White mark on cheek 8 months after lower facelift- what it could be? (photos)

Question

I have a white mark on my cheek almost 8 months after lower facelift that the surgeon says is not sure what it is but could possibly be a pressure wound? Immediately after the surgery it was red and almost looked almost like a burn but over the months has turned white and looks like a scar although the surgeon says he did not make any cuts there. Any idea on what this could be? It is very hard to cover up with makeup and after exercising or any redness to my face makes it even more noticeable.

Derek Fletcher, MD · Answer

During facelifts, the layers of the face are often separated from each other to allow the surgeon to manage each layer independently. The first layer to be elevated is the skin, separating it from the superficial musculoaponeurotic system (SMAS). The skin must be separated as a flap with a thin layer of fat to ensure adequate blood supply and keep the skin healthy. If the skin/fat layer is dissected too thin, it can damage the blood supply to the skin and cause a scar. This is especially true if the method of dissection used to lift the skin/fat flap off the SMAS layer or to stop bleeding utilizes monopolar electrocautery. Monopolar electrocautery generates heat that can damage the dermis (undersurface of the skin), causing a burn from the inside out. It is hard to say for sure not knowing which surgical techniques were used during your operation. But, your description of the initial injury and the photos suggest this may be a possible explanation.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Dilip D. Madnani, MD, FACS · Answer

Its probably from an area that took longer to heal. This can be seen if there is some breakdown of the overlying skin so its loss of pigmentation over the area. One excellent  treatment for this is medical tattooing of the overlying skin to match the surrounding skin.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! Sorry that you're having trouble with your facelift outcome. The white mark is certainly unusual. It could be scarring and thinning of the skin from possible excessive tension in the area or suture underneath. Options would be massaging and possible nanofat to the area. Nanofat provides stem cells and growth factors which help the skin heal. Sometimes, Morpheus can help to soften the scar at the area but an evaluation first would be needed. A last result would be cutting the scar or area out but that certainly isn't ideal. Hope this helps!

Darryl J. Blinski, MD · Answer

Based on the posted photos you must have has a under dermal burn effect. This resulted in hypo pigmentation of the area. Not must to improve except some lasers (maybe but doubtful) or a light color matching tattooing.

White mark on cheek 8 months after lower facelift- what it could be? (photos)

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