problems with Platysmal Plication

[seroma]

Dear Dr Rosenberg,
I  had a lower face lift with platysmal plication. The permanent sutures that were left inside seemed to cause my tissue in my throat under my chin to swell out like a bullfrog. I mean huge and my previuosly flat jawline became rounded and jowly. I had a ct scan done and showed a mass of irritated tissue. My PS performed a second surgery 3 months after the first to remove the permanent sutures. It helped considerably but several months later after it seemed resolved there were 2 lumps that seemed like perhaps a suture or fragment of a suture left inside. It was itchy and irritating. One of them worked its way to the surface of the skin near the suture scar and opened up and looked like a staph infection. I was treated w antibiotics but they didn't help it and it didn't resolve. The first lump seemed to heal after several weeks but left thickened tissue near my origial incision line. The second lump kept forming and and extremely irritating. My PS injected it w a steroid shot. He was reticent in removing it as it was about the size of a pea and he was afraid of taking too much tissue in that area and causing what is described as a "turkey neck". The lump kept organizing until it got to a place where my PS could remove it. He had to make a couple mm incision about an inch or so behind the original incision to remove it. It was sent to pathology but no suture or suture fragment was found. No allergy or systemic issues were noted.I was told I have a high histamine reaction and basically I heal funny. The lump was a necrotized lymph node and necrotized fat.the tissue where the  lump was removed is still swollen and it has been 8 weeks since it was removed. I had a good jawline prior to having this "maintenance" cosmetic surgery performed. I now have what looks like a double chin and its kind of jowly from the swelling of the tissue.additionally, I also suffered a seroma after the original surgery which was performed on June 23 2008. The second surgery to remove the permanent sutures was performed on August 24th 2008 and the third surgery to remove the lump was done May 14 2009. Will this swelling ever fully resolve?  I was a beautiful woman and now I purchased a very expensive scarred double chin and jowls Help?

[seroma]

Thank you so much for your time and reponse to my questions. I do so appreciate it. Just a quick additional bit of info. The swelkling under my chin swells up considerably in the morning and seems to look near perfect by the time I am ready to go to bed at night. I am trying to be patient but it has been quite a long grueling process. Yes my poor throat has been cut open 3 times in 11 months so I can imagine it will take some time now to finally heal. The last "surgery" was such a teeny incision to remove the necrotized lymph node/fat tissue so I thought it would heal faster but guess not. Thank you again for being so kind with your valuable time.
Sincerely
Seroma

[Howard Rosenberg, MD]

From the sounds of your history, you had extensive scar tissue formation that required additional surgery to improve.  The scar tissue that develops following any surgical procedure becomes its most sever at one month and gradually matures with time (four to six months).  It is way too early to evaluate the results of your latest procedure.  additional surgery to an area that has recently been surgically treated will most likely result in further exacerbation of the scarring.  Compression dressing and occasional steroid injections can help.  You must be patient with the outcome of your latest procedure.