What helps reduce bruising after a facelift?

Reducing Bruising After Facelift

Strict blood pressure control maintaining systolic BP <120 mmHg postoperatively is the single most effective evidence-based intervention to reduce bruising and hematoma formation after facelift surgery. 1

Primary Blood Pressure Management

Maintain systolic blood pressure below 120 mmHg throughout the perioperative period, as this has been demonstrated to reduce hematoma rates from 3.76% to 0.5% with no adverse events in a large consecutive case series. 1 This represents a more aggressive target than the traditional <140 mmHg threshold and provides superior outcomes. 2, 1

• Prophylactic management of hypertension should begin preoperatively and continue through the immediate postoperative period 2
• Treat any systolic readings ≥120 mmHg promptly with antihypertensive medications 1
• Monitor blood pressure continuously in the recovery period to catch early elevations 1

Tranexamic Acid (TXA) Infiltration

Local subcutaneous infiltration of tranexamic acid combined with lidocaine and epinephrine significantly reduces bleeding, operative time, and postoperative drainage. 3

• Use 1-2 mg/mL TXA combined with 0.5% lidocaine and 1:200,000 epinephrine for subcutaneous infiltration 3
• This technique achieved mean time to hemostasis of only 6.4 minutes per side 3
• Postoperative drain output averaged 13.9 mL on day 0 and 15.1 mL on day 1, allowing drain removal by postoperative day 1-2 3
• TXA works by inhibiting plasmin and plasminogen, preventing fibrinolysis and reducing rebound bleeding 4, 3

Fibrin Glue Tissue Sealants

Fibrin glue tissue sealants have been shown to significantly reduce hematoma formation in facelift surgery. 2

• These agents have both hemostatic and sealant properties demonstrated in multiple randomized controlled trials involving vascular, bone, skin, and visceral surgery 4
• Apply fibrin sealants to raw tissue surfaces after flap elevation 4

Anesthetic Technique

Local anesthesia is superior to general anesthesia for reducing hematoma risk. 2

• Local anesthesia allows better intraoperative blood pressure control and reduces the hemodynamic fluctuations associated with general anesthesia 2
• Patients under local anesthesia can communicate discomfort from rising blood pressure, allowing earlier intervention 2

Prophylactic Symptom Management

Aggressive prophylactic management of pain, nausea, and vomiting significantly reduces hematoma formation by preventing increases in intrathoracic pressure and blood pressure spikes. 2

• Prescribe antiemetics prophylactically to prevent vomiting-induced pressure increases 2
• Provide adequate pain control to prevent hypertensive responses 2
• Avoid constipation which can cause straining and increased intrathoracic pressure 2

Perioperative Medication Management

Supplements to Hold

Hold ginger for 2 weeks preoperatively due to laboratory evidence of decreased platelet aggregation, though human trial results are mixed. 4

Hold ginkgo for 2 weeks preoperatively as ginkgolide B decreases coagulation by displacing platelet-activating factor, despite meta-analyses showing no significant bleeding effect. 4

Supplements That May Continue

Fish oil/omega-3 fatty acids may be continued as prior concerns about bleeding risk have not been supported by prospective studies. 4

Green tea extract may be continued until surgery, as while it may theoretically increase bleeding risk, the benefits to cardiac function are considered to outweigh concerns. 4

Interventions Without Proven Benefit

Homeopathic arnica does not reduce bruising or swelling despite widespread belief in its efficacy. A randomized placebo-controlled trial showed no difference in pain (P=0.79) or bruising (P=0.45) between arnica 30C, 6C, or placebo groups. 5 The conflicting studies about arnica's efficacy for postoperative bruising and swelling, combined with potential antiplatelet effects, suggest it should be avoided. 4, 5

Compression dressings, drains, perioperative SSRIs, and perioperative steroids have no significant effect on hematoma formation and should not be relied upon as primary preventive measures. 2

Postoperative Lymphatic Management

Manual lymphatic drainage initiated on postoperative day 3-5 can help reduce edema and bruising, but must be performed by a trained professional using techniques specific to post-facelift patients (not standard lymphatic drainage protocols). 6

• Lymphatic networks remain damaged for at least 7 days post-surgery, as demonstrated by gamma camera studies showing no absorption of lymphatic tracers. 6
• Cold compresses (such as decongestive cold tea) can be applied starting on postoperative day 2 6
• Avoid tight platysma plication and elastic bandages on the neck, as these increase venous congestion and worsen facial edema 6

Common Pitfalls to Avoid

• Do not rely on the traditional <140 mmHg threshold—the evidence supports a more aggressive <120 mmHg target 1
• Do not use elastic bandages tightly on the neck, as these significantly increase peripheral venous pressure and worsen congestion 6
• Do not perform standard lymphatic drainage techniques—post-surgical drainage requires specialized reverse techniques 6
• Do not assume drains prevent hematomas—they have no proven benefit for hematoma prevention 2