FAQs

Common Questions that Facial Plastic Surgery Patients ask after their Surgery

Everyone has some stress and anxiety before and after surgery. For you, this is likely the first time you are experiencing the process of a Cosmetic Surgery. Many people are unclear of the details that are part of the healing process. Over the course of healing, there are things that will worry you. You will ask yourself, “Is this normal? Is this dangerous? Will this swelling go away? Why am I so swollen? Why is my lip numb? Why can’t I move my mouth? Why does my nose look so big after this rhinoplasty? ” And so on. If I was not a surgeon and had surgery for the first time, I can assure you, I would be asking the same questions!

After some thinking, I’ve decided to start a resource on common post-operative questions. This will be a place where patients can go to get some information on common problems after surgery. Perhaps eventually, I’ll start updating with some images to demonstrate some of these issues but in the short term, I’ll spend time discussing some common questions.

In addition to this, I will link my answer to similar questions on Realself.com so you can compare my answers with answers by other Plastic Surgeons and Facial Plastic Surgeons. Hopefully this will help you understand what is happening and help reduce your stress around the situation.

I always tell patients, every surgery carries risk, there are always potential risks. The goal of the surgeon (Dr Bonaparte) is to do the best job possible and ensure the healing process is as smooth as possible. Many risks and complications are unpredictable and seem to just ‘happen.’ However, the good news is that the majority of these complications or side effects of cosmetic surgery are temporary and resolve with no long lasting issues.

*Disclaimer – Although Dr Bonaparte tried to answer these questions with enough detail, every situation is different and every patient is different. If you ever have a concern, you should contact your treating plastic surgeon to ensure there are no concerns.

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Facelift

I cannot move the corner of my mouth after a facelift? Is this permanent? How long will it take to heal?

When we do a facelift, we are close to a collection of nerves called “The Facial Nerve.” The facial nerve is what is known as a cranial nerve. This nerve leaves the brain and actually travels through your ear. It then leaves the bone of the ear in front of the entrance to your ear, but deep in your face, within your salivary gland called the Parotid Gland. The nerve then travels within the Parotid Gland and eventually leaves the deep protection of the gland and connects to muscles that move your face. All the muscles of facial expression (Muscles that move your mouth, eyelids, forehead) are under the control of the facial nerve.

When Plastic Surgeons perform facelift surgery, we pull, reposition and move tissues of the face. This often pulls and tugs on these delicate nerves. During the process of a facelift, pulling on these nerves can cause swelling. The problem with swelling in nerves, is that when a nerve is swollen the signals that leave from the brain and travel to the muscle, telling them to move, get blocked. Because of this, you may not be able to move your face temporarily after surgery. About 5-10% of people have this problem and it is almost always temporary. It can be very concerning, but rest assured, the vast majority resolve in a days to a few weeks. It is important to note, that in some people, it can take many months to resolve but be patient and in the majority of people, it will eventually come back to normal. Very rarely, this can be permanent but as I mentioned, this is rare.Click here for more informationReturn to the top

Is there anything I can do to speed up the recovery of the loss of movement on my face after a facelift?

Unfortunately no. After a facelift, It takes time for the swelling to go down in the nerves and it takes time for the nerves to heal. Nerves can heal slowly and this can be very frustrating, but rest assured, the vast majority of people heal quickly in days to weeks although in a small minority, the healing can take months. The loss of movement after a facelift is very rarely permanent. Some people say that steroids or other treatments may help, but time and patience is the best treatment. In addition to this, if you ever notice a loss of function or the inability to move your face after a facelift, you should always talk with your surgeon (Dr Bonaparte) to ensure there are no other signs of complications.Click here for more informationReturn to the top

What is a hematoma and why is it dangerous after a facelift surgery?

A hematoma is the medical word for a collection of blood (heme means blood). After a Facelift Surgery, there is a change that blood can collect under your skin. If this happens, the blood itself is not dangerous. The concern is the pressure the blood can place on the skin. Your skin needs all the little blood vessels inside it to work so it stays healthy after a facelift. If the pressure from the hematoma under the skin is greater than the pressure of the blood getting into the skin, the blood flow into the skin can stop and the skin can die. This is a VERY serious complication (the skin dying) if the hematoma is not recognized and treated as soon as possible. The good thing is, if you get a hematoma after surgery and it is treated, there is little risk involved. If you ever notice swelling on your face after surgery that looks tense, red or purple or is bigger on one side you should always be safe and check with your doctor immediately. If it occurs overnight and you are worried, you should go to the emergency department and get checked to ensure it is not dangerous. As I mentioned, a hematoma in itself is not the danger, but rather the pressure on the skin.

One other important piece of information, if you smoke cigarettes, your risk of a hematoma goes up as does the risk of skin loss after a facelift. It is important to try to quit smoking for at least a month prior to facelift surgery.Click here for more informationReturn to the top

I had a hematoma after my surgery, it was stopped and fixed, but will this cause long term damage?

Hematomas can occur in any patient who is having a facelift however the risk is higher in people with problems with bleeding, on certain medications or who smoke. Most times, they are noticed in the first hours to first days after surgery. A hematoma is a collection of blood under the skin. There are different reasons why this can happen.

Sometimes after surgery, you can cough or strain and get your blood pressure up (elevated). This can cause a small blood vessel or a blood vessel that was treated during your surgery to open and bleed. This is very unpredictable, but can happen. Another reason is sometimes blood vessels go into what we call ‘vasospasm’ during surgery. This means they tighten and squeeze so blood will not leak out of them. However, after time passes, the blood vessel starts to relax and open up causing it to bleed. So, during surgery the surgeon may not see any bleeding but after surgery, the blood vessel can start bleeding. We look for this during surgery, but in some cases it is almost impossible to identify.

In all these cases, as the blood increases under your skin, it starts to put pressure on your skin (expanding hematoma). The problem with this is that if the pressure on the skin is greater than the pressure needed for blood to bring oxygen and nutrients into your skin, it will cut off the blood supply to the skin and result in skin loss and potentially serious scaring on your face. This is why we want to see patients who think they have a hematoma. It is better to be safe in this situation.

Now, all this may sound scary but rest assured, as long as it is treated within a 24 hours (ideally less) the odds are you are fine and it will heal with no problems. Sometimes little lumps and bumps under the skin that form after a hematoma can appear scary, but they almost always resolve without issues. So in the end, if you get a hematoma and it is treated, you will most likely heal like everyone else.Click here for more informationReturn to the top

Why do I feel pins and needles or tingling on my face after a facelift? Will it go away?

When your Facial Plastic Surgeon (Dr Bonaparte) performs a facelift, we use a scalpel to make a cut in the skin of the face near the ear and sometimes behind the ear. There are small nerve fibers that are cut during this. There is no way to prevent cutting these nerves. These nerves called, sensory nerves, meaning, they are responsible for sensation of the skin. This includes touch, pressure and pain. These nerves are VERY different than Motor Nerves, which move the face. As mentioned, the sensory nerves are responsible for the feeling of touch, pressure as well as pain on the skin of your face. It is very common to feel numbness on the skin of your face after a facelift due to cutting these nerves. However, over time these nerves will grow back. When they start to grow back, you may feel tingling and pins and needles on the skin of your face. Remember, this is a good sign in the long term as it means the feeling will almost certainly start to come back. Very rarely do people not get any feeling back. Eventually, the pins and needles and tingling sensation will go away.Click here for more informationReturn to the top

The facelift scar behind my ear is thick, will this go away?

There is always a scar with a facelift; the goal of the facelift plastic surgeon is to make the scar look as good as possible. It is important to ensure you have a qualified surgeon like Dr Bonaparte. Having a good understanding of scar placement and treatment is the key to making sure you get the best result. However, there are individual factors that are out of the control of the surgeon. These are the things we need to monitor and treat if they occur.

The most common area for a poor scar is behind the ear. The skin is thicker in this area and there is often more tension and stress behind the ear in the hairline. Because of this, in the early phases of healing (the first few months after your facelift) the scar may not look as good as you want. Although we always do what we can to make the scar look perfect, it is not uncommon to have some thick parts of the scar. The good thing is this often fades over time. If it is not fading as quickly as we would like, we can use treatments to improve this. Typically, it takes up to a year for a scar to fully mature, so patience is required.

With respect to treatment of these scars, we often can soften and reduce the size by injecting steroids. In addition to this, I often recommend that people use silicone gel or silicone sheets placed directly on the scars early after the facelift. Another method that can be helpful is to massage the thick scars behind the ear. If these things don’t work, we typically will use a laser or do a surgical scar revision. Rest assured however, your scars will look great when everything is completed.Click here for more informationReturn to the top

There is swelling in front of my ear after I had a facelift; it gets worse when I eat. What is this?

This could be one of a few things, but is most represents a minor injury to your parotid gland, a glad that produces saliva. This gland sits deep under the skin in front and below your ear. When you eat, this gland produces saliva. During a facelift, there is a chance that this gland be injured and some clean saliva can leak under the skin. When this happens, it is very rare for it to cause serious problems but we typically need to drain it with a small needle. This is often painless and completed in under a minute in clinic.

To stop further swelling, facial plastic surgeons often ask people to eat bland food for a week or two and put pressure over the swelling site when they eat (with their hand). It will often resolve in a week or two with these simple methods. The style of facelift Dr Bonaparte performs has a lower risk of this than other methods. In addition to receiving advanced training in Facial Plastic and Reconstructive Surgery, Dr Bonaparte is a certified Head and Neck Surgeon who received very specialized training with respect to surgery of the Parotid gland. This helps limit the chance of unnecessary injury. However, if you ever notice swelling on your face, you should contact your surgeon to make sure it is not another type of swelling like a hematoma.Click here for more informationReturn to the top

How long until I can go back to normal activity after a facelift?

This is a common, but difficult question as everyone heals differently after a facelift. We always advise that people take a week off of any significant activity. This means, no heavy lifting or bending or straining. No work and no exercise. It is ok to do some light work around the house, but ideally you spend the week watching movies, reading and listening to good music. The main issue for the need for rest is that we do not want you to move too much and potentially open the incision or cause changes that can occur under your skin. Also, if your blood pressure gets high, there is a risk of bleeding and a hematoma. After the second week, you still do not want to exercise or do any significant activity. You can do normal things around the house, however we still advise rest. After the third week, you likely will want to get out more and do things outside; this is fine, but still, not exercise. By Week 4, you can get back to fully normal with no concerns.Click here for more informationReturn to the top

Can I play sports after a facelift?

No, you should not play sports or exercise in the first three to four weeks after a facelift. You risk complications if you do. Please discuss exercise and activity with Dr Bonaparte or your Plastic Surgeon to ensure it is safe for you.Click here for more informationReturn to the top

The muscles in my neck feel tight after a facelift, what can I do about this? Will it go away?

Almost everyone who has a neck and facelift will have tightness in their neck. This is often due to the muscles in the neck going into spasm or from the actual tightening of the procedure. This is a good thing in the early phases of surgery. Most people find that after a week or two this resolves. We typically advise people to take their pain medication to help with this. If the tightness doesn’t go away after a few weeks, massage can often help. It is very rare for neck tightness after a facelift to last longer than a week or two. In some cases, you can actually see the tight muscles, rest assured, this will go away. However, you should always check with Dr Bonaparte or your plastic surgeon if you are concerned.Click here for more informationReturn to the top

My face is very swollen after a facelift, my doctor says I do not have a hematoma, but is this swelling normal?

All patients will have swelling after a facelift. It is an unfortunate, but necessary part of the surgery. Anytime you see swelling or get pain, you should have Dr Bonaparte take a look, but as the title of this questions suggests, if it is not dangerous swelling, then what else could it be? Often, it is fluid and ‘inflammation’ within the tissue under your skin. This can look distressing early on, but about 60% of the swelling will be gone by 2 weeks. After 2 weeks, you must be patient as the remainder of swelling will resolve over the course of 3-6 months. It can be slow, but in the end, it is worth it.  There is not much you can do to speed this up apart from avoiding smoking and trying not to eat too much salt in your diet.Click here for more informationReturn to the top

I still have some loose skin under my neck after a facelift, what can be done about this?

When we perform a facelift, our main goal is to tighten the tissue layer under the skin. Pulling too hard on the skin can result in a ‘fake’ and abnormal appearance. This is especially difficult under the chin. Almost all patients have some loose skin under the chin after surgery. There is no safe way to make this completely tight. In some situations, this is due to your anatomy. Also, as time goes on the skin will normally relax, this can result in some loose skin under the chin.  The good thing is, there are options to improve the loose skin under the neck after a facelift. We often try things like radiofrequency skin tightening or other skin treatments. IN the end, we can often improve this after treatments, however, patients do need to expect some loose skin under the chin after a facelift.Click here for more informationReturn to the top

How long does it take for the scars to fade after a facelift?

Any time you have surgery, you need to be prepared to have a scar. Any time the skin is cut a scar will result. It doesn’t matter who does the surgery, what type of surgeronperformed the surgery or what type of stich (suture) was used, everyone scars after the skin is cut. However, Facial Plastic Surgeons and Head and Neck Surgeons use special techniques to make sure you get the best and smallest scar possible. The problem is, everyone is different. No matter how perfect the stitching is, some people form bad scars.  The key to remember, is that over time, almost all scars, good or bad, will fade and improve. If you look at the science and biology of scars, you will see that the human body puts a lot of effort into scars. Initially, the body lays down the scaffolding of the scar. This is like the beginning of building a house. Its all the structure. If is the framework in which you are going to start building. Think about it as the plans for the house. This isn’t strong yet, but it is ready to start working to improve the strength. Next, the body starts to replace some of the weaker structural parts with stronger more long lasting tissue. At this point, the scar still looks red and thick. This occurs starting a few weeks after surgery and takes a few months. Once this is completed, the body then starts to mature the scar. It starts to break down all the big bulky tissue and replace it with smaller, stronger and more efficient tissue. This can take up to 12 months or even longer. During this phase, the scar will flatten and become closer to skin colour. So the answer is, after a facelift, it may take up to 12 months for the scar to look ideal. Remember however, after a facelift, you can then treat the scar with lasers and medications as well as silicone sheeting to improve the scars.Click here for more informationReturn to the top

When should I change the dressing after a facelift?

This is one of the most common questions I get asked after surgery. If you ask 100 Facial Plastic Surgeons or Plastic Surgeons, you will probably get 100 different answers, however, we likely all are reasonable close in terms of our thinking. I recommend people do their best to keep the dressing on for the first 48 hours. This is the most important time. It is ok to change the dressing if it gets a bit dirty, but it should be placed back on after changing. This helps keep the skin in contact with the underlying tissue and places a very small amount of pressure on the tissue to help prevent unnecessary bleeding. However, you do not want too much pressure, just enough so it is comfortably snug. After 48 hours, I recommend having the dressing on as much as you can handle, however I strongly recommend keeping it on over night. The reason is, if you turn over or get your ear or incision caught on something, there is a risk you can open the incision. The risk is highest where the ear attaches at the earlobe. One week after a facelift, there really is no significant benefit, apart from wearing it at night.

Like all facelift surgery, the dressing should be clean and you should still put Antibiotic ointment (ie Polysporin) on your incision a few times a day. The other benefit of changing the dressing 2 times a day, is that you can look and make sure you do not have any abnormal swelling. If you notice this, you should alert Dr Bonaparte.Click here for more informationReturn to the top

What should I be putting on the incisions after a facelift?

For the first two weeks after a facelift, you should put an antibiotic ointment like Polysporin. It should have the consistency of Vaseline. You can do this every time you change your dressing. Keeping the wound covered and moist with the Polysporinwill help healing and potentially improve the scar. After two weeks, we then recommend people NOT use Vitamin E or any other Herbal medication on their scars. The only treatment that Dr Bonaparte Recommends is Silicone Gel or Sheets. There is evidence that this works. Vitamin E can actually make your scars look more red.  You can purchase silicone gel or silicone sheets at your local pharmacy under the wound care sections. Ask the Pharmacist if you can not find what you are looking for. We recommend using this for the next 3-6 month or longer to help the scarring.  In addition to this, after 3 weeks, you can start to message the scars to help break down the dense tissue.Click here for more informationReturn to the top

Is it ok to take the facelift dressing off after surgery?

Similar to the answer above, yes, you can take the dressing off to change it. The key is, for the first 24 hours, you want to keep the facelift dressing on as much as possible. It is ok to change it if it gets dirty, but if you can, keep it on for the first 48 hours. Once the first 48 hours is over, you can change the dressing daily.Return to the top

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I am having trouble moving parts of my face after facelift surgery, is this normal and when will it go away?

Similar to the answer above, it is common to have some temporary weakness, particularly around you mouth, after a facelift. This can be due to the freezing that was injected or to pulling and tugging on the tissues of the face. The tugging on the tissue can stretch the nerves that move your face and cause them to temporarily not work.  The type of facelift Dr Bonaparte performs has a very low risk of permanent loss of movement, however, there is always a very small risk. Most people will find the movement returns in a few weeks, however some people do take longer. This can take up to 6 or more months in rare situations. The best advice if this ever happens to you, is try your best to be patient. It is not easy as it can be very concerning. Rest assured, in the vast majority of people this will resolve. It is important to remember, that all surgery has risks, but the risk of permanent paralysis or loss of motion is very low.  There is no medication that can speed up the healing.Click here for more informationReturn to the top

How long will it take for bruising to go away after a facelift?

All patients will have Bruising after a facelift. Some, more than others. Most people find the worst of the bruising goes away after about a week. The rest of the bruising is typically gone by two weeks. In rare situations, people can have longer than 2 weeks of bruising, but it can usually be covered with make-up. Unfortunately, there is no really method to speed up the healing process with respect to bruising. There are naturopathic medications available, but if you look at the research evidence, they have no effect.

One of the keys with bruising, is to make sure it is not swelling. If you ever are not sure if the bruising is in fact swelling or bleeding, you should contact Dr Bonaparte or you Facial Plastic SurgeonClick here for more informationReturn to the top

The skin on my face feels numb after a facelift, how long will this take to go away?

Although this is a frustrating and strange issue after surgery, it is typically not serious. Nearly all patients will have some numbness on the skin of their face after Facelift Surgery. The reason for this, is that then we make our incision in front of the ear, we cut some very some nerves  that provide sensation to the skin. This is different than the nerves that move your face. The nerves that provide sensation are from a nerve called the Trigeminal Nerve. The nerve the moves your face is called The Facial Nerve. When you damage the small sense tionand touch nerves, this results in numbness of your face. Over time, (months – year) the nerves grow back and you start to get feeling back. It is not uncommon to get a tingling or pins and needles sensation in your face after a facelift, this is due to those nerves growing back. Be patient and in almost all cases, the feeling comes back.Click here for more informationReturn to the top

My ear feels numb after my facelift, how long will this take to go away?

Similar to question number 18, this can be due to cutting small nerves after a facelift. However, in some situations (particularly if you have a neck lift) this can be due to cutting a nerve call the Auriculotemporal Nerve. This is a branch of the Trigeminal and is bigger than other sensory nerves. If you cut this, you may lose some sensation in your ear. However, commonly this nerve isn’t cut but stretched and like other nerves will come back with time.Click here for more informationReturn to the top

There is red skin behind my neck after a facelift, will this last forever?

After a Facelift is performed, there is often some redness on the skin behind the ear. The skin behind the ear and neck is often thicker with more attachments to the muscle underneath. Also, bruising tends to build up in this area after a Facelift. In most people, this will fade after a few weeks. However, the scars tend to last longer as the wound is under more tension and stress. In very rare situations, we need to do treatment to reduce the redness. In my practice, I will use IPL treatment, a non-surgical treatment that can get rid of redness.  Another thing to consider, is that if you use antibiotic ointment for more than 2 weeks, you may be causing some of the redness. After 2 weeks, it is just as effective to use regular Vaseline as opposed to things like Polysporin.Click here for more informationReturn to the top

I still have wrinkles on my face after my facelift, is this normal?

The answer is yes. A common question that is asked of Facial Plastic Surgeons, is whether a facelift will get rid of wrinkles on the face. Although some wrinkles will improve after a facelift, this is not the primary purpose of a facelift. The goal of a facelift is to reduce the sagging and tired appearance of the skin. It helps to tighten the tissue under the skin and remove loose skin.  If a patient’s primary goal is to remove wrinkles, we often recommend laser treatments to help with this. Some patients have both, a facelift and then a laser treatment. If you still have wrinkles in your skin after a facelift, this is normal.  Be sure to ask about laser treatments that can go hand and hand with your surgery to help get the best results.Click here for more informationReturn to the top

The folds below my nose (nasolabial folds) are still present after a facelift, is this normal?

This is a common question and an often misunderstood aspect of a Facelift. When Facial Plastic Surgeons perform a facelift, the primary goal and purpose of the facelift is to rejuvinate the lower face and in many cases the neck. There is a misconception that a facelift improves the entire face from forehead to chin. This is not the case. A facelift focuses on the lower face, improving the jowls, chinline and neck.  The folds by the side of your nose (The Nasolabial Folds) are typically improved with a procedure called a “MidFace Lift.” The problem with a mid-Face Lift, is that it is technically more difficult and there is a slightly higher risk to the nerve the moves your face (the facial Nerve). So, in many cases, the nasolabial folds will remain after a facelift.

However, in my practice, I utilize the cutting edge and most advanced facelift techniques that allow me to improve your lower face and in many cases, the mid face without doing a standard mid-facelift.  The technique I utilize allows me to lift the tissue under your skin and reposition it in a more youthful part of your face. This will help provide volume to your midface (which is lost with aging) and give you more youthful appearing cheeks. In many cases, this helps improve the Nasolabial Folds. It is important to note, that this technique does not improve the NasoLabial folds in all people, but in many cases it does help.Click here for more informationReturn to the top

Some of my hair fell out after my facelift, what should I do about this?

Although it is uncommon to have hair loss after a facelift, it does occur in some people. In Men, you can have some hair loss in the facial hair in front of your ear. You can also have some hair loss in the temple region. In women, you can also have some mild hair loss after a facelift. In almost all the cases, it is due to swelling and cutting the hair during the incision. This will grow back. Rarely, if the cut is not made in the correct area, you can have permanent loss, but fortunetly this is very uncommon after a facelift.