Skin color
The area near the wound, on the flap, or the nipple turns blue, becomes purple, gray, or darkens. This is a sign of impaired circulation — see a surgeon immediately.
CONDITION / SKIN AND SCARS
Skin necrosis after surgery.
Skin necrosis after surgery is the death of a skin area that does not receive enough blood after the intervention. It turns blue or darkens and eventually becomes covered with a dark crust. Such an area is treated without delay: from dressing changes to closure of the wound with the patient's own tissue.
CONCEPTUAL VISUALIZATION- What it is
- A patch of skin, and sometimes the fat beneath it, dies because it lacks blood supply after surgery.
- How common
- It depends on the surgery: in a series of 278 abdominoplasties, skin or fat necrosis occurred in 2.5%, while in a meta-analysis of 25 studies of breast reduction using one of the techniques, on a medial pedicle (1033 patients), nipple and areola necrosis occurred in 1%.
- Smoking
- In a meta-analysis of 140 cohorts (479,150 patients), the odds of necrosis in smokers were 3.6 times higher than in non-smokers.
- The most dangerous
- Spreading infection and sepsis. Confusion, very rapid breathing, chills — 103.
01 / WHAT IS ITWhat is
What is
skin necrosis.
During many plastic surgeries — facelifts, abdominoplasty, breast reduction or reconstruction — the skin is separated from deeper tissues and moved. After that, it is nourished through the remaining blood vessels. If insufficient blood reaches a certain area, the tissue dies. According to the NHS, after breast reduction, loss of blood supply to part of the skin, fat, or nipple may occur, and then this area can die.
Initially, the skin changes color — turning blue, purple, or gray, then darkens. Later, a dry dark crust (scab) forms on its surface, under which there may be a wound. Necrosis can be partial, affecting only part of the skin thickness, or full-thickness.
Dead skin does not hold the suture, so necrosis can lead to wound dehiscence and infection, and after breast reconstruction — to the point where the implant becomes visible through the wound. Estimates of incidence vary widely: in a systematic review of 59 studies on skin necrosis after mastectomy with reconstruction, different authors defined it differently, and the frequency ranged from 2.3% to 41.2% per breast.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow does it look
How does it look
necrosis.
The first changes are usually noticeable in the first days after surgery, at the edges of the wound or on the skin flap.
Dark scab
At the site of dead skin — a dry dark or black scab. There may be a deeper wound underneath, so it should not be removed by yourself.
Blisters
Blisters or oozing areas of skin appear near the wound.
pain
The area hurts significantly more than it should after such surgery, or the pain increases.
The wound is coming apart.
The edges of the wound do not hold together, the wound opens or oozes.
Difference of seamsSigns of infection
Redness spreads, pus flows from the wound, fever rises. Rarely, infection of the deeper layers of the skin spreads very quickly.
Consequences of necrotizing fasciitis03 / REASONSWhy the skin
Why the skin
dies.
There is one reason — the tissue lacks blood and oxygen. But the risk depends on the surgery, the person’s health, and how the first few days go.
Smoking
Smoking worsens the delivery of oxygen to the tissues. According to a meta-analysis of 53 studies, it increases the likelihood of infections, slow healing, and skin necrosis after facelift, abdominoplasty, breast reduction, and reconstruction.
Hematoma
Blood accumulation under the skin (hematoma) is the most common complication of a facelift, and it can lead to prolonged swelling or skin necrosis. In a series of 1,078 facelifts, hematomas occurred in 4.2%.
Complications after a faceliftHealth
In a review on skin necrosis after mastectomy, the risk factors were identified as smoking, diabetes, obesity, radiation therapy, previous scars, and severe comorbidities.
Type of surgery
In a meta-analysis of 183 facelift studies, the frequency of skin necrosis varied depending on the technique: with the SMAS flap it was higher than with others — 1.57%.
Plan and Technique
According to the same review on mastectomy, careful planning and surgical technique can reduce the frequency of necrosis. And in the review on nipple ischemia after breast reduction, it was emphasized: knowledge of anatomy, risk factors, and proper technique cannot prevent this complication in all cases.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Necrosis is an acute complication: it should be treated without delay, and one should not wait for a scheduled check-up. First, contact the surgeon who performed the operation; they know the details of the procedure. If any of the signs listed below appear — it may be sepsis. Do not go on your own; call 103.
103 immediately if:
- confusion, unclear speech, speaking nonsense;
- very frequent breathing;
- skin all over the body or lips bluish, pale, or blotchy;
- very high or very low temperature, severe chills;
- the heart suddenly races, beats very fast or irregularly;
- rash that does not disappear when pressed;
- the neck or face swells quickly after surgery, and it becomes difficult to breathe;
- severe bleeding from the wound that does not stop.
Do not wait for a scheduled check-up:
Immediately - to the surgeon who operated, and if it does not work - to the reception department: skin near the wound, flap, or nipple darkens, turns blue, becomes crimson, gray, or black, blisters appear, especially if the area is painful; pain in the surgical area is significantly worse than it should be or increases; the area swells quickly and becomes tense. On the same day: consult the surgeon who performed the operation, and if this is not possible — any surgeon, if the wound became red, hot, oozing pus, stitches came apart, or fever rose to 38°C or higher. As scheduled, according to the dressing change plan: dry dark scab that the surgeon has already seen and does not increase, as well as scar after healing.
05 / DIAGNOSTICSHow to evaluate
How to evaluate
necrosis.
- Conversation
What surgery was done and when, how the area changed, whether you smoke, what medications you are taking, whether you have diabetes.
- Review
The surgeon assesses the color, boundaries and depth of the lesion, the condition of the wound edges, signs of infection or hematoma.
- Follow-up
The boundary between living and dead tissue sometimes does not become clear immediately, so the area is re-examined.
- Examination as needed
Blood tests and wound cultures are done if there are signs of infection, ultrasound — if accumulation of blood or fluid is suspected.
06 / TREATMENTHow we treat
How we treat
necrosis.
The goal is for the wound to heal and for the scar to be as inconspicuous as possible. According to a review on skin necrosis after mastectomy, it is treated with or without surgery, and in some patients, early intervention reduces complications.
01
The first days
While the tissue is still alive.
- Early ischemia
- It is important to notice impaired nourishment as early as possible. A review on nipple and areola ischemia after breast reduction emphasized: what can be done depends on when it is detected.
- The reason
- If blood collects under the skin (hematoma), the surgeon decides whether to remove it and monitors how the area changes.
02
When necrosis has formed
Wound debridement.
- Dressings
- Small superficial areas are managed under dressings until the skin under the scab heals.
- Removal of necrotic tissue
- For deep necrosis, the surgeon excises it down to viable tissue so the wound can be cleaned and closed.
- Vacuum therapy
- According to the European Wound Management Association (EWMA), a vacuum dressing is also used to prepare a wound for skin or flap grafting. At the same time, high-level evidence regarding its effectiveness is still limited.
03
Wound closure
- Suture or graft
- A small clean wound is sutured; a wider one is closed with skin from another area.
- Patches
- A deep defect is closed with tissue with good blood supply — either a local or a microsurgical flap.
04
scar
After healing.
- Scar correction
- A scar remains after necrosis. When the wound has healed and the swelling has subsided, the scar can be corrected — by excision, lipofilling, or laser.
- Smoking
- In 4 randomized studies, perioperative smoking cessation support reduced wound infections, although it showed no impact on other healing complications. Therefore, it is worth quitting smoking before a correction.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Skin necrosis after surgery at the Doctor Valikhnovskyi Institute of Surgery is treated under the direction of "Treatment of Complications of Aesthetic Surgeries" — especially in cases when the surgery was performed at another clinic or abroad. Acute complications — bleeding, hematoma, infection, necrosis — are treated immediately, aesthetic scar correction — after healing and reduction of swelling.
CLINIC SERVICE
Treatment of complications of aesthetic operations
Skin necrosis, dehisced wounds, capsular contracture, liposuction irregularities, and gross scarring.
View service
What we do for this condition
- Dressings — small areas, especially on the face, often heal under dressings.
- Wound cleaning and vacuum therapy — dead tissues are removed, the wound is prepared for closure, if necessary — under vacuum.
- Local flaps and grafts — the wound is closed with adjacent tissues or transplanted skin.
- Microsurgical flaps — for a deep defect, a complex tissue transfer from another area, for example from the thigh, is performed with vessel anastomosis under a microscope; on the face and neck — thin perforator flaps.
- Lipofilling — autologous fat under scar tissue can soften scarred areas.
- Scar care — silicone from the first weeks, fractional laser, and when the scar has matured — excision if needed.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the area, a description of the surgery, and the discharge summary — for preliminary assessment. If there are signs from list 103, call an ambulance first.
- ReviewThe surgeon assesses the boundaries and depth of necrosis, signs of infection, and general condition.
- PlanWhat to do now — dressings, cleaning, vacuum — and how and when to close the wound.
- TreatmentRemoval of dead tissue and wound closure — in one or multiple stages.
- RecoveryRegular dressings, examinations, scar care; the final appearance forms over months.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
The skin near the suture has turned blue. Is this necrosis?
Not necessarily, but it is a sign of impaired blood supply. Immediately contact the surgeon who performed the operation, and if you cannot reach them, go to the emergency department. If confusion, very rapid breathing, or severe chills appear — call 103.
Can I remove the dark scab myself?
No. There may be a deeper wound under the scab. Whether and when to remove it is decided by the surgeon.
Will necrosis heal on its own?
It depends on the depth. Small superficial areas, especially on the face, often heal under dressings. Deep necrosis is removed and the wound is covered.
Will there be a scar?
Yes, a scar remains. The goal of treatment is for the wound to close stably and for the scar to be as inconspicuous as possible. Scar revision is planned after healing.
Does smoking affect it?
Yes. In a meta-analysis of 140 cohorts, the odds of necrosis in smokers were 3.6 times higher. It is better not to smoke before surgery and during healing.
The surgery was performed at another clinic. Can I consult you?
Yes. If possible, first contact the surgeon who performed the operation. Send us photos, a description of the surgery, and the discharge summary — the doctor will tell you what to do next.
What is a vacuum dressing?
It is a dressing under which a device creates reduced pressure: it removes wound exudate and helps prepare it for closure.
Sources
17 sources · systematic reviews, meta-analyses, patient series, EWMA and NHS guidelinesshowCollapse
- Defining Mastectomy Skin Flap Necrosis: A Systematic Review of the Literature and a Call for StandardizationPlastic and Reconstructive Surgery, 2022doi:10.1097/PRS.0000000000008983 ↗
- Mastectomy skin flap necrosis: challenges and solutionsBreast Cancer: Targets and Therapy, 2017doi:10.2147/BCTT.S81712 ↗
- Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysisArchives of Surgery, 2012doi:10.1001/archsurg.2012.5 ↗
- Current evidence on the role of smoking in plastic surgery elective procedures: A systematic review and meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2018doi:10.1016/j.bjps.2018.01.011 ↗
- A Meta-Analysis of Complication Rates Among Different SMAS Facelift TechniquesAesthetic Surgery Journal, 2019doi:10.1093/asj/sjz045 ↗
- The prevention of haematoma following rhytidectomy: a review of 1078 consecutive faceliftsBritish Journal of Plastic Surgery, 2001doi:10.1054/bjps.2001.3623 ↗
- Managing Complications in Abdominoplasty: A Literature ReviewArchives of Plastic Surgery, 2017doi:10.5999/aps.2017.44.5.457 ↗
- Complications of 278 consecutive abdominoplastiesJournal of Plastic, Reconstructive & Aesthetic Surgery, 2006doi:10.1016/j.bjps.2005.12.060 ↗
- Evidence-based insights into medial pedicle reduction mammaplasty: A systematic review and meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2026doi:10.1016/j.bjps.2026.07.023 ↗
- Management of the Ischemic Nipple-Areola Complex After Breast ReductionClinics in Plastic Surgery, 2016doi:10.1016/j.cps.2015.12.011 ↗
- EWMA Document: Negative Pressure Wound TherapyJournal of Wound Care, 2017doi:10.12968/jowc.2017.26.Sup3.S1 ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Necrotising fasciitisNHS, 2026nhs.uk/conditions/necrotising-fasciitis ↗
- Breast reduction (female)NHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/breast-reduction-female ↗
- FaceliftNHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/facelift ↗
- Tummy tuck (abdominoplasty)NHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/tummy-tuck ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
Skin after surgery
has changed color?
First, contact the surgeon who performed the operation. If that is not possible or a second opinion is needed — send a photo and the discharge summary, and the doctor will tell you what to do next.