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

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. 

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.    

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

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

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 EnglerMember of RealSelf100