Evidence of Hematoma Prevention After Facelift.

Abstract

Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed which identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size less than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia over general anesthesia, and strict blood pressure control of at least <140mmHg were found to significantly reduce hematoma formation. The use of quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors (SSRIs), and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunctive measures have been shown to reduce post-operative hematoma formation in facelift procedures.