Duration of Postoperative Compression After Facelift
Compression dressings should be worn continuously for 24-48 hours after facelift surgery, then discontinued once the patient is ambulatory and drains are removed. 1
Evidence-Based Compression Protocol
Immediate Postoperative Period (0-48 Hours)
Apply compression dressings immediately after surgery and maintain continuously for the first 24-48 hours to minimize dead space and reduce hematoma risk during the highest-risk period. 1
Most hematomas (the primary complication compression aims to prevent) occur within the first 12 hours postoperatively, making this the critical window for compression therapy. 2
The fundamental principle is that compression works by enhancing venous return during periods of dependency and activity, not during recumbency, which limits its utility beyond the immediate postoperative period. 1
After Initial 48-Hour Period
Remove compression dressings once the patient is fully mobile and drains are removed (typically 24-48 hours postoperatively), as continued compression provides no additional benefit and may cause discomfort. 1
Compression stockings and dressings are unnecessary and potentially uncomfortable during sleep when lying flat, as venous return is not compromised in the recumbent position. 1
Do not continue compression for extended periods like 28 days, as this practice lacks evidence and contradicts the physiologic rationale for compression therapy. 1
Critical Distinction: Compression vs. Hematoma Prevention
The evidence reveals an important nuance: compression dressings have NOT been shown to significantly reduce hematoma formation in facelift surgery. 3 The most effective hematoma prevention strategies are:
Prophylactic administration of analgesics, antihypertensives, antiemetics, and sedatives before extubation (reduces hematoma rate from 7% to 0%). 4
**Strict blood pressure control maintaining systolic BP <140 mmHg perioperatively**, as preoperative SBP >160 mmHg and operating room peak SBP >165 mmHg are independent risk factors for hematoma. 5
Use of fibrin glue tissue sealants and local anesthesia rather than general anesthesia. 3
Common Pitfalls to Avoid
Improperly fitted compression dressings that are too tight can cause skin breakdown, with a 5% risk of skin complications (RR 4.18,95% CI 2.4-7.3). 1
Do not confuse facelift compression protocols with thromboprophylaxis compression stockings, which serve an entirely different purpose and follow different duration guidelines. 1
Recognize that male gender, history of hypertension, and aspirin use are the primary risk factors for hematoma, not inadequate compression duration. 6, 5
Most hematomas requiring intervention occur after normal office hours, so establish a preemptive plan for recognition and treatment rather than relying on prolonged compression. 2