Is Skin Necrosis?
potential, but rare, complication that may cross the path of a facelifter
is skin necrosis. Skin necrosis is a complication that results in
the death of the skin tissue. Skin necrosis occurs when not enough
blood and oxygen are supplied to a given skin region. The main causes
of skin necrosis are extensive hematomas and seromas that are left
undetected and untreated for a period of time, cigarette smoking,
and infections. Once necrosis has taken shape in an area, the complication
is not reversible because there is nothing that can be done for
skin that has undergone the necrotic process. Yet, the earlier skin
necrosis is detected the better because steps can be taken to prevent
further damage. In a good many cases, when skin necrosis occurs
after a facelift it is confined to small areas that heal without
serious consequences. In certain cases, however, skin necrosis leads
to unsightly scarring.
Does Skin Necrosis Happen?
the case of a facelift, skin necrosis is due to the lack of blood
and oxygen coming to a particular tissue of the body. During a facelift,
the skin is separated from up to 80% of its blood supply. If the
skin flap that has been detached from its underlying structures
is deprived of blood supply for a long period of time, then necrosis
can occur. Of course, a competent surgeon should perform the facelift
in a way that will not expose the patient to this risk. During the
procedure, the extent the surgeon will pull the skin may be a factor
that causes skin necrosis. As a matter of fact, the tightness of
the skin in certain areas can cause a decrease of the blood circulation
and even in some rare cases to loss. During surgery, skin necrosis
can occur if a surgeon pulls the skin too tightly to the point that
circulation is lost and an inadequate blood reaches the skin cells.
risk of skin necrosis is significantly heightened when one smokes
during the few weeks before surgery or by smoking during the initial
weeks of post-op. Skin necrosis may even be caused as a result of
secondhand smoke. This is because nicotine can cause the blood vessels
beneath the skin to become constricted, thus blocking the flow of
blood and oxygen to the skin. Because these blood vessels sometimes
represent the only blood supply to certain skin tissues, the tightening
of these vessels that results from smoking can have severe consequences.
Moreover, the carbon monoxide that is produced during smoking may
further decrease oxygen levels flowing to the skin, increasing your
chances of getting skin necrosis. For this reason, it is important
to stop smoking for 2-3 weeks before surgery and for 2-3 weeks following
necrosis may also be caused by Hematomas
or Seromas that may form after
surgery beneath the skin which are left untreated for a period of
time. If you have not yet read about these complications, a hematoma
is a collection of blood that forms under the skin, whereas a seroma
is a collection of fluid that forms under the skin. When a hematoma
or a seroma form, they may put pressure on the tiny blood vessels
underneath the skin surface and thus decrease circulation to the
affected tissues. If a hematoma is detected and treated early enough,
skin necrosis should not occur. However, if a hematoma or seroma
is left untreated for a certain period of time, skin necrosis may
take shape. The reason being that often in a hematoma, blood pools
underneath the skin and then it often coagulates and hardens. Blood
clots are usually a good sign of recovery in relation to wounds.
However, blood clots can prevent or hinder blood flow to the surface
of the skin if formed underneath the skin. Because of this (but
this is by no means a definite outcome), it is important to know
how to identify the warning signs of a hematoma or seroma so that
you may be able to report it immediately to your doctor. We discuss
these warning signs shortly below, as well as in the discussions
on hematomas and seromas that appear in their own individual areas
in this room.
an infection that occurs during post-op may also cause skin necrosis.
Indeed, the infection stimulates the swelling and tightness in the
area causing the vessel to constrict. This occurs when an infection
causes the blood vessels to block up by stimulating swelling and
tightness in the area that leads to vessel constriction. After surgery,
your immune system can be down and it is not unusual for you to
contract such infections, which can cause inflammation, thereby
causing blockage in the regular blood circulation. In rare cases,
skin necrosis can occur if a surgeon pulls the skin too tightly
to the point that circulation is lost. For this reason, it is important
to do significant research on the surgeon with whom you have decided
to partner on your journey.
is important to note that skin is more prone to skin necrosis after
a surgery, because after a surgery skin tissues, blood vessels and
the entire body works collectively towards the healing process.
At this time, the skin needs more blood and oxygen, its nutrients
to repair the damaged tissues and replace the dead skin tissues.
However, if the skin does not receive the needed nutrients, it cannot
properly repair, leading to accumulation of dead skin tissues and
even skin necrosis. Beside the blockage of blood supply, the bacteria
can cause the skin to swell and become discolored, usually purple
Is Skin Necrosis Bad For Me?
skin necrosis literally represents the death of the skin cells,
the affected skin tissue is irreversibly damaged. In a considerable
number of cases, skin necrosis resulting from a facelift is limited
in its severity so long as it is treated early enough so that the
necrosis doesn’t spread to other areas. Whenever necrosis
occurs, the affected area turns black, dies and a scab forms thereafter.
The real harm that is done to you is the scarring that can result
in the affected area. In a good number of cases, the scar will be
minimal and superficial. Yet, scarring can be considerable and the
degree of its severity will depend on how early the skin necrosis
was detected and treated, as well as on individual factors such
as your body’s individual response to the complication and
how well it heals the affected area. Many times, Hypertrophic scars
develop at the site because of excess collagen synthesis. Ultimately,
skin necrosis is not a life and death issue. Yet, skin necrosis
can cause scarring that can be aesthetically unattractive or so
unsightly to the point of requiring you to have further surgery
done such as through a scar revision procedure.
Are My Chances Of Getting Skin Necrosis?
should bear in mind that skin necrosis is a very rare post-op complication.
Studies have shown that the incidence of skin necrosis after a facelift
ranges between 2% to 3%. But, certain factors can increase this
risk. The main factor of skin necrosis is the cigarette smoke. Studies
have revealed that it happens in about one in ten smokers who have
a facelift (studies reveal figures of anything from 7.5% to 19%).
This makes it the most common complication of a facelift for smokers.
Remember: This risk of skin loss is 12-20 times higher in smokers
than nonsmokers. As a matter of fact, it has been shown that nicotine
interferes with wound healing and slows down the circulation of
the blood into the body. Smokers must be advised to cease all smoking,
including secondary, at least 2-3 weeks before surgery and 2-3 weeks
after surgery. Do not forget to tell your PS the absolute truth
and mention any cigarette you smoked before the surgery. Indeed,
they can us a more conservative procedure, using a short flap technique,
to promote better healing.
than smokers, patients with protein C or S deficiency are also at
risk of developing skin necrosis. Protein C is a Vitamin K-dependent
protein. It is an inhibitor of the coagulation process and it interferes
with the formation of clots. Similarly, diabetics are also at an
increased risk of developing this complication.
Can Skin Necrosis Occur On The Journey?
necrosis can pretty much develop at anytime during the first few
weeks of post-op, after which the risks of developing skin necrosis
lessen. Yet the factors that cause necrosis to develop can be the
result of your smoking before surgery, your surgeon pulling the
skin too tightly during surgery, or a hematoma, seroma, or infection
developing sometime during post-op. For this reason, the onset of
skin necrosis can occur during the first few weeks of post-op and
then lessen as you continue to heal beyond this timeframe.
Can Skin Necrosis Occur?
a facelift, skin necrosis may occur in any area where there is a
loss of blood flow and oxygen supply to a tissue. The most common
area where skin necrosis occurs is the area right behind the ears
(post auricular region). The reason why skin necrosis occurs in
this area more frequently is due to the fact that this region is
the farthest away from the regular blood supply. Also, because the
incision lines are closed with tension around the ears, this can
compromise the circulation to the surrounding skin tissues. Finally,
it is worthwhile to mention that it is possible for skin necrosis
to affect more than one area.
Are the Warning Signs?
blood flow in a particular area is a good way to detect skin necrosis.
Usually, you will notice this decrease in blood supply because the
area is pale. An increasing blood flow is also another warning sign.
You will notice in this case some kind of blood congestion as if
the blood was accumulating in a localized area without any way to
escape. This excess accumulation of blood often happens in the case
of a hematoma, and beside other reasons, thinning of blood can be
a cause of such excess blood flow. Usually because skin necrosis
is a result or occurs after an old hematoma or seroma in the skin,
the skin in that area is usually red and can very easily bleed and
usually the fat underneath the skin is yellow. Usually, the symptoms
of skin loss start with blistering that progress to a purplish mark.
A rough and dry sensation, a darker and black discoloration are
also signs of skin necrosis. With time as the blood circulation
to the affected area decreases, the skin becomes black and usually
with time this skin may also fall off.
warning sign that may indicate the onset of necrosis is if you see
a clear liquid with a yellow or brownish color flowing out of your
drains placed in your incision areas. This occurrence may possibly
mean that skin necrosis has begun.
a hematoma can lead to skin necrosis, understanding the warning
signs for this complication will also be helpful in detecting skin
necrosis in its early formation. You may have a hematoma if you
experience a sudden pain or swelling developing in a localized region,
or if the skin in a small area turns into a bluish-purplish color,
or if you feel a tender, burning sensation, or if a small region
feels appreciably warmer than the rest of our face and neck. As
a result, if you experience any of these symptoms, you should immediately
contact your doctor who shall then decide how to proceed. A detailed
discussion of this complication is found in the Hematoma
area of this room.
can have the same effect as a hematoma and need to be also detected.
You may have a seroma if you feel a particular area to be lumpy.
You may also monitor any irritation of the skin tissue especially
next to the wounds because it can cause the formation of a seroma.
A detailed discussion of this complication is found in the Seroma
area of this room.
Does Skin Necrosis Change And Heal Over Time?
area that is affected by skin necrosis usually starts out looking
purplish and then it turns into a darker discoloration, ultimately
becoming black. The texture of the area can be rough and dry. During
the weeks following the onset of skin necrosis, the area turns into
a scab that can be quite hard. Once the area heals, the scab turns
into a scar. It takes around 5 to 7 days for the black area to detach
form the healthy skin. Then, the period it takes for an area affected
by skin necrosis to heal is usually several weeks.
many cases, if skin necrosis is treated early on, the affected tissue
usually heals well. However, if the damage from skin necrosis is
more considerable, then noticeable scars can form. Fortunately,
a good number of cases of skin necrosis occur in areas behind the
ears so the damage that occurs is not detectable to the eye in such
101: What Are The Healing Tips?
Can I Do To Lessen/Prevent The Possibility Of Skin Necrosis?
you smoke, you should quit for at least 2-3 weeks before and 2-3
weeks after surgery. Similarly, you should try to avoid secondhand
smoke during these periods. You should remember that you multiply
the risk of having skin necrosis anywhere from a factor of 12-20
times if you continue smoking during these periods. If you are a
diabetic or have a protein C or S deficiency, be sure to disclose
your condition to your surgeon in advance of surgery so they may
decide how to proceed. An additional safety measure that you can
take during your recovery is to wear loose-fitting clothes that
do not put pressure on your skin (such as tight collars) and refrain
from activities that can put significant pressure on the skin and
interfere with the circulation.
Should I Do If I Detect Skin Necrosis?
you believe that you have the signs that typify skin necrosis, the
first thing that you should do is go back to your bed and prop yourself
above pillows and then proceed to call your doctor immediately.
Keeping your head in elevation will help the circulation. Moreover,
you should avoid applying pressure to the affected area. You might
have to release the sutures if you believe that the tension is too
high. By intervening in a timely fashion, you can impede the expansion
of the necrotic process.
Are The Surgical Treatments?
skin necrosis has taken shape, the affected tissue is definitely
dead. However, the earlier skin necrosis is detected the less damage
that occurs. A surgical procedure called debridement may be necessary
to remove the necrotic tissue. It is an operation by which the surgeon
will cut away the dead skin with a scalpel. Usually, this procedure
does not require any anesthesia because the tissue removed is dead
and you don’t have any sensation. In some very rare and severe
case, a more invasive debridement technique involving coming back
to the operating room might be required. But, this occurrence is
an unrecognized hematoma may be the culprit behind skin necrosis,
if a hematoma occurs the surgeon may elect to have the hematoma
drained by a needle or with compression. Less frequently, the surgeon
may need to open the incisions and operate again. For a full discussion
on this complication, take a walk to the Hematoma
discussion in this room.
Are The Non-Surgical Treatments?
far as non-surgical treatments for skin necrosis, you may ask your
doctor if he/she would prescribe you topical and oral antibiotics
that can help the healing of the necrotic tissue. However, it seems
that this non-surgical treatment is not as effective as a surgical
one especially because tissue removal can be important if you want
to prevent skin necrosis from spreading to other skin areas.
What Can I Do To Improve The Appearance Of Necrotic Tissue?
the necrotic tissue has healed, a scar can be left. In many cases,
the scar is superficial. Yet, in some cases the scar may be unattractive
that you may want to consider having a scar revision to improve
its appearance. The scar revision technique that is most often used
is skin grafting that can soften, smoothen, and lessen the appearance
of the scar. Skin grafting involves taking a thin layer of skin
from another part of the body and placing it over the scarred area.
You may also consider using scar healing products such as silicone
gels that can further help in improving the appearance of the scar.
A detailed discussion about various scar healing products is found
in the Scar
Healing Solutions area of the Hygiene
& Personal Care tab.
you have an area of your face or neck that is affected by skin necrosis,
you can effectively conceal it with the use of camouflage makeup.
Of course, before applying makeup to the affected area it should
be properly healed (you should consult with your surgeon). A detailed
discussion about camouflage makeup, including tried-and-tested tips
and techniques, as well as product recommendations, may be found
in the Makeup & Camouflaging Techniques section of the Beauty
Secrets, Potions & Techniques Room.