From the Research
The incidence of hematoma in facelift surgery ranges from 1-8%, making it the most common major complication of this procedure, as reported in the most recent study 1.
Risk Factors and Prevention Strategies
The risk of hematoma is higher in men (7-9%) compared to women (1-3%), likely due to differences in vascularity, blood pressure, and facial hair. Other risk factors include uncontrolled hypertension, anticoagulant use, smoking, and extensive surgical dissection. Prevention strategies include:
- Meticulous hemostasis during surgery
- Blood pressure control (keeping systolic pressure below 150 mmHg)
- Head elevation postoperatively at 30-45 degrees
- Avoiding medications that affect coagulation (aspirin, NSAIDs, vitamin E) for at least 2 weeks before surgery Some surgeons use drains or compression dressings, though their effectiveness remains debated, as shown in studies 2, 3, 4, 5.
Management of Hematoma
If a hematoma occurs, prompt evacuation is necessary to prevent skin necrosis, prolonged edema, and poor aesthetic outcomes. Small hematomas may be managed with needle aspiration, while larger ones typically require a return to the operating room for evacuation and identification of bleeding sources. The use of tissue sealants, such as fibrin tissue adhesives and platelet-rich plasma, may reduce postoperative drainage, ecchymosis, and edema, as reported in studies 4, 5.
Key Takeaways
- The incidence of hematoma in facelift surgery is significant, ranging from 1-8% 1.
- Risk factors include male gender, uncontrolled hypertension, anticoagulant use, smoking, and extensive surgical dissection.
- Prevention strategies, such as meticulous hemostasis, blood pressure control, and avoiding medications that affect coagulation, can reduce the risk of hematoma.
- Prompt evacuation of hematoma is necessary to prevent complications and poor aesthetic outcomes.