Skin Necrosis After a Facelift

Skin Necrosis and Facelifts

While you may experience many possible symptoms after a facelift, some are more severe than others. You should expect swelling and bruising after your facial procedure, but if you notice an abnormality on the skin’s surface or intense pain underneath the incision, consult your doctor right away. One of these rarities could be skin necrosis.

What is Skin Necrosis?

Skin necrosis occurs when there is not enough blood and oxygen flowing to a specific tissue region, causing that tissue to die. This condition is rare because there’s a two to three percent chance of skin necrosis after a facelift, but if you are a smoker or have protein C or S deficiency, your risk of skin necrosis is higher.

Skin necrosis is one of the most common complications after a facelift for smokers — one in ten smokers tend to get skin necrosis after a facial procedure. Nicotine interferes with the healing process and slows down the circulation of the blood to the wound. Patients with protein C or S deficiency are also at risk of developing skin necrosis because protein C interferes with the formation of blood clots — another key component to the healing process.

Skin necrosis typically develops during the first few weeks following the procedure. Once necrosis starts, it cannot be reversed. But, the earlier the diagnosis, the sooner you can take steps to prevent the necrosis from spreading. Skin necrosis can be caused by hematomas or seromas: collections or blood or fluid that form under the skin. These pockets put pressure on the blood vessels under the skin, and decrease circulation to the tissue. Hematomas and seromas can be treated, but if they are unaddressed for too long, they can cause skin necrosis. Talk to your doctor about how to identify hematomas and seromas in their early stages.

It’s important to choose a surgeon who is experienced and trustworthy. During a facial procedure, the skin can be separated from about 80% of its blood supply. If that skin has been detached for a long period of time, or if the skin is exposed to bacteria, necrosis can occur. Infections can stimulate swelling and tightness in the area, and cause skin necrosis. Avoid unnecessary risk by doing your research and choosing a surgeon you trust.

Symptoms of Skin Necrosis

Patients with skin necrosis tend to feel intense pain and very ill and have a rapid heart rate and low blood pressure. The affected area may look pale at first but will quickly become red and warm to the touch. Later, the skin becomes violet and will have fluid-filled blisters. With time, the blood circulation decreases, the skin turns black, the area dies, the nerves stop working and the affected area loses sensation, decreasing the patient’s pain. At this point, the skin may also start falling off.

If you sense early signs of skin necrosis, consult your doctor right away. A delay in diagnosis can worsen the condition.

Treatment for Skin Necrosis

Skin necrosis can be treated surgically and non-surgically. If you have been diagnosed with skin necrosis, your surgeon can cut away the dead skin, tissue or muscle with a scalpel, or you can be prescribed topical and oral antibiotics to help heal the tissue. Non-surgical methods are not as effective because the tissue removal can prevent the condition spreading to other areas.

In some cases, skin necrosis can be confined to a small area and can heal without serious consequences, but in other instances, it can lead to scarring. You may consider having a scar revision, like skin grafting, to smooth and lessen the appearance of the scar. You may also consider using topical scar healing products.

If you have an area of your face or neck that is affected by skin necrosis, you can conceal it with the use of makeup. BUT…the affected area should be properly healed before you apply makeup to the area.

How to Prevent Skin Necrosis

There are some steps you can take to prevent skin necrosis. If you are a smoker, you should quit smoking for two to three weeks prior to your facial surgery, and for two to three weeks following your procedure. You should also try to avoid second-hand smoke during this time period.

After your procedure, wear loose-fitting clothes — you don’t want any pressure on your head or neck! Refrain from any activity that will put pressure on your skin and interfere with your body’s circulation.

If you smoke, are a diabetic or have a protein C or S deficiency, be sure to let your surgeon know.

If you notice the signs of skin necrosis, prop yourself up with pillows and keep your head elevated. Avoid applying pressure to the affected area, and proceed to call your doctor immediately.

Bruising and swelling are normal after a facelift. Skin necrosis is rare but needs to be diagnosed and treated in person. Follow up with your surgeon or an experienced, board-certified facial plastic surgeon.

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