Feeling tight and uncomfortable 1yr post facelift

Question

I had a SMAS facelift almostexactly one year ago. I still have the sensation that my ears are being pulled down from the inside. I feel extreme discomfort and tightness along my jawline, under my chin and around the ears. I have brought this up with my surgeon and he claims to have no idea what this might be and offered to refer me to a pain clinic. Can someone please explain to me what may have caused this and what, if any, imaging or scan can be done to prove that damage was done? I seriously feel like I have been in chronic pain for the past year. I feel this tightness and pain every single moment of every day and I’m worried that this is irreversible and that the surgeon did irreparable harm. Please help!

Fas Arshad, MBChB, MRCS, FRCS · Answer

I'm truly sorry to hear about the persistent discomfort you're experiencing—it’s absolutely valid to feel concerned, especially after living with these symptoms for a year. Your situation deserves to be taken seriously.

A SMAS facelift involves lifting both the skin and the deeper muscular layer (the superficial musculoaponeurotic system). During this process, small sensory nerves in the face and around the ears can be stretched, repositioned, or even transected. In most patients, these nerves regenerate gradually over time, and any tightness or altered sensation typically improves within a few months.

However, in a minority of cases, prolonged tightness, pulling sensations, or neuropathic pain may persist. This can feel like burning, hypersensitivity, or a deep pulling or tugging—as you’ve described. For some, the discomfort becomes chronic and significantly impacts daily life.

Given that your symptoms have lasted a full year with no improvement, it would be appropriate to explore further evaluation. Here are some steps to consider:

Referral to a neurologist or pain specialist: They can assess whether your symptoms are consistent with neuropathic pain, and may recommend treatments that specifically target nerve-related discomfort.

Imaging: While standard imaging like MRI or ultrasound is unlikely to show "nerve damage" clearly in this context, a neurologist might recommend a nerve conduction study or refer you to a facial pain clinic where more specialised diagnostics can be done. These won’t always yield definitive answers but can help rule out other causes.

Scar tissue or fibrosis: In some cases, persistent tightness may be due to internal scar formation (fibrosis) in deeper tissue planes. A consultation with an experienced facial plastic surgeon—especially one skilled in revision facelifts—could help assess this possibility.

Though it’s disheartening to hear your original surgeon couldn’t offer further insight, don’t lose hope. There are avenues to explore, and patients with similar experiences have often found relief through multidisciplinary care.

You deserve to feel heard, understood, and supported—and to work with specialists who take the time to investigate your symptoms with care.

Semih Yildiz, MD, FEPOBRAS · Answer

Persistent daily tightness and pain one year after a SMAS facelift is not something to dismiss, but it also cannot be diagnosed accurately from the description alone. Possible causes can include scar tethering, nerve irritation or neuropathic pain, muscle or fascial tightness, salivary gland or lymphatic irritation, TMJ/neck-related pain, or less commonly a localized collection, suture issue, or neuroma. A careful in-person exam is more useful than trying to prove damage with one scan.

A pain clinic referral can be appropriate if this has become chronic pain, but I would also consider an in-person second opinion with a board-certified plastic surgeon or facial plastic surgeon who performs revision facelift work. Imaging such as ultrasound, MRI, or CT is usually chosen based on exam findings; it may help look for a mass, fluid collection, gland problem, or structural issue, but it often cannot prove whether tissues were pulled too tightly or a nerve was irritated. If you have progressive weakness, new facial drooping, severe worsening pain, redness, swelling, drainage, fever, or trouble swallowing or breathing, seek prompt medical care.

Stefan Mark Szczerba, MD · Answer

Not sure what is causing that however some surgeons use permanent sutures- I personally do not.   Review the operative report with your surgeon to see if that could be the cause.  For treatment, consider subcision and discontinous undermining with blunt instrumentation over the right areas.  The "sliding browlift" uses this technique for a forehead lift technique that loosens the skin from the underlying muscle.  Best Wishes with this issue.

Matthew Tamplen, MD · Answer

Hi,I am so sorry you are dealing with this. I have heard of this sensation from a few patients. The entire goal of a facelift is to lift and pull some of the deeper tissues and muscles tighter. This is especially true around your ears. 100% of my patients complain of a tight feeling after surgery that usually subsides in a few months. Rarely patients have complained about a similar tight feeling at 1 year after surgery. I have injected some botox in the tight areas to release some muscle tension and this had worked very well. Also massaging the area can be very helpful. I don't think any irreparable harm has been done and I would try these treatments. Time will also help. 
Wish you the best,Matthew Tamplen MD

Ali Cetinkaya, MD · Answer

Hello,
First of all, I understand that you are going through a difficult time due to the discomfort and persistent pain you have been experiencing. After a SMAS facelift, some patients may feel tightness and discomfort, especially in the early healing stages. However, if these symptoms persist for a year, further evaluation is necessary.
Possible Causes:Nerve Sensitivity or Damage:
The nerves may have been affected during surgery, leading to prolonged discomfort.Some patients experience nerve irritation or compression, which can cause persistent tension and pain.Tissue Tightness and Scarring:
Scar tissue formation and fibrosis can lead to a feeling of tightness or pulling in the skin.If the SMAS layer was tightened excessively, it could result in prolonged discomfort.Lymphatic Drainage Issues:
Changes in lymph circulation after surgery may cause swelling, tightness, and discomfort in the affected areas.Muscle or Fascia Tension:
Since the SMAS facelift involves repositioning the facial muscles and fascia, excessive tension can sometimes persist.What Can Be Done?✔ Imaging Tests: MRI or ultrasound can provide insights into the condition of soft tissues and nerves. If nerve damage is suspected, an EMG (electromyography) test may also be helpful.✔ Alternative Treatment Options: If the issue is nerve-related, nerve block treatments, physical therapy, or botulinum toxin injections may provide relief.✔ Consult Another Specialist: Seeking a second opinion from a plastic surgeon or neurologist can help determine the cause and possible solutions.
I understand how challenging this situation is, and I believe your pain should be taken seriously. I recommend consulting with a specialist for a detailed evaluation and treatment plan.
Wishing you a smooth recovery.

Jeffrey H. Spiegel, MD · Answer

It's hard to answer without pictures or seeing you in some way. I'd consider a steroid injection into the tight areas to loosen tight scars.

Feeling tight and uncomfortable 1yr post facelift

Answers (6)

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