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Ask Dr. Yang any questions about facial plastic surgery, including facelifts, necklifts, eyelid surgery (blepharoplasty), browlifts, otoplasty, and non-surgical treatments such as Botox and injectable fillers.
Hi Dr. Yang. I had a facelift (my second, if it makes a difference) 16 days ago. My PS said I did have quite a bit of scar tissue from the first one. The swelling in my cheeks has come down nicely. But under my chin and around my jawline is still puffy and stiff. Some strange contours too, which I am hoping are mainly because of the remaining swelling. Do you have any tips for me to help get the swelling to leave these areas? I am back at work now, and feeling a little conspicuous. . .
You can stay on a low salt diet to prevent water retention. Use warm compresses (not hot) to help encourage blood flow to the area. Since the skin is numb, the skin could get burned using hot compresses or electric heating pads, so DON'T use them. A warm wash cloth that your hand can handle without feeling hot should work fine. Gentle massage of the area can also help increase circulation to the surgically injured area.
Some aestheticians at plastic surgeon's offices will offer Manual Lymphatic Therapy/Massage to help with the drainage of the swelling fluid (edema). The surgical separation of the skin from the underlying soft tissues, disrupts the normal lymphatic vessels and drainage of the normal swelling. It can take a few to several months for the lymphatic vessels to re-establish themselves and help an area to drain it's excess fluid normally.
I personally have my patients wear a compression garment to add compression under the chin area to help the skin to heal nicely there. Imagine the different layers that we separated during the face and necklift, and when we put it back together, it is like a plywood laminate with multiple layers sticking together. I think it makes sense to wear some compression early after the procedure, and less important as the days progress. If I were to glue three layers of wood together with glue between each layer, wouldn't it make sense to clamp the three pieces of wood together while the glue is drying to full strength? My protocol is to have my patients wear the compression for a month. 16 hours a day for the first 2 weeks, then 12 hours for the 3rd week, and 8 hours (just while sleeping) for the 4th week, before stopping completely after a month. The compression will also help to keep the swelling down while you are sleeping, so the swelling isn't as much first thing in the morning. Once the swelling comes out, it take several hours for it to come down. It is easier to keep the swelling down. Exercising too early within the first month after surgery can also promote more swelling, so my patients are not allowed full exercise until after one month after sugery.
One analogy for the swelling after surgery is with breast cancer patients who may have had their lymph nodes removed from their arm pit area. This can cause lymph edema, which can make the whole arm swell up. These patients often wear a compression garment on their arm to keep the swelling down. Luckily after a facelift the lymphatic vessels are microscopic and should fully come back, as opposed to the major lymphatic vessels which don't fully grow back after lymph node removal.
These are my preferences based my experience and what makes sense to me. I'm sure other surgeons who perform facelifts may not tell there patients to do anything specific after surgery, since there's no standardized way to do it. The reason I have my patients go through the hassle is to give them the best chance heal nicely, since they already put a significant amount of time and money into the procedure. Other surgeons may think it's a waste of time and don't want to put their patients through the "hoops," so that's their reason not to recommend it. If they don't perform that many facelifts, then the facelift procedure is relatively minor compared to a tummy tuck or breast reduction, so they don't think much of the procedure.
I would go with what your surgeon recommends typically, to get your surgeon's typical results.
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