Facial massage is a longstanding and proven method to aide in the healing process after facelift surgery. Surgeons instruct their post-operative patients to gently massage the facial skin with two goals in mind: smoothing of subcutaneous lumps, bumps and thickness from early swelling. Second, massaging away from incisions, especially around the eyes, is used as a “lymphatic drainage procedure” to decrease lymphatic stasis when incisions block the normal direction of lymphatic drainage.
It is also important for patients to massage the incisions around the ear when they are in the phase of scar deposition as the incisions begin to thicken at about 6 weeks. Massage as a form of touching helps during the first 6 months when many patients complain of hypersensitivity and shooting pains due to the normal process of nerve regeneration. Prolonged numbness can be disconcerting to some; massaging helps the psyche integrate the numb areas back into the normal body sensations so that the numb areas cease to feel separate from the remainder of the face.
Massage and wound care also engage the patient in their own recovery from surgery, giving them tasks that will make them take ownership of their recovery.
For the last 10 years, we have been doing extensive fat grafting with facelift procedures to address the effacement or flattening that occurs with all skin tightening procedures, especially in the cheek area. We also offer fat grafting in the lips, nasolabial and peri-oral region as there is very little that a standard facelift does to improve the peri-oral loss of fat with subsequent wrinkling. Attempting to tighten the cheeks enough to remove or affect the deepening nasolabial folds will not last and usually distorts the face in ways that are hard to camouflage. It should be an aphorism that you cannot lift the corner of the mouth by pulling of the lower face skin.
For the first 2 weeks post-operatively, the patient is asked NOT to massage at all so as not to affect the fat grafts. Usually, we extend the “no massage” time to 6 weeks unless a reason to massage the fat grafts arises—this is a rare occurrence. Massaging the fat grafts in the face prematurely will cause the grafts to dissolve away. It is also important to note that massaging the face while bruising is still present can cause the face to bruise and swell more.
We use standard marking pens to map the areas for fat grafting. Try as we may, it is difficult to remove these marks even with alcohol without having to rub hard enough to move the fat grafts once accurately injected. By the time that we start our staged suture removal, the marks are easier to remove with much less disruption of the fat grafts. Under no circumstances do we tell the patients to try and remove the markings. Patients are also instructed NOT to scrub their faces when washing, but gently pat the face to clean. Washing the face can mimic the massage-like pressure that we are trying to avoid during the healing process.