Infected or allergy around incision after facelift? 3 weeks post-op. (Photos)

Question

Hi, I don't have a surgeon to ask in my country. My incision is incredibly itchy. Is this infected? I'm 20 days post operative after neck lift and face lift.

Brian K. Machida, MD, FACS · Answer

The redness is limited to your incisions so it might be due to a reaction to any ointment you are placing on the incisions. If you are using a neomycin containing topical ointment, that might be the cause. It’s best to see your doctor to have this checked.

Francis Johns, MD · Answer

Thank you for your question.The right side incision is healing a little slower and along the wound edge you have some eschar. The redness is confined to just the incision, which could be just a reaction to ointment that you are using. I would keep the area clean and dry, also avoid picking at the eschar on the would to decrease the chance of scarring.

Garrett Griffin, MD · Answer

These are good photos and I think that likely on your right side you have had a little epidermolysis or loss of the top layer of the skin which is why it is more dark/crusty on that side.  This can happen because the blood supply to the skin is very challenged during facelift and the edges furthest from the blood supply (where it is dark) can sometimes just not have enough blood supply and slough.  This creates extra redness because your body is trying to heal that area under the crusting.  This same process creates itching as well.  The good news is that even if the top layer of skin has died, it usually looks great in 3 months or so and in this location, your hair can hide it until then.  I think it is unlikely you have an infection or skin reaction.  I recommend you keep aquaphor ointment on the dark/scabby areas until they look like skin again.  Keeping it covered with ointment usually decreases the itching as well.

Mark Beaty, MD · Answer

Your photos show areas which have at least epidermalysis and possibly some mild skin necrosis.  This is manageable but needs to be seen by a physician and evaluated to determine best management.  An experienced plastic surgeon would be ideal but an evaluation by any physician for whether there is an infectious component is needed.

Charles Nduka, MD · Answer

Based on the photo, the incision does not seem to be infected. It might be due to an allergic reaction or local tissue necrosis due to compromised blood supply. Either way, it would be best to have this checked by your surgeon.

Gregory D. Roberts, MD · Answer

It is difficult to tell from these pictures, but it appears you may have two issues.  It appears that the dark areas could be scabbing from necrosis of the skin in those areas.  This should slowly heal over time.  To improve healing, these areas should be kept covered with ointment.  However, it appears you could have a second problem as evidenced by the red discoloration behind the ears.  This appears to be an allergic reaction to the ointment you have been putting on these areas for healing.  That could explain why these areas are itchy.  You should see a physician to give you an alternative ointment to put on these slow healing areas and make sure there is not an infection.  Also the scabbing areas may need to be debrided to help speed up healing.  Ask the physician about this too. Best wishes, Dr. Roberts

Carlos Gonzalez Legarda, MD · Answer

Even if not a plastic surgeon, other doctor can see you to answer you.By pictures you don't looks like an infection, you looks ok. But any case this is the kind of diagnosis we can't do without a personal valuation.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facelifts over the past 30 years.  These are rare events typically seen when the blood supply to the skin flap has been compromised.  The photos show areas behind the ear where the skin has sloughed.  The outer layers of the skin are damaged and are healing by secondary intent which can take several weeks to months.  This creates excess scarring in the skin that would explain the itching sensation.  These healing wounds should really be under the care of an experienced Facelift Surgeon and I'm certain that there are some in GB.  You should be followed by one of these surgeons to ensure proper healing and the best possible scar.  Hope this helps.

Robert E. Zaworski, MD (retired) · Answer

You may have an allergy to the ointment you are using.  Wash with hypoallergenic soap and let the area dry out.  I would stop any ointment at this time.   Contact your surgeon so he can monitor your progress.

Infected or allergy around incision after facelift? 3 weeks post-op. (Photos)

Answers (9)

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