Swelling Supraclavicular Area 7 Months Post- Lower Facelift

Question

I am 7 months postop lower facelift. I still have an area of soft, "puffiness" above each clavicle, but more pronounced over the left one. It tends to increase with activity during the day, and recedes at night. Is this a probable lymph drainage issue?

Raj S. Ambay, MD · Answer

It does sound like a lymph problem but is extremely uncommon. I have not had this issue before. You should visit with a plastic surgeon to do a formal physical exam.

Philip Young, MD · Answer

At this point you likely have around 80% of your healing. We usually tell people that they will have 60% of their healing / recovery complete by 6 weeks, 80-90% by 6 months. 100% can take as long as 2 years. This is based on wound healing studies and tensile breaking strength of a heal wound.

	What I have experienced based on doing more than 1200 face and neck lifts is that the swelling could be related to old fluid accumulation. The fluid tends to settle at the bottom of the neck lift which is right above the clavicles, only your surgeon would know what he did during surgery. This swelling can be improved with steroid injections, pressure dressings, taping etc.

Edwin Ishoo, MD · Answer

This is an unusual problem especially this far out from the procedure. It is too low to be a sialocele or saliva fluid collection. Given that the fullness appears to fluctuate with activity, it may be a pre-existing venous abnormality (e.g. high riding subclavian vessel, AVM, prominent thoracic duct) that has become more appearant after debulking or correcting the sagging of neck tissue. You do not describe any erythema, induration or tenderness which would suggest an inflammatory process. Does it pulsate? It is possible that this may be a Chyle fistula or lymphatic fluid collection but I would expect that it would continue to fill up and not return to normal in the intervening period. There is no substitue for hands on physical exam by your doctor. If I was concerned with a fluid collection or a vascular process, I would investigate with an imaging study and likely start with an Ultrasound. I strongly recommend you schedule a follow up visit with your surgeon.

Reginald Rice, MD, FACS · Answer

If you are a healthy person (no diabetes, or other systemic illness) this is unusual, especially this low in the neck. Yes, tissue fluid drains down and it could be simply lymph fluid that is still trying to find a new drainage pathway as invariably, surgery does disrupt some lymphatic channels. However, this many months out from surgery these changes should have resolved themselves, so go see your surgeon to have the area inspected/examined. It might help to take some photos of the areas when they are swollen and when they are not to help him/her identify the extent of the issues.

	Good luck!

Richard Galitz, MD, FACS (in memoriam) · Answer

Sounds like a Lymph drainage issue at this late date. Very unusual senario as I have been doing facelifts for 25 years and have never had this problem. You must see your surgeon and get the problem checked out, perhaps steroids will help....do not know.

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

This might be a lymphatic drainage issue but these should be resolving sometime around 6 months post op from a Face Lift and Neck Lift. You should have the plastic and cosmetic surgeon that did your Neck Lift give you further advice.

Swelling Supraclavicular Area 7 Months Post- Lower Facelift

Answers (6)

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