Though facial aging may be unavoidable, there are many products on the market promising to slow or reverse the signs of aging. Plastic surgery remains the time-honored method for alleviating the effects of aging and gravity on the skin. Drooping brows, excess skin and fat in the upper and lower eyelids and sagging necklines are sending aging baby boomers to plastic surgeons for cosmetic procedures such as facelifts. Though many patients are happy with the results, complications can sometimes be experienced after a facelift.
Hematoma
A hematoma is an area of bleeding under a closed incision. According to a September 2005 article published in “Dermatologic Surgery," expanding hematomas occur on average in about 2 to 4 percent of patients after facelift procedures. According to the author, Dr. J. Niamtu, there are no predictable ways to determine who will develop a hematoma after facelift though he does cite blood thinning medications, spikes in blood pressure, being male and post-surgical vomiting as possible contributing factors. If these hematomas are not cared for immediately, the expanding pressure they place on the incision can cause death, or necrosis, of the skin with resulting separation of the wound and subsequent scarring. If severe, the wound may need skin flaps in order to heal.
Facial Nerve Injury
The facial nerve is responsible for supplying, or innervating, the muscles that produce facial expression and provide facial sensation. Facial expressions are unique to each individual and nerve loss can be functionally and psychologically devastating. During a facelift, significant undermining or detaching of the facial skin from the muscle layers is performed. This allows the surgeon to “lift” the skin over the underlying musculature and remove the excess skin. The facial nerve anatomy is complicated, often variable and lies over the muscle layer. There are five branches of the facial nerve that control our facial movements and any one of these branches can be injured during surgery. It is also not unusual for patients to complain of facial numbness immediately after surgery. This numbness is usually temporary and will resolve with time.
Poor Healing
Poor healing of the skin can occur, particularly in smokers. Patients contemplating a facelift should stop smoking long before their surgery to allow the body to rid itself of the nicotine and chemicals that smoking leaves behind. Smoking has been shown to not only age the face prematurely but it can interfere with wound healing as well. The nicotine in cigarettes constricts blood vessels and the skin is deprived of vital nutrients and oxygen. Occasionally poor healing is the result of other types of problems such as arteriosclerosis, diabetes or steroid use.
References
- Expanding Hematoma in Facelift Surgery: literature review, case presentations, and caveats. Abstract. J. Niamtu. Dermatol Surg. 2005 Sep;31(9 Pt 1):1134-44
- “Sabiston Testbook of Surgery The Biological Basis of Modern Surgical Practice”. Courtney Townsend, MD and et al. 2008.
- UW Health.org: Smoking and Wound Healing
