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After a facelift and fat grafting of my neck, I’m still black and blue. When will this go away?

Dr. Dean Kane Q & A. Still black and blue after a facelift and fat grafting?

Q. A lot of the black and blues have gone away but I still have some on my left cheek and some swelling. I am worried why there are some black and blue marks. Will they go away?

A. This is a universal concern and very reasonable question for all patients to understand.

There is a dynamic and similar course of healing everyone goes through following surgery or an injury.

Physiologically, any incision or puncture of the skin will cause bleeding and bruising. The length of the incision and amount of lift or undermining determine the magnitude of the healing to occur. More surgery means more bruising, swelling and potential side-effects or complications but the healing time is similar and that is because the “army” of healing cells and scar formation is the same for any injury.
Please anticipate:

  1. Swelling and bruising for 10 days to 3 weeks
  2. Potential bleeding complications and incision concerns during the first 3 weeks
  3. Under the skin firming, lumpiness and irregularity during the first 3 months

I separate 2 levels of activity for my patients.

  1. ADL: activities of daily living; what you need to get by with daily rituals such as hygiene, breathing exercises and mobility. No stooping or bending and no lifting over 2 pounds as any increased activites may generate more swelling or bleeding. ADL’s for the first 3 weeks.
  2. Exertion: starting to do more than what is required such as exercise, sex or pulling and lifting suitcases. After 3 weeks.

In general, I have found scar formation and tightening to the point of restrictive movement and some skin irregularities for the first 3 months.
Different and changing levels of massage as the healing process progresses such as:
1. Gentle pressure
2. Gentle lymphatic or “squeege” motion
3. Firmer lymphatic or “squeege” motion
4. “Rock and roll” or firm deep massage for lumps

Emotionally, patients go through a “roller coaster” of concerns and presentations. You can expect:

  • 1-5 days: initial surprise: “I didn’t expect this”
  • 1-3 weeks: concern and a feeling of “did I do the right thing”
  • 2-4 weeks: worry: “when is this swelling, bruising going to go away”
  • 4-12 weeks: more worry: “why am I forming lumps and irregularities”
  • 2-4 months: depression: “I have to look socially acceptable and I look deformed”
  • 3-4 months: sunlight: “it’s getting better”
  • 6 months: elation: “wow, I look good”
  • 9-12 months: super-elation: “wow, I look hot!”
  • 3-10 years: eventual disappointment: “where did it all go?”

Each patient and each physician interpret their changes and findings differently.

Return to your treating physician and discuss what is best for you.
All the best!

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