It's been a week since facelift. Is this necrosis? (Photo)

Question

Been a week since face lift. I was put back on antibiotics. What do you think is this Necrosis , or will I be ok?

Andres Bustillo, MD, FACS · Answer

I do not believe it is frank necrosis, but it does appear to be epidermolysis. If taken care of adequately, it should heal well. Necrosis is when there is full thickness skin death.

Thomas P. Sterry, MD · Answer

Based on the photo shown, I don't think we are looking at necrosis.  That said, I would say that the skin is struggling a little bit, but this kind of thing typically works itself out fine as time goes by.Necrosis is more typical at the wound edges and a week after the operation would probably look flat out black or even beige/green.  It is more typical behind the ears and usually heals very well.I wouldn't worry too much about it for now.  Just keep the antibiotic ointment on it (as it appears you are already doing).Good Luck!

Konstantin Vasyukevich, MD · Answer

Dear Christine,From the photo you've provided a patch of darker skin does not seem to be necrotic.  Minor skin ischemia is not uncommon after a facelift and in majority of cases goes away without leaving any visible skin marks.  Please follow closely your surgeon's wound care recommendations.   With good care you should expect the area to heal within the next 2-3 weeks.Best wishes!

P. Daniel Ward, MD · Answer

Dear Christine12001,I am sorry to hear and see that you are having some difficulty with healing. Based on the picture provided, I can't tell exactly what is going on, but it looks like there may be some degree of necrosis. Be sure to stay in close touch with your Surgeon as you get through this process.Thank you for your question, and please let us know if you have any other questions or concerns!Sincerely,Dr. P Daniel Ward

Christian G. Drehsen, MD · Answer

This could be indeed severe skin suffering with early ischemic changes. Tension relief, topical antibiotic cream and some blood thinning measures can help mitigate possible damages.Christian Drehsen, M.D.

Adam D. Stein, MD · Answer

There is definitely some epidermal lysis which comes from decreased blood supply to the skin.  If it were necrotic it would already have turned dark grey/black in color. Aggressive local would care with ointment or a biologic wound dressing like those used for burns would help the area heal up quicker and reduce any long term cosmetic issue.  Make sure your surgeon follows up with you frequently over the next few weeks to make sure things progress positively.  It will likely be ok when fully healed. Good luck.

John Michael Thomassen, MD · Answer

It does appear that your skin flap has been compromised.  However it may only be partial necrosis where only the superficial skin sloughs.  This will heal much quicker than full thickness necrosis.  Keep the area moist with antibioitic ointment and follow up closely with your plastic surgeon.  Also have him make sure no subcutaneous fluid collection or blood is present that may compromise healing.

Raymond E. Lee, MD · Answer

Thanks for sharing.  The skin looks more "stressed" than usual. The lifted skin needs to receive.  Follow up with your surgeon to make sure the skin is getting the best care it can.  ie. important not to smoke, proper wound care, etc. The skin in the face overall heals very well.  Even if there is to become any necrosis or just epidermolysis the end result with proper care is very good. Best of luck!

Dana Goldberg, MD · Answer

Your skin looks stressed but not yet necrotic. Stress can happen from tension on the skin edges, infection, tight compression, and illness that lowers blood oxygen levels or blood flow to the skin. It's important to see your doctor frequently and have a clear understanding of your restrictions and care to this area.  Areas of delayed healing can be discolored and firm temporarily or permanently after surgery. Sun avoidance, proper use of skin care products, and possibly laser treatments in a few months can help you get the best result possible. Good luck.

Parker A. Velargo, MD, FACS · Answer

This does not have the appearance of full blown necrosis yet, but the skin is definitely struggling.  The fact that it is not an eschar at one week is promising.  Keep in close follow up with your surgeon.  Skin necrosis is a known, but rare, complication of facelifting surgery.  Oral antibiotics, topical nifedipine ointment or nitrobid ointment to increase blood supply, oral trental, hyperbaric oxygen therapy, and local wound care are the mainstays of treatment.  Good luck moving forward!