Why Do I Have Ridges on Cheeks After Facelift? (photo)

In general, the side effects of a facelift may include:

1) Swelling
2) Hematoma
3) Bruising
4) Irregularities

After 9 months, it is abnormal to have a bump on your cheek as shown in your photo. It appears to be edema or a pocket of fluid, and should be evaluated by your surgeon. I hope this helps, and I wish you the best of luck.

This is an unusual place to have a ridge after a facelift. It suggests thinness in front of the ridge (which could be from doing too much liposuction in the jowl area, find out if the surgeon did lipo there) or could be from too much fullness behind the ridge. Doctors don't add tissue/fullness there routinely, so it is possible that you had a fluid collection that has thickened up and created some scar. Also if the surgeon used purse string sutures it could bunch the tissue in this area.  I would expect it to improve somewhat over the next few months. Is it the same on the other side of just a problem on the right? If it is symmetric it would indicate something the surgeon did intentionally, even if it doesn't look right. If it is just on one side, it would indicate a complication such as a fluid collection.

Hello,

This is a good question – and I am sorry that you have to ask it.  Common irregularities after a facelift surgery would be resolved by your stage of healing. What is most important to your circumstance is the of facelift you have had performed and the fashion in which it was performed. When excellent pull is applied, but the slack is not taken up or removed the result can lead to bulging in regions that are unnatural. This type of result does not change unless a revision facelift is performed.

Be healthy and be well,

James M. Ridgway, MD, FACS

The cheek swelling you have appears to be fairly large. I would guess that this represents a seroma, or fluid collection, related to your surgery. Only an exam by your surgeon can confirm this. Its fairly typical to have some ridges and irregularity to the facial skin a few weeks after facelift surgery, but these issues smooth out with time. 

   If this is bilateral, this would be extremely unusual but would speak to something technical as a part of the surgery and less likely a random fluid collection or hematoma.  This does look like a parotid outline, but only a physical exam will help to explain the results in your case.  Kenneth Hughes, MD Los Angeles, CA

You should not have the ridges which show on the photograph at nine months post surgery. You need to see your surgeon to determine what the cause of this is whether it's due to  sutures or do to fluid collection.

It is not possible to determine for sure what is causing your contour abnormality based solely on the picture, but I suspect it's from internal sutures in your SMAS.  It could also be a collection, although this would be unusual 9 months post-op.

You should see the surgeon that performed your surgery.  Hopefully they can examine you and determine the exact cause.  It is unusual, for sure.

Best,

Although this photo provides limited information, my guess is that the fullness may be related to a procedure known as a MACS lift and the suture loop applied to fixate the SMAS.  In addition, there appears to be a hypertrophic scar on the left side of the limited photo. No doubt this is unusual. Only an examination will provide a more complete answer.

The photograph suggest there might be a fluid collection under the skin of the cheek. This should be brought to the attention of the surgeon. It might require evacuation.

 

Contour irregularities are not uncommon following facelifts. They can result from multiple causes:

 

·         Bleeding and hematoma formation. This is an early postop complication that usually occurs within the first 2 to 3 days following surgery and presents as a localized uniform swelling with severe bruising over the area. A hematoma needs to be quickly drained as it puts the adjacent skin at risk for necrosis and irreversible scarring.

 

·         Seroma. This is also an early postop complication but can occur up to 2 or 3 weeks following surgery. Caused by collection of extracellular tissue fluid, these should be drained during normal postoperative follow-ups. They can be prevented or limited by using compression dressings.

 

·         Sialocele. This is an uncommon event that can show up within a few weeks following surgery when the surgeon has dissected/resected the parotid salivary gland. It presents as a soft fluid-filled swelling and may persist for months. Usually resolve with time but often require multiple aspirations.

 

·         Tissue bunching or pleating. Usually appears within 3 to 4 weeks following surgery as swelling resolves. Results from not ensuring that the skin and or deep tissues are not properly released and smoothly redraped during the resuspension process of facelift surgery. These tend to improve over time, however, beyond a year or so will likely require revision surgery to fully correct.

 

·         Inadvertent scarring. This tends to appear late in the healing process. Difficult to correct.

 

In your situation 9 months following surgery, if the lump of tissue feels firm it is likely due to tissue bunching and will require revision. If it feels soft and fluid-filled it is likely a sialocele.

 

Mario J. Imola, MD, DDS, FRCSC.