3 months since my facelift. Do I have to wait for a revision? (Photos)

Question

I posted photos 6 weeks ago. Expected that I would see improvement with time. Now at the 3 month mark with no improvement. Dents, ridges,and swelling/ripples, my L side. It feels firm and spongy. I .posted photos to my PS who is OS who advises to wait 6 months. Any idea what could be causing this ( early on I had a seroma which was drained ) and why there has been no improvement? Do I need to wait or can I get it fixed now? I have been having red LED Therapy. Any input greatly appreciated.

Brian K. Machida, MD, FACS · Answer

After any type of seroma, healing and results are always delayed.  Early revision before 6-9 months will likely not improve your result.  Be patient and follow with your original surgeon.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  I am sorry to hear about this.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, you are still swollen.  You may benefit from a revision in the future.  I would recommend waiting for the 6-month post-op mark prior to a revision.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Kenneth D. Steinsapir, MD · Answer

First, letting the face heal as much as possible is very helpful.  That is not to say that all the issues will settle down in that time frame.  Seroma and hematomas can interfere with the out come of facelift.  However, I also question the design of this facelift.  The red LED is not doing anything-sorry, so you can stop this.  I would encourage you to see other opinions when it comes to revision the face.  While your original surgeon would normally be the most motivated to fix your result, that assumes they have the knowledge, skill, and experience to accomplish this.  I wonder.

Damien Grinsell, MBBS, FRACS (Plast) · Answer

Hi.  Your results are certainly not normal at the 3 months mark as you have correctly pointed out.  Re-operating on a facelift is not to be taken lightly and I would definitely wait until the 6 month mark.  Without examining you it is difficult to say what the cause of your asymmetry is however if it hasn't settled at all in 3 months then it is likely to need revision.CheersDamien

Michael J. Rodriguez, MD, FAACS · Answer

Thank you for sharing your photos and thank you for your question. I am sorry you are experiencing a delay in healing. Any time there is a seroma involved, healing and results always take a while longer. I personally do not do any revisions until about 6 to 9 months after the original surgical date. Follow up with your original surgeon and try and be a bit patient, as difficult as that may seem.

William Portuese, MD · Answer

It's best to wait at least six months to a year to allow full healing to occur before and undergoing another facelift procedure. The seroma itself will cause extended swelling and edema and contraction forces of healing in the interim.

Wayne F. Larrabee, MD · Answer

It is really difficult to wait for healing but that is the best course. Likely the seroma caused scar tissue under the skin. Scar tissue heals with contracture and may actually have muscle like cells in it (myofibroblasts). By 6 months from the time of surgery the scar tissue should be somewhat resolved so a safe and effective revision can be performed.  In the meantime massage and perhaps some diluted steroid injections might help.  It would take an exam to determine this. Occasionally therapeutic ultrasound is also useful. It is likely you can have an excellent outcome with patience and a revision.

Lavinia K. Chong, MD · Answer

Thanks for pics and question.  A seroma is an abnormally large collection of fluid, under a flap, which has been "undermined" or lifted off its original blood supply.  If it was drained percutaneously, (serial aspiration = sticking a needle through skin and drawing off excess fluid), the overlying skin may redrape in an unpredictable manner, causing pleats, folds and pseudobursae (doughy areas).  Your operating surgeon is best qualified to discuss the timing for revision, however as a general rule, I would recommend waiting a minimum of 6-9 months, post-op, as a matter of safety.  Re-elevating a scarred cheek flap is facilitated by interim wound healing and scar softening.  Good luck.

Rajat Gupta, MD, MS, DNB - Account Suspended · Answer

I would appreciate that if you can wait.
There are certain things like tissue unevenness which I am not very happy to
see and at 3 months they should have improved. But I still advice you to wait
before going for anything. DO consult your own plastic surgeon who has operated
you and I am sure he will be able to answer your question much better.

3 months since my facelift. Do I have to wait for a revision? (Photos)

Answers (9)