Face and Neck Lift Article 8
Facelift Complications Continued
Infection in plastic surgery of the face is uncommon due to the generous blood supply of the head and neck tissues. The rare infection almost always follows the bacterial colonization of a small unsuspected hematoma. If an infected hematoma does occur, adequate drainage is mandatory along with cultures and aggressive antibiotic therapy.
Skin Slough or Skin Loss
Skin slough results from diminished circulation of the undermined skin flaps and usually occurs adjacent to the periauricular incision line. The primary cause of diminished circulation is excessive tension on the flap, which has to be judged at the time of closure by the surgeon. Hematoma is certainly a factor in increasing the skin tension, and the presence of a systemic autoimmune disease or the chronic use of steroid medication can predispose to the occurrence of skin slough. Skin slough is 10 times greater in patients who smoke. Closure of the skin flap is without any tension at all, but merely a redraping type of approach with appropriate trimming. After secondary wound healing, a subsequent scar revision can be done electively.
Undermining the face lift skin flaps interrupts the superficial sensory nerve endings, resulting in localized loss of sensation. Nerves take between 6 and 18 months before sensation is regarded as back to normal. This lack of sensation typically concerns patients quite a bit for the first 6 or 8 weeks and then seems to be less bothersome there after.
In a subcutaneous face lift, the branches of the facial nerve injured most commonly appear to be the frontal and the marginal mandibular. In the course of sub-SMAS-platysma dissection, the cervical branch has been the most frequently injured, followed by the marginal mandibular. The frontal branch lies deep in the substance of the parotid gland until it reaches the caudal margin of the zygomatic arch. It is only after passing the cephalic margin of the zygomatic arch that the frontal branches penetrate the deep fascia and continue on the undersurface of the superficial temporalis fascia accompanied by branches of the superficial temporal artery. Dissection at the plane between the temporalis fascia and the deep temporal fascia, which should be performed bluntly in the region 1 to 2 cm above the zygomatic arch.
Click on the Additional Face and Neck Lift Article Links Below to Learn More about Facelifts:
Article 1: Lip and Marionette Line Improvement in Facelifts
Article 2: Laser Resurfacing and Treatment of Nasolabial Folds in Facelifts
Article 3: Jowl and Neck improvement in Facelifts
Article 4: Skin Only Facelifts
Article 5: Deep Plane Facelifts and Extended SMAS Flap Facelifts
Article 6: SMASectomy, SMAS imbrication, and MACS Facelifts
Article 7: Complications of Facelifts: Hematomas
Article 8: Complications of Facelifts: Infection, Skin Loss, and Nerve Injury
Article 9: Optimal Scar Placement in Facelifts
Article 10: Secondary Facelifts
Or View Before and After Photo Galleries of Dr. Hughes’s Face and Neck Lifts Below: