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

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.

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.

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.

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. 

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.