Why Did This Happen After my SMAS Facelift? (photo)

The most appropriate quote here imo is from Oscar Wilde's Importance of being Earnest

Lady Bracknell: To lose one parent, Mr. Worthing, may be regarded as a misfortune; to lose both looks like carelessness.

Sadly in this case I woulds substitute the word parent for Skin flap.

I am so sorry for your rare complication on both sides, one which I have never seen photos of before.

I agree with all other expert comments posted.

 

I am sorry that this happened to you since this is not expected. There is obvious compromise to the circulation of the skin. This can result from  compromised circulation in someone who either uses nicotine or has a disease like diabetes that is not well controlled. It  can also result from the technique of dissecting too superficially and too far anteriorly or from placing too much tension on the skin.  Pressure on the skin from a tight dressing or from bleeding underneath (hematoma) can also be a cause. In any case, it will need to heal from underneath which can take several weeks with meticulous wound care. You should follow up with your surgeon regularly until it is healed and then discuss what if anything will be beneficial to achieve an acceptable result. It can be difficult to be patient during this time.  Usually it appears worse for several weeks while it prepares itself to heal and then it progressively gets better.  Remarkably, in most cases the body eventually heals itself surprisingly well with proper care.

Than you  for your question and photos.  What these pictures shows is the face  skin is suffering by blood supply.  These condition is not only seen in the SMAS  face lift but in any technique.

It appears (based on the photos provided) that there is some skin loss on both cheeks. This can happen for a variety of reasons, including bleeding under the skin (hematoma), smoking, a thin skin flap, etc. This is a rare complication, and requires very close follow up to achieve the best long-term result. Healing will take time and will require supportive wound care.
Best,

Local wound care, hyperbaric oxygen, and time will help you get through this process. Scar treatments afterwards can help improve skin texture. Best, Dr. Karamanoukian