Q. Why don’t doctors prophylactically prescribe a broad spectrum antibiotic like Keflex to all facelift patients to prevent infection in the incision areas? I’ve been reading reviews here and a common theme seems to be swollen, throbbing ears where the stitches are, as well as pus in those areas, even if the incision areas are cleaned daily. A. This is a great question. I would like to correct some of your misunderstandings. Myth 1: doctors don’t use prophylactic antibiotics for facelift. Generally, Plastic Surgeons do use antibiotics prophylactically with clean/sterile surgery. Currently, the standards for their use are changing due to the challenges in over usage of antibiotics creating super-infective bacteria. Antibiotics only kill a limited kind of bacteria, therefore, a general skin specific antibiotic like cefazolin is used once at the beginning of a surgical procedure to kill any skin surface bacteria that may enter under the defensive barrier of the skin when the incision is made. Other infectives include: mycobacteria, fungus and viruses which are not killed by antibiotics so we depend on the topical anti-infective (anti-septic) skin prep and post-operative cleansing. Myth 2: swollen, throbbing ears indicate infection Different sites of the body heal slightly differently. As compared to the eyelids for example, the back of the ear skin heals with a more robust inflammatory response creating a thickened scar. There may be many factors including increased tension on the incision, hair and oilier skin, nerves and diminished hygiene behind the ear but mostly, it is hypertrophic scarring and not infection; although the two are many times confused. Most patients are also unaware that the single line of a scar is only one dimension of the 3-dimensional scar surface created under the skin flap created by the surgeon to provide the patient with the virtues of a facelift. Antibiotics should be used when a progressive invasion of bacteria overwhelm the body’s natural defense and stopped when the balance of healing favors the host, ie. body. Myth 3: pus equals infection Pus is the slurry of debris made up of broken down cells, bacteria, suture, oil or fat which accumulates and not carried off to the lymphatic system for bodily removal. It comes to the surface for drainage reducing the energy required to get rid of it. If there is no progressive cellulitis, ie. bacterial invasion, then there is no active infection. Myth 4: antibiotics improve healing While antibiotic are extremely useful as one option to curb a progressive infection, it is only one part of a extremely dynamic, early and coordinated multi-step process in the 6 to 12 months or more of stable scar formation. I hope this has helped explain the use of antibiotics in face lift surgery and why it’s use is so limited. All the best! This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.