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

    Flap compromise after facelift happens very infrequently.  If the patient is a nonsmoker and there is no hematoma, this may never happen.  If a hematoma is present, it should be drained expeditiously.  If tension on the flap is suspected the sutures should be released.  If everything has been managed and there are no signs of infection, conservative management is the best option.  The flaps should be allowed to heal.  Scar revision may be necessary in the future.

As others have mentioned, the blood supply to your skin (subdermal plexus) was compromised by any of a number of possible factors.  If you smoke or have a history of smoking, then the delicate microcirculation that supplies blood to your skin could have been impaired.  Raising a skin flap in a plane that is too thin, aggressively dissecting too large a flap, excess tension on the wound, excessive compression from dressings, untreated hematoma, etc. can all lead to vascular compromise and skin flap necrosis.  

Some treatment options to consider with your surgeon:  hyperbaric oxygen, Trental (medication to improve bloodflow), and Santyl ointment (to help the necrotic areas heal more quickly).  

Thank you for your question and photographs.  I am sorry that your are having complications after your facelift.  It appears that you are suffering from poor blood flow to the skin flaps in front of your ears.  This is the skin that has been elevated and moved forward.  

There are several reasons that this could be happening:  1) smoking, 2) skin flaps that are too thin, 3) bleeding under the flaps (hematoma), 4) excessive skin removal, 5) or skin closure under too much tension (tightness).  

If there is a hematoma under the skin flaps, this should be addressed quickly.  Topical nitroglycerin may be an option to help minimize the area of tissue that undergoes necrosis (death of skin tissue).  I would not recommend removal of the dead tissue until the full extent is known.  Topical antibiotic ointment can be used to help encourage the dead skin cells to slough off. You may need a skin graft if you have a large open wound or the body may heal itself with scar tissue.  This scar can be revised at a later time to improve the appearance.  Frequent follow up with your board certified plastic surgeon is essential to help maximize the aesthetic outcome. 

I am sorry for your unfortunate result.  It appears that you at least had a hematoma that may have contributed to skin loss (dark area).  There are many more reasons for skin loss including smoking, Skin that is sewn too tight, and skin too thin would be some examples.  The best treatment now would be to allow the area to heal and debride any unhealthy skin.  The area can be revised or grafted if needed.

 

Dr. ES

There are many reasons for this rare occurrence. Not having been there I cannot honestly say what caused this.  For more than 35 years of facelifting fortunately I have never had this complication. 

The blood supply to the dark areas of skin is less than what is needed for the skin. Frequent follow up with your surgeon is needed. Polysporin ointment over the dark areas and no surgery for at least a year. This will look worse before it gets better and then will get much better