Could you please describe in detail the healing process in the year following a face lift? Thank you.

I am confused about the healing process after having a face lift. Prior to surgery 4 mos. ago, my PS told me to expect swelling and tightness for a couple of weeks. That has been SO far from my experience. I am very uncomfortable, still completely numb, have enormous tightness & pulling sensations as well as intermittent throbbing, prickling/stinging. I was never told that healing can take a year or more. All my PS says is "everything is fine." I can't seem to get adequate patient education.

Doctor Answers 10

Wants advice on healing process

Thank you for your question about your face lift healing.

I am sorry your plastic surgeon has not been more helpful.
This is what I tell my patients to expect:
  1. First week - just get over the surgery
  2. Second and third weeks - everyone is depressed, face looks strange, is tight, numb, swollen, ears painful.
  3. Sixth week - things feel better, swelling subsides a bit, numbness and dysesthesias - strange feelings such as tingling - appear. Bending over causes facial discomfort because of persistent swelling. Tissues under chin may feel very hard and be visibly swollen.
  4. Sixth month - some swelling, numbness and strange feelings persist for many people.
  5. Sixth month to 18th month - swelling completely subsides, full feeling returns.
This varies. Some people heal faster and most people don't take as long as 18 months.

Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Tightness after facelift

I am sorry to hear that you are still uncomfortable four months after facelift surgery.  The sensation of tightness you describe is sometimes present early on after surgery, especially when the platysma muscle has been aggressively tightened or when long-term sutures are used to define the chin-neck angle. Most of the time, the sensation of tightness abates over time. If the feeling persists longer than a few months, it is possible that a band of scar tissue is responsible, or you are strongly "tuned-in" to sensations that others are able to ignore. I suggest that you talk to your doctor about stretching, massage or light physical therapy. These measures are often very help to diminish the sensation of tightness.

Numbness around the ears and under the chin is common after facelift surgery.  Sensory nerves are injured during the procedure leading to a temporary loss of sensation. A majority of patients have some degree of numbness for up to 3 months. Others may experience longer term numbness that will continue to improve up to a year or more after surgery. The funny sensations you are experiencing (prickling, tingling,etc) occur in a smaller subset of patients in my experience. They are thought to be nerves "waking up" after the procedure.

Brock Ridenour, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 118 reviews

Prolonged tightness and discomfort

if you are experiencing tightness and pulling sensation, it may be to overly tightened skin and muscle.  You may look great which is why your surgeon say everything is fine but it may not feel fine to you.  The good news is is that the human body is very flexible and elastic, and over time this tightness should relax.  Stretching exercises can help with that.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Recovery after a facelift

Everyone has a different postoperative experience after a facelift, but in general, a patient can expect the following:
*There are always some patients who heal differently. The following information is just a general overview.*
  • Bruising lasts for approximately 7 – 14 days; individuals with light complexion tend to have more bruising.
  • Initial swelling lasts for approximately 7 - 21 days; there is a significant amount of variability depending on the surgical techniques, the individual’s healing process, and the actual surgeries performed.
  • Secondary healing process typically begins after initial swelling resolves and may take up to 6 months for everything to finalize.
  • Ear numbness – everyone will have numbness of their ears for approximately 8 weeks. It is rare to have it longer than that but can happen in a small percentage of individuals. It is also rare to have shooting/throbbing pain past 8 weeks but can happen in a very small percentage of patients.
  • Feeling of tightness – fairly common in the first 6 – 8 weeks but will mostly subside after that in a majority of patients.
  • Smile or facial muscles weakness and asymmetry – common in the first 48 hours; if persists longer than 48 hours, let your physician know.
  • Back to work and normal social functions within approximately 10 – 14 days.
  • Ready for black tie functions/important events within approximately 4 weeks.
  • Return to exercise and full training typically after 3 weeks.
  • Pain – typically pain is limited with facelift procedures and most people need pain medications in the first 72 hours; thereafter extra strength Tylenol could be used. If you have excruciating pain, please call your surgeon.
  • Avoid the following for 2 weeks prior and 2 weeks after surgery – Asprin, Advil, non-steroidal pain medications, fish, herbal supplements, vitamins, smoking, all nicotine products, marijuana, illicit drugs
  • Use cold compresses in the first 72 hours after surgery (20 minutes per hour when awake) then switch to warm compresses (20 minutes, 3 times per day) thereafter over the areas of bruising.
  • Gently clean incisions with hydrogen peroxide once a day for the first 7 days.
  • Apply antibiotic ointment 3 times a day over all incisions.
  • All stitches will be removed in 6 – 8 days.
  • Wear head wrap garment as much as possible for the first week after surgery. If irritation occurs, remove the head wrap and call our office. It is important that you prevent the bandage from rolling up or wrinkling under your chin. Continue wearing head wrap as much as possible when at home and at night for 3 weeks after surgery.
  • Keep head elevated for at least 1 – 2 weeks following surgery. This includes while you sleep, rest or relax.
  • You may remove compression garment to shower starting 2 days after surgery.
Speak with your facelift surgeon about expectations for recovery, as some doctors vary in their guidelines for recovery based on their particular surgical techniques. 

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Sequence of healing after a facelift.

.Most facelift patients have little postoperative pain. A feeling of tightness particularly in the neck may last several weeks. Numbness of the face may last as long as six months to year before complete recovery. Your discomfort at four months is unexpected

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Tightness after facelift

There is four stages of healing process to a facelift. Stage one is post op first 1-7 days after surgery rest. Stage two 7-14 days out patient will start feeling better and will see progress, bruising and swelling is normal and part of the healing process. Stage three 15-30 days out patient is feeling better and recover incisions will start to improve. Stage four 30 days out patient will feel like they have approached the finish line

Edward E. Dickerson, IV, MD
Fayetteville Facial Plastic Surgeon
4.7 out of 5 stars 120 reviews

The healing process of a facelift

 It is important to remember that all people heal differently in a different timeline. Usually by 10 days, the patient should be able to put on makeup and go out into public. By four to six weeks, the patient will be healed, however, will still have tightness in the areas of the scar, numbness on the side of the face, and tightness under the chin. This tightness can persist up to a year. It is absolutely normal to have tingling and pain, in the side of the face. Some people do have scars that take longer to soften There is a percentage of people who will feel completely normal after four months, however, there are also a group of patients who will require a full 12 months before they feel completely normal.

Diana Breister-Ghosh, MD
San Diego Plastic Surgeon
4.6 out of 5 stars 14 reviews

Facelift Healing Process

Generally speaking, the healing process differs from patient to patient.  It is best to consult with your plastic surgeon or his/her clinical team to help you through your concerns.

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 120 reviews

Healing, Scarring, Facelifts

Dear Seajay:

The Nature and Timing of the Scarring Process
Any time the tissues undergo an injury, a cascade of events occurs to rid the body of dead or non-functional fibers, cells, particles and other changed material and redevelop a functional bodily defense. While the same cells, proteins, blood vessels, nerves, and scaffolding are used in the repair of skin as they are making skin, scars become more stiff, thickened and irregular than natural skin. Much of this is because it is collagen 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. It also misses the addition of oil glands which give scars a shiny rather than satin reflection and dry rather than moist texture. Scars typically have no pigment as no melanocytes are weaved into the collagen to tan or form color.

Collagen is the thread that holds the edges of a wound or incision together. It is not produced by the fibroblast for some 10-14 days after the incision or wound. So, it is sutures and fibrin which glue, approximate and make waterproof the cut. As is 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. Patients of color and other individuals of American Indian and Irish descent as well as particular body areas such as the triangle between the shoulder blades and xyphoid also have the propensity to develop thicker, ropier, redder scars for a prolonged time; called hypertrophic scarring. Occasionally, collagen production can so far outweigh collagen break-down that the injury develops a benign tumor which grows bigger than the cut itself. This is called a keloid.

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. Occasionally, the breakdown of scar is greater than the buildup quality and quantity of scar and only the epidermis and the very thinned dermis of a “stretch-mark-like” scar results called an atrophic scar.

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 every time, scars are permanent reminders of the injury to the skin of a quality predestined and not overly influenced by surgical technique.

You may read much more on wiki and the link below.

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

All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 82 reviews

Facelift postoperative period

What happens in the postoperative period of a facelift depends on many factors:
1. technique used (deep plane facelifts tend to have the longest recovery, mini facelifts the fastest)
2. adjunct techniques used (laser, liposuction, fat grafting, salivary gland removal)
3. individual healing variations
4. complications such as hematoma
5. additional areas of surgery (brow lift, eyelid surgery)

If you have an uncomplicated mini facelift , you could be back at work feeling very little pain or tightness at 10 days.  However, if you have a deep plane facelift with fat grafting, you could potentially have significant swelling for 3 to 6 months.  A SMAS facelift usually has swelling that goes away by one month.  It would be helpful for you to know exactly what type of facelift you had and what other adjunct techniques were used.  

There are also technologies like ultrasound and lymphatic massage that could help you get rid of residual swelling.  Go back to your plastic surgeon for continued follow up and discussion.  wish you the best of luck. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 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.