Hematoma, a blood collection under the skin after surgery, is one of the major risks of any surgery, but it is particularly important after facelift surgery. We know certain things increase your risk of hematoma. You are at higher risk if:
- male
- anticoagulant use (blood thinners for afib/history of blood clots, baby aspirin, NSAIDS, collagen, fish oil)
- high blood pressure
- increased intrathoracic pressure (can be from things like straining, coughing, lifting something heavy)
- operative technique.
This study was in the February 2024 Aesthetic Surgery Journal. “Evidence of Hematoma Prevention After Facelift” a Review Article. It was a overview of the existing literature to try to see what actually helps lower the risk? They looked at 478 manuscripts and abstracts and after criteria were met, they focused of 45 articles.
What did they find?
What does seem to help:
- prophylactic management of pain and nausea
- following blood pressure and managing it if too high
- the use of fibrin glue tissue sealants
- local anesthesia rather than general anesthesia (though many of us use both)
- strict blood pressure control of at least <140mm HG
- In high risk patients, quilting sutures showed benefits
What didn’t seem to help?
- drains
- compression dressing
- perioperative use of serotonin reuptake inhibitors
- perioperative steroids
My thoughts?
This is good information. Hematoma formation frequently is small and can be drained easily with a small needle in the office. If it is larger, it may require a take back to the operating room to stop whatever is bleeding. But even small hematomas can delay healing, causing more bruising and swelling. They can cause distortion of the tissue. Hematomas can lead to more inflammation and scarring.
I thought it was interesting that some things we were taught in training, like using a drain or compression, were not effective. There also seems to be a big focus on blood pressure management (see my blog on keeping blood pressure low after facelift). If you are nauseous or in pain, that can raise your blood pressure (and is just no fun), so that is not surprising.
Overall, good advice. And for those of you at high risk- men, those with a history of high blood pressure, on blood thinners- being a really good patient is key. Nausea? Take your medication. In pain? Don’t be stoic. Take your medication. If you have a history of high blood pressure, use your at home blood pressure cuff and monitor your blood pressure. If it is over 140/90, there are medications we can use to help lower your blood pressure and reduce your risk.