Has anyone seen this type of infection after facelift? (Photo)

Question

I've been quite active on this site thoughout my facelift tecovery since having my surgery 12 weeks ago, but have yet to post. I've uploaded a picture from 4 days after surgery of an infection that developed and took weeks to heal. My question to the community is has anyone else had or seen this type of skin infection? I have not been able to find anyone. 12 weeks post it's healed, however has left behind a couple of raised scars. My PS is working hard to make sure that all looks great in this end.

Evan Ransom, MD, FACS · Answer

Thank you for the picture and your questions. It certainly looks like the skin flap is necrotic (meaning the skin has, at least partially, died). This can happen when the tissue blood supply is severely compromised. Reasons that this may occur include patient-related factors (e.g., smoking, diabetes, vascular disease, radiation exposure) and surgery-related factors (e.g., how the flap was raised, how much tension was placed on the closure). Necrotic tissue is much more prone to infection. With less blood flow, the immune system just can't get into the areas that need to be protected. The type of tissue damage that you show will require extensive medical care to heal. In some cases, hyperbaric oxygen treatments can be useful. Please stay in touch with your surgeon and seek second opinions locally if this relationship is strained. I wish you the best of luck moving forward. Take care.

Thomas A. Mustoe, MD, FACS · Answer

Infection after facelift is quite rare, due to the robust blood supply in the head and neck. When the blood supply is compromised, however, the resistance to infection is greatly diminished. The color of your skin looks consistent with compromised blood supply with a superimposed infection. However, cellulitis or erysipelas, which can very rarely arise, may increase metabolic demand and compromise a tenuous blood supply. I am glad you are on the mend and virtually healed. Your surgeon has obviously taken good care of your complication. Scars can be treated with steroid injections and other conservative measures. It is best to not consider surgical revision for up to a year, as it may very well be that the scars will improve to the point that no revision is necessary.

Jag Chana, MD, FRCS(Plast) · Answer

From the photograph this looks to be due to some loss of blood supply to the skin flap. There is some superficial sloughing of the skin which may be infected. There appears to be some venous congestion as well. This is very rare indeed. I have had some success using nitrate patches which helps with the venous congestion and can limit the vascular impairment to some degree. If you say this has now healed the residual scars simply need to be left to mature spontaneously but you should ask your plastic surgeon about the topical management of these scars.

Kenneth D. Steinsapir, MD · Answer

The photo you provided is at 4 days. You are not 12 weeks healed from your facelift. I think most of us would be curious to know what your current appearance is like. Unfortunately human beings can become infected after tissue trauma including surgery.  It is essentially unavoidable.  Some insults are much worse than others.  The remarkable thing is how well the face can heal despite these challenges.  This type of complication is rare after facelifting and I more commonly see this in diabetics and smokers.  Generally I have a very frank discussion about this possibility in association with these risk factors.  Often, I will advise against the facelift when there is the setting of chronic microvascular injury associated with long term smoking and advanced diabetes.

Parker A. Velargo, MD, FACS · Answer

I'm sorry that you had to go through a rougher healing period than normal. You did not just have an infection...you had skin necrosis of the facelift flap (perhaps you developed a superficial infection on top of it at some point). This can be caused from several factors and is a documented risk (though rare) of facelifting surgery.  Treatment in the short term includes wound care, topical and oral medications to increase blood flow, possibly hyperbaric oxygen, and antibacterial prophylaxis.  It sounds like your surgeon guided you through the recovery process, and that's great.  Your scars will continue to improve with time, and your doctor may want to help them along with a variety of scar treatments, including kenalog/ 5FU injections, silicone sheet scar treatment, or laser scar resurfacing.  Things should only get better from here. Good luck moving forward!

Mark Been, MD · Answer

It sounds like your surgeon is doing everything he or she can to optimize your recovery. I'm sorry that this has been your experience. Infections like yours following surgery are quite uncommon, but with diligent attention and enough time, even your scarring will improve.

P. Daniel Ward, MD · Answer

I am sorry that you went through that experience after your facelift. Infection after facelift is quite rare. I would do exactly what you are doing. Stay in touch with your plastic surgeon so that you can have a plan on how to address the issues related to the infection.

Romy Ahluwalia, MD · Answer

I’m glad to hear this is healing well, the skin flap at post op day 4 appears to be suffering vascular compromise, this may have led to an infection. Wound healing will continue to improve for the course of a year.

Jessica Kulak, MD · Answer

Based on your pictures and your history, you appeared to have suffered from skin flap necrosis and not an infection.  This is a rare complication that can occur following a facelift due to reduced blood supply to the skin which can cause part of the skin to die.  Usually patient factors such as smoking, diabetes, autoimmune disease, vascular diseases, etc..  increase the risk of this complication as the face typically has a very strong blood supply.

Michael Zenn, MD · Answer

This appears to be a primary problem of blood supply, and a secondary infection issue.  The face is an area where infections are rare due to great blood supply.   Blood brings in our immune system to fight infection.  When the skin was elevated, too much blood supply was sacrificed and although the skin survived, the dark color suggests poor blood supply.  This allows the normal bacteria on the skin to set up shop and establish infection since the guardians (immune cells) cannot respond as they need good blood supply to get there.
Glad to hear your PS is fixing you up!
Dr. Z

Has anyone seen this type of infection after facelift? (Photo)

Answers (15)

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