Dark, suspicious areas of skin following Facelift. Any suggestions? (photos)

11 days post op surgical facelift. (non-smoker) Skin is warm, hard and taught. Doctor appears unconcerned and says that there might be a little vascular compromise in the area but it will clear up on its own. No specifics on how long this would be. My questions are: is this a cause for concern? can I do anything to promote healing? is this a common occurrence? will it resolve untreated? if treatment is needed, what would be some recommendations? Will a scar be left?

Doctor Answers 31

Skin Loss Following Facelift

The changes to your skin are consistent with vascular compromise.  Such injuries can be partial thickness in nature (top layers of the skin only) or full thickness. Partial thickness injuries often heal with little or no scarring, while full thickness injuries usually lead to skin loss and scar formation. The darkest area at the top of the ear is of most concern because it may represent a more full thickness injury.  However, there is no immediate course of action needed at this time. Topical and oral medications to improve blood flow are of uncertain value in these situations and it is beyond the timeline for them to be effective.  I would consider taking a daily aspirin and keeping the compromised skin covered with ointment to minimize trans-epidermal water loss. Treatment is variable and can include a period of wound healing,  injections with steroids and/or 5FU, pulse dye laser, fractional resurfacing lasers and revision surgery.  I would keep in close contact with my surgeon so that you can act to minimize the injury and to achieve the most favorable outcome. 

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 98 reviews

Skin Loss Following Facelift

This is vascular compromise.  The only thing I recommend is keeping the area well hydrated with an antibiotic ointment such as polysporin.   There will some layers that slough off and new skin will grow to heal the wound.  Stay away from any type of smoke as this can make the problem worse.   Best of luck.

Dark areas

I am sorry that you are experiencing this.  But, the only thing to do at this time is to wait.  Please avoid smokers or any type of nicotine products and follow your doctor's instructions at this time.  This may take 4-6 weeks to heal.  Try to be patient and maintain close communication with your surgeon.  Best wishes.

Jules Walters, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 45 reviews

Concerned about healing after face lift

Thank you for asking about your face lift healing.

  • I am sorry this has happened -
  • It is of concern but things will heal better if left alone.
  • If you smoke or are exposed to smoke, it is important to stop smoking and avoid smoke.
  • It may take a month or more for the skin to heal - 
  • It is likely to leave a less appealing scar but surprising these often end up much much better than expected.
  • The only treatment for now is waiting and protecting the skin.
  • It is often helpful to see your surgeon frequently, for support and monitoring of your healing.
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes

Waiting is the right thing at this time

Your doctor's observation and recommendation is absolutely right. You have compromised circulation in your facial skin. What happens next is hard to predict at this time. Sometimes it will all clear up. Other times skin will die and leave behind a visible scar. Watchful waiting is the only thing to do at this time.   

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

Skin slough after a facelift

This is a known complication after a facelift.  Make sure you're plastic surgeon is following you closely with would care to help with best results.

Skin compromise

Thank you for your question.  It does appear that you have an area of skin compromise.  Its a little too early to know if the black area is full or partial thickness compromise.  I would follow closely along with your surgeon.  Generally these heal by themselves as the body removes the dead skin and heals in.  Stay away from any nicotine, and touch base with your surgeon for any concerns.  All the best, 

Keshav Magge, MD
Bethesda Plastic Surgeon
5.0 out of 5 stars 27 reviews

Complication of facelift

Yes, it appears that there is some vascular compromise of the flap.  This does occasionally happen - even to good surgeons using careful techniques.  It's more common in smokers, diabetics, and certain medical conditions.
At this stage, careful management of the wound is the best plan.  Don't rush to surgery - let the tissues slowly recover.  Part of the skin may die, leaving an open area.  Fortunately, it will gradually heal in - and usually this leaves a much better scar than if you tried something now.

Ask your surgeon about the types of dressings to use for this.  See your surgeon frequently for management of this issue.

All the best,

Dark, suspicious areas of skin following Facelift. Any suggestions?

Hello prylett,
Thanks for your question.
That definitely is some amount of vascular compromise.  There are areas of the skin that did not have enough blood supply after being lifted to tolerate it.  This is certainly more common in smokers, which doesn't describe you.  I have seen in in situations where patients fell asleep with ice packs on the face in close contact with the skin cause frostbite.  I have even seen it in patients who took those blue gel packs and heated them in the microwave oven, placed them on the skin, and gave themselves a thermal burn.  This can even happen if a facelift wrap is placed too tightly and constricts blood flow.
Wound healing takes time but there are things you can do to help.  This is not a common situation but does happen.
A high protein diet, Vitamin C supplementation, and use of Silvadene SSD cream on the affected skin can promote healing.
Unfortunately, you will have a certain amount of scarring and discoloration to the area once new skin forms. Laser treatments, IPL, and scar revision may be necessary to improve the situation.
Work closely with your plastic surgeon and if you are not comfortable with their care, I recommend you seek a second opinion.  
Good luck,
Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Pending skin loss.

 Thank you for your picture. In my opinion, this is concerning.   You will most likely have skin loss  that will require wound care and healing. This will eventually heal in a scar that may need revision if possible. 

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.