I am 2 weeks post face and neck lift. What can reduce under skin hardness? (Photo)

Question

No swelling but outer face and neck feel hard and thight, what can reduce under skin hardness? Also can I get a full body massage?

Francis Johns, MD · Answer

Thank you for your question.Lymphatic massage will help to decrease the hardness and promote healing. Make sure it is with someone who is certified in Lymphatic massages, so that they know what they are doing and do not do anything to hurt the surgical results.

Anil R. Shah, MD · Answer

As tissues heal, they may feel different than their final outcome.  Firmness around the tissue of a face and neck after a facelift is common for the first few weeks and typically resolves at around a month for most patients.  Best Dr. Anil Shah

Andrew Turk, MD, FACS · Answer

It is very common for firm or hard areas under the skin after 2 weeks undergoing a facelift. The healing process can take several weeks to months due to the lift of deeper facial  tissues resulting in the new shape of the face.In our practice, we commonly include facial lymphatic massages before and after the surgery. This helps lymphatic flow improve in the facial tissue to reduce swelling.  The timing of the facial  massages should be determined by your provider.I would not recommend a body massage until approved by your surgeon.

Evan Ransom, MD, FACS · Answer

Thank you for the question and your photos. Some firmness under the skin is normal after facelift, as the skin is still re-adhering and shrink-wrapping. However, if there are isolated firm or tender areas, these should be checked by your surgeon. It could represent a small hematoma that would need to be drained in order to avoid compromising your result. Take care and good luck!

Jeffrey M. Darrow, MD · Answer

The tightness you are feeling is due to a scar which is forming under your skin where your facelift/necklift was done.  This is normal, in that everyone forms this scar as the body heals, and the scar initially tightens for about the 1st month or 2 and then gradually relaxes over 1-2 months.  Nothing has to be done about this, it will self correct.  As every surgeon can have their own post operative protocol for returning to other activity, check with your surgeon about your body massage before proceeding.

Dean P. Kane, MD, FACS · Answer

Dear Ana M G:

Any time the tissues undergo an injury, like a cut (small injury or face and neck lift (larger injury), a cascade of events occurs heal the body.
The “scar” you see along the incision line follows the same healing progress as the tissues that were lifted under the skin. The same cells, proteins, blood vessels, nerves, and scaffolding are used in the repair of as they do under the skin. Scars become more stiff, thickened and irregular, ie. lumpy, swollen, bumpy than natural uninjured skin. Much of this is because it is collagen developing in a random alignment that is laid down rather than the basket weave pattern and stretchiness of natural dermis. This allows for strength but not elasticity.

Collagen is the thread that holds the a wound or incision together. It is not produced by the fibroblast for some 10-14 days after the cut was made. So, it is sutures and fibrin which glue, approximate and make waterproof the cut. As with the “ying and yang” balance of all body functions, so is it with collagen or scar formation. Changes over time occur. Production and break-down of collagen over 1-2 years yields the strongest, most flexible and thinnest final scar.

Most of the time, scar production peaks in thickness, lumpiness, swelling, redness and irregularity in 12 weeks (3 months) and has subsided by 6 months. Another 6 months or more of scar remodeling occurs to breakdown the thick, lumpy scar into a smooth, thin sheet or line scar we desire.

With this background it is understandable how each patient’s repair process is unique and will differ in quality. While surgeons desire a perfect scar and smoothness every time, scars are permanent reminders of the injury to the skin of a quality predestined and not overly influenced by surgical technique.

Consider massaging techniques to assist in remodeling your skin.

If you have any further questions, contact your surgeon.

Always consult with a well-qualified Board Certified Plastic Surgeon regarding your concerns.

I wish you all the best!

Inessa Fishman, MD · Answer

At 2 weeks after a facelift, there are a number of post-surgical changes are normal and expected.  Swelling (which usually manifests as hardness, shiny skin, lumpiness, etc) and early scar formation are expected post-surgical changes.  At 2 weeks post-operatively, about 80% of the maximal post-surgical swelling is resolved--with the remaining 20% swelling resolving slowly over the next 4-6+ months.  Discuss your concerns with your surgeon for a follow-up exam, reassurance, and possible additional care.  Time, steroid injections, lymphatic massage, external ultrasound therapy, and a variety of other adjuncts may be considered to aid healing.  Good luck in your recovery!

Darryl J. Blinski, MD · Answer

ONLY 2 weeks postop, so this could be the normal healing fir you? But only in person examinations could allow a determination if external or minimally invasive therapies are indicated. I might offer external ultrasound therapies or under skin PRF injections/red laser light treatments or both.

Robert E. Zaworski, MD (retired) · Answer

Check in with your surgeon regarding massage.  The hardness/ tightness is normal at 2 weeks post op as this is the scar forming.  Our bodies heal with scars.  It will take months for all the swelling to subside.  You can help with massage.

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