Facial Skin Necrosis after Facelift Surgery

We would like to describe a catastrophic case of skin necrosis in a heavy smoker patient after facelift surgery which was managed with non-surgical wound care and conservative treatment. Our patient is a 57-year-old smoker woman presented with bilateral extensive ulcers on the both sides of the face with sharp and distinct margins. She had undergone face lift procedure bilaterally 2 months earlier in another center. In the early postoperative period she started smoking again, which then ischemic blisters and discoloration with undermined skin happened, which was a sign of impending necrosis to occur. Eventually complete necrosis and skin loss happened, which was subsequently debrided by the surgeon 3 weeks postoperatively. Although she was seeking a rapid magic solution for her problem, the lesion was a dramatic subtotal skin loss. She did not have any relevant past history, including rheumatologic or collagen vascular disease. The lesion was painless and had a clean red base. She was a heavy smoker 30 pack/year of 30 years of 1 packs a day of cigarette smoking. The evaluations were pointing towards the diagnosis of flap necrosis which has happened because of insufficient blood supply due to continuous cigarette smoking.