Contributing Factors of Extended Swelling after a Facelift

Author: Amiya Prasad, M.D.

Thank you for your question. You're about 13 weeks after your face lifting surgery. And you state in your question that you just completed a course of using the Medrol dose pack which is an anti-inflammatory, in the steroid family, to reduce some swelling. And you're concerned about the persistence of swelling as well as some difficulty with chewing and the roundness of your face after the surgery. So I can certainly give you some guidance as to how we address issues such as yours in our practice.

A little bit of background, I'm a board certified cosmetic surgeon and fellowship trained oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years. And facelifts and neck lifts are a big part of what I do in my practice. So I can certainly tell you from my experience how we deal with issues such as yours. Well first of all I would advise you that it is good to seek additional opinions.

But chances are, when you chose your surgeon, you were aware that the surgeon is an experienced surgeon and is a right – was the right choice for you in terms of having the surgery done. Which means that it’s – I think it’s a little early to abandon hope and think that the surgeon is missing anything. And that being said, when you talk about surgery, you also talk about the level of surgery and the degree of swelling that is appropriate for a certain amount of surgery. When I was in training in facial plastic surgery, it was almost routine for our facelift patients to be very swollen for over a month. And my preceptor used to put multiple drains and to – and [pick?] [0:02:25] up patients overnight and we would go the following day to pull these drains and to change dressings. Now move the clock forward and in my practice, we actually don’t use drains and we let people go home.

And we have a very good track record of getting people to recover very quickly. And with doing exactly the same type of surgery but with a different approach. In your situation, I would consider the possibility that because of the natural thickness of your skin, your face looks a little bit red. I wonder if you have any history of Rosacea that may be your skin has such a little bit of tendency towards a little bit of inflammation. And I – definitely in my experience people who have this type of thicker skin and reddish skin, they have the tendency to swell a little bit longer. And even though it’s – it may not be that significant from a medical perspective, it’s significant for you.

Contributing Factors of Extended Swelling after a Facelift

The follow up questions would be is like, how did your swelling improve with the Medrol dose pack? You know, this is about management. In surgery, in face lifting surgery, one of the things that we were concerned about immediately after surgery typically is hematoma. But just with your photos, it doesn’t seem likely. There is also something called the seroma which is – basically what’s something called serosanguineous fluid, a straw-colored fluid that collects in this space that does have to be drained in order to allow the skin to heal.

So that’s – you know, that maybe amongst the possibilities. But in the absence of my – of anybody doing a physical exam, it doesn’t make sense to say that would be likely the cause. It seems more likely that based on your surgeon’s management that you're just having a little bit of prolonged swelling. And it’s maybe now just the inflammatory but it’s just could be a matter of fluid getting absorbed over the course of time. So I think that as long as you have a good continuous follow up with your surgeon, and since you know and trust this surgeon, I would say that any other opinion you're getting maybe just more confusing than being helpful.

Again, a competent experienced surgeon will know the basics of management of prolonged swelling after face lifting surgery. And again, at 13 weeks, depending on the type of surgery and the anesthesia and others, other factors, this may not be that unusual for your surgeon to deal with. So the bottom line is there’s a lot of customization. And certainly if you wanted to mention your surgeon the possibility of a seroma or sometimes if there is some trauma to the parotid gland, there’s something called the sialocele which is basically the parotid gland – the gland that produces saliva producing saliva in a way that’s collecting in the cheek. But I would still think that’s not that likely looking at the photos that you have. But again, this is a question that it’s really more to be directed to your surgeon. So the questions to ask, is this seroma or sialocele.

And if your surgeon says no, it’s not, then chances are your surgeon is correct because your surgeon knows your face and was there for your surgery, and has been there for your follow up. So no one should know it better. If for any reason you don’t feel comfortable with your surgeon, your surgeon turns out not to be so connected to you, then of course you need to see other doctors to clarify this. So in the meantime, continue following up with your surgeon. Hopefully the information I provide you was helpful. So I wish you the best of luck.

Thank you for your question.

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