What Can I Expect? Common and Unique Symptoms after Surgery:
Creeping Reinnervation, paresthesias, and other unique feelings or sensations will happen after a facelift or neck lift. The most common and also the unique symptoms will be discussed in detail. This educational writing will review what you can expect after these cosmetic facial operations. There are specific and extremely important recovery instructions after these operations. You can link to these now. This writing is more about the unique feelings, symptoms, and different sensations that occur with these procedures. But I will also review common symptoms as well. It was written at the request of a patient from Philadelphia, PA.
Common and Typical Symptoms:
Bruising, Swelling, Tightness, and Pain
The most common symptoms after a facelift are bruising, swelling, tightness, and pain. These are ALWAYS present and are to be expected during the recovery process.
Bruising and swelling peak on the first or second day after surgery. The color of the bruising will vary and change. It often starts as a red color and then changes to your typical brown to black and yellow colors. With time it will move down and into the neck area. This is called “dependent drainage” as gravity and lymphatics help resorb and carry away the blood.
Swelling is always present. You will notice this after the procedure, but most people still look presentable, and it’s typically not excessive. Some patients swell more than others, and icing is very important. More commonly it’s much less, and you are just swollen with the extracellular fluid typical of swelling after surgery. The swelling will gradually resolve, like the bruising, over two weeks or so. The first week has much more swelling than the second. By the third week, 80-95 % is gone. Lingering swelling can leave small hard spots. These always go away but resolve slower. They can hang around for up to 6 weeks, but they are hard to see and easy to feel. Don’t worry about these spots, because they always go away. You can read more about these spots in another writing by linking there now.
Tightness is another symptom that is extremely common. Most people like the sensation; because we are “tightening” the face and muscles, and it’s reassuring that the face is tight and more youthful. It’s more common to feel this in the lower face and neck. It’s not excessive, and it’s never worrisome. It will gradually go away as you heal.
What also is typical after cosmetic facial surgery is a low degree of pain. Severe pain is NOT common with a facelift or neck lift, and you should call if you have this. People will be surprised by how little pain they have after a facelift. Some pain around the ears accompanied by a headache is normal. But this pain should be low grade. Usually Motrin or Tylenol is all that is needed. It’s reassuring to most that pain is low. Recovery predominately involves slow resolution of bruising, swelling, tightness, and pain.
Unique Feelings:
Numbness, Creeping Reinnervation, and Paresthesias
Numbness is a symptom that is ALWAYS present. It’s from the cheeks to the neck area. It feels like the areas where the dentist injects your mouth for fillings or a crown. This numbness is not nerve injury. It’s just associated with the elevation of the skin as part of the rejuvenation process. The numbness will hang around for months and gradually get better. You should expect it for 6-12 months.
What is unique about numbness is how slowly it goes away. Bruising and swelling resolve relatively fast, but the numbness resolves differently, and it takes its sweet time. It’s called “CREEPING REINNERVATION .” The name itself refers to how slow it is. It creeps along. The decreased sensation and numbness will gradually go away. It’s slow and steady. It will linger in front of and behind the ears and the neck area, where it lasts the longest. It will basically be all gone after 6-12 months. Many people still have a tiny bit after a year. Numbness is not a complication or a problem; it’s just common. It will be most noticeable with application of makeup and in men when they shave. As I mentioned, this is not nerve injury, just a normal symptom after this cosmetic operation.
Paresthesias are abnormal sensations that occur after all operations from appendectomy to hysterectomy to liposuction and tummy tuck. The word means abnormal sensations. These feelings can be different and unusual. Patients will describe sensations from electric shock, vibration feelings, water dripping, bugs on the skin, tingling feelings, to stabbing pain. They are characteristically short and quick. They are completely normal and common. They are intermittent and gradually go away. They are nothing to be concerned about. They are believed to be the nerves “waking up.” Once again, they are benign and gradually diminish and go away over 3-6 months.
What to Expect:
After these cosmetic procedures, you can expect all the symptoms I described above from the common and typical to the unique. They all are normal and benign. They gradually resolve and go away. Most will resolve over weeks. The vast majority of bruising and swelling over 1-3 weeks, with lingering swelling over a month or so. Numbness is much slower to resolve. This goes away extremely slowly. It’s called creeping reinnervation, as described above. Knowing this helps understand the recovery and what to expect.
During this recovery period, I often will say it’s a “HIBERNATION PERIOD” where you hide to be private and confidential. By hibernating, you are giving yourself privacy to allow for the resolution of the symptoms discussed. Patients that don’t care about this confidentiality or privacy can go out and be seen earlier, if they don’t care. I will instruct my patients that after 10 days you can go out to dinner with friends or loved ones. But you will still have some visible bruising and swelling. Makeup, scarves, and masks can help hide this.
Summary:
In summary, there are common and typical symptoms that all patients have after a facelift or neck lift. Bruising, swelling, tightness, and some pain are present in all patients. They will gradually go away, slowly at first, and then the last bits will take a few months. Numbness and its resolution are part of the recovery process. The numbness goes away very slowly and is called Creeping Reinnervation. Paraesthesias are unusual sensations that can be surprising because they can feel weird and can pop up unexpectedly. They are also common and benign and gradually go away.
