Lumpy tender swollen neck 3.5 months after Facelift and Neck Lift and Platysmaplasty (with hematoma)

My neck (under chin) is still an unsightly mess 3.5 months after surgery. When I had stitches removed at 12 days post-op and asked why my neck was so swollen, lumpy and painful, ps said it was "blood clots under the skin" (ie. hematoma) but that it didn't need treatment, other than "firm pressure massage" after 3 weeks. he said the clots would resolve/disperse on their own, and I had to be patient. He wouldn't give a timescale.Since then, with self-massage and warm compresses, the hard lumps have softened but neck is still lumpy, feels swollen (or is this the final result?) and sometimes tender. Sometimes the swelling feels firm, sometimes "flabby". I can't tell if there is some kind of fluid in there, or whether I will be left with this double-chin effect.I am not overweight, but had some loose chin under my chin and on my neck (I am 52).There is also a hard pea-sized lump in the centre of my neck, about an inch below the submental incision.The are looks worse than before surgery, and I feel like it's never going to look normal again.Can anyone give me any good news about when this might heal, or if it can be fixed if it ends up permanently disfigured?Thank you!

Doctor Answers 6

Unhappy with face lift result after hematoma

Thank you for asking about your face and neck lift surgery.

It is very hard to tell from a description as to what to expect.
To get a reliable answer, you might need a second opinion.
  • Fluid is unlikely to be present, but an ultrasound can make sure if you think there is.
  • Hematomas are such a problem - the blood makes the tissues hard and swollen.
  • Low dose steroids may help.
  • But it is also normal to have a slight fullness under the chin after a platysmaplasty - it swelling and it does go down on its own.
  • You have months of continuing improvement
  • But if you don't know if to trust your surgeon, consider a second opinion. 
Always see a Board Certified Plastic Surgeon
Hope you found this answer helpful. Best wishes.


Hello petaross, 

Thank you for your question.

Without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of any further treatments it is difficult to be comprehensive.

Hematoma formation can lead to extensive inflammation in the tissues which can lead to the findings you are describing.  

The firmness can be buildup of scar tissue and could be injected with steroids to improve and soften these areas in addition to the compress and massage you are doing.

I would followup with your surgeon or obtain a second opinion.

Best of luck, 

Dr. S

Scott Shadfar, MD
Edmond Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Treatment of Hematoma After Facelift

Bleeding in the form of hematoma sets off an inflammatory process that can lead to unpredictable contour irregularities and scarring of the skin.  Most of the time, visible or palpable blood clots should be removed quickly either by a return to the operating room or by forcing the blood clot out between sutures. Needle aspiration is another technique that can be used once the blood clot has liquefied. In this case, you surgeon judged that your bleeding was minor and did not require treatment. However, looking back with the benefit of hindsight it seems that your surgeon may have underestimated the significance of your bleeding.

The next stages of healing will likely take a number of months but you will get better!  The remaining bumps and lumps are scar tissue that must be broken down and then reorganized by your body. You may help this process along with things like massage, therapeutic ultrasound, and the occasional low strength steroid injection. Any squishy areas should be aspirated to check for liquefied blood or seroma. Hopefully you are continuing to see your surgeon on a regular basis in an effort to achieve the best possible outcome. If not, you might consider seeing someone in your area for a second opinion. I wish you the best and I am sorry that you are having a difficult time right now. 

Brock Ridenour, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 98 reviews

#Facelift - Lumpy after hematoma

I'm very sorry for the problems you're having.  In general, treatment of a hematoma depends on how extensive it is.  There is almost always a little bleeding into any surgical space so that is to be anticipated.  Larger hematomas should be drained; either with a return to the operating, the insertion of a drain, massage and evacuation through an incision, etc.  With the benefit of hindsight it is possilble that this hematoma should have been drained.  However, it it not always that clear at the time.

At this point, though, there really isn't much for you to do.  But the good news is that it will most liklely not stay like this.  It can take a long time - months and months - for all of te swelling to go down after a procedure and event like this.  The blood that is left behind can organize into scar tissue, in addition to the hoped-for process of liquefaction and subsequent absorption by the body.  Massage and ultrasound can help break up the lumps, but if any areas feel soft and squishy (not a medical term) it may be appropriate to have then aspirated to see if there is any liquefied blood in there.  If you have additional questions you can seek second opinions from surgeons near you to see if there are any other suggestions.

Agan, I'm sorry for the problem.  I hope this has helped, and good luck,

Dr. Alan Engler
Member of RealSelf100

Lumpy neck post-op

If you had a true hematoma it would usually be drained as soon as it occurs.  You may have had some deep smaller hematomas, which will eventually resorb.  Until they do they can produce lumps and an irregular appearance.  They may also cause some irregularities of the fat in the neck.  Warm compresses help.  I have also found that using some ultrasound to the nodules can help to soften and smooth out the area.  So you may want to ask your doctor if he has this sort of machine, and if not find someone who does.    

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Hematomas after a facelift should be surgically evacuated.

 Expectant treatment of the hematoma will prolong convalescence and possibly result in unwanted contour abnormalities. Any significant hematoma should be drained.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.