Why Has My Skin Sloughed Off 2 Weeks out from Facelift? (photo)

Question

What are the lines? Although it is healing over, the lines show up through the 'new' skin. 2 Weeks out from Facelift, my Skin Sloughed Off, Leaving the Underneath 'Dermis'?

Stephen Prendiville, MD · Answer

The photo shows epidermolysis, related to a restriction in blood flow. This area should heal well as long as appropriate measure are taken. As others have commented, smoking causes a much higher risk of skin loss after facelift and smoking cessation is essential. I would avoid any form of compression garment, or rough handling of the skin and see your Surgeon ASAP

Kenneth Hughes, MD · Answer

The skin slough appears to be superficial and healing should be uneventful.  Kenneth Hughes, MD Los Angeles, CA

J. Brian Boyd, MD · Answer

You have had a severe reduction in blood flow to your cheek skin following the facelift operation. At worst this can lead to total full thickness skin loss and severe scarring; but fortunately, in your case, it appears to be only a partial thickness injury and the skin should heal.

	The operation itself causes a temporary reduction in cutaneous blood flow, but this is magnified by smoking, diabetes and various technical factors. Most plastic surgeons refuse to operate on smokers and uncontrolled diabetics. Technical factors include making the skin flaps too thin and an unrecognized hematoma (bleeding) in the wound.

Dana Goldberg, MD · Answer

Your skin has had very superficial loss and will heal well. The lines represent wrinkles that were present before surgery. A facelift reduces winkles and folds in the skin but does not completely remove them. Additional techniques, like laser, peels, botox, or fillers can complement a facelift if wrinkles remain after surgery.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

This does not represent complete skin slough.  The skin may have been swollen and now that the swelling has decreased the skin is peeling or may represent a small decrease in the circulation in that area early in the healing process.  This of little consequence and healing fine.  I hope you enjoy the results of your facial rejuvenation.

	Dr. ES

Jamil Asaria, MD · Answer

During a facelift, the skin is elevated and thus, some of the blood supply is reduced. The facial skin generally has a very rich blood supply, and in most cases, it tolerates this very well. In certain cases this blood supply can be deficient and put stress on the skin. This can be due to patient factors (older patients, cardiac disease, smokers, etc.), or surgical factors (bleeding under the skin, pressure on the skin from bandages, overly tight closure). From your photograph, it appears that only the superficial layer of the skin is sloughing which should heal nicely with time. When the full-thickness of the skin is involved, it can be more serious.

Kenneth D. Steinsapir, MD · Answer

This superficial slough should heal nicely. It is related to circulatory compromise of the flap, an issue really with all facelift flaps to some degree. To facilitate epithelialization, the skin should be kept moist with Vasoline. Dry skin heals much slower than skin that is kept moist. Vasoline is petrolatum whipped with water. Some would also advocate hyperbaric oxygen treatment until the circulation to this area perks up.

Eric Egozi, MD · Answer

There are many reasons for skin slough after a facelift which include smoking, hematoma (collection of blood under skin), infection (less likely), etc. The lines are likely creases within the skin that are slightly more visible now that the skin is swollen. These should all settle down and your skin slough looks as if it should heal with time and proper wound care. Ask your surgeon how to best treat this from a wound care perspective.

Jeffrey Zwiren, MD · Answer

It seems that you have developed a superficial epidermal skin slough. This can be due to several factors including smoking, excessive tension or undermining of the blood supply. In any event it is the direct result of a decrease in blood supply to this area. If you smoke then stop immediately. Be very careful with this area, do not use any detergent based soaps and see your surgeon immediately for instructions on care. The last thing that you want to do in this situation is make it worse. With proper care it should heal without problems.

Darryl J. Blinski, MD · Answer

Yes but at this point as seen in your posted photo you have a superficial second degree loss. BUT you need care ASAP! Causes are smoking, tension on the closure, bleeding, diabetes, any restrictive event to the capillary flow in the sub dermal/dermal circulation. Before this becomes a full thickness skin slough or unfortunately it might be to late you need oxygen therapy, stop the smoking. Best to see your chosen surgeon ASAP!

Why Has My Skin Sloughed Off 2 Weeks out from Facelift? (photo)

Answers (14)

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