptoms are strongly linked to surgery, I doubt the likelihood of another cause such as MS or fibromyalgia. Also consider stretching, biofeedback and mindfulness exercises. I wish you the very best in your recovery. Dr. R.

Kenneth D. Steinsapir, MD · Answer

However, at some point, you need more help that just waiting for the face to feel better. A lot goes on with a facelift.  Responders are absolutely correct that for many, time is very helpful.  Then there are rare individuals with clinically problematic nerve discomfort. While it is still likely that over time, these sensations will get better, it is possible that your will benefit from treatment for what is basically a type of neuropathy. I recommend asking your plastic surgeon to refer you to a neurologist or pain management specialist for help with treatments to ease your current discomfort. Because you are likely to get better over time, it is also likely that you will only need medical treatment for a limited period of time.  Feel better.

Michael B. Lyons, MD, FAACS · Answer

The deep layers that were tightened during your procedure utilised sutures to pull and reposition the sagging superficial muscle and fat pads. These same sutures could well have incorporated small sensory nerves that would result in some of your complaints. 12-18 months after your surgery there should be some resolution of your symptoms. If they persist, I would encourage you to follow thru with some of the other recommendations: deep massage, labs to rule out collagen vascular disease namely Fibromyalgia, and return to your surgeon. 
If you can pinpoint an area of pain or discomfort, a trigger point injection may resolve some of the discomfort. This is usually a dilute amount of cortisone with local anaesthesia that will reduce the scar tissue around the small sensory nerve ending. The Massages will help with venous and lymphatic circulation. The possible need for medication such as neurontin or a similar drug that will alter the pain threshold. IF spasming seems to be occurring, you may benefit from a muscle relaxant. The botox recommendation would also help if there is a muscle group that continues to be triggering the discomfort. I hope this has helped.

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
Sensory alteration after face and necklift is not uncommon. The division of small cutaneous nerves during the procedure may deaden the area or give rise to abnormal sensations. 
Thick scars may result in a feeling of tightness which usually resolves within a year or so. As it is persisting, it may be wise to return to your surgeon for reevaluation and possible treatment.
I cannot explain the cause of your lightheadedness and disorientation. Is it secondary to your pain? It is a bit disconcerting. Your primary care physician should be made aware of this problem as it may be unrelated to the face / neck lift.
Best wishes...

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

Hi, I have performed many brow lifts, SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  The more invasive the procedure(s), the longer the recovery.  If you are concerned about things at this point, it would be best to discuss these issues with your surgeon as only he/she knows what was done, how invasive the procedure(s) were and the expected healing time associated with the surgery.  In my experience prolonged recovery is one of the reasons many facelift candidates are seeking minimally, invasive SMAS facelifts that offer a much more rapid healing time.  Perhaps your surgeon has some suggestions on how to minimize the sensations that your are describing.    The reality is, 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).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  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.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.4. Be certain that you choose a facelift procedure that allows you to resume your active lifestyle in a reasonable amount of time.  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
proper SMAS Imbrication technique
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.  Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Shaping cheeks that are flat or concave in the front (cheek augmentation) with precise placement of a dermal filler or by using silastic cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
Hope this helps.

Tightness in scalp and face/neck 12 month after facelift. What can I do?

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