Minimizing complications in the use of fibrin sealant in aesthetic facial procedures

Abstract

Background: Bulky dressings, drains, and postoperative support garments are commonly used after facial aesthetic surgery. Fibrin sealant has been used as a successful alternative in Europe and Japan for more than 20 years but was only recently approved for use in the United States. Objective: We sought to determine whether application of fibrin sealant would eliminate the need for dressings, drains, and garments and provide satisfactory aesthetic results without an increase in postoperative complications. Methods: Fibrin sealant was used in 105 patients undergoing 128 facial aesthetic procedures, including face lifts, coronal brow lifts, temporal tucks, midface rejuvenations, and neck lifts. The surgical techniques performed were unchanged from those used by the senior surgeon without the use of the sealant. The sealant was applied only after achievement of complete hemostasis. In response to a number of complications, methods were developed to minimize pooling, ensure homogeneous application, and stabilize flaps until the sealant had “set” for a specified time. No drains, dressings, or support garments were used during the postoperative period. Results: Although successful aesthetic results and increased patient satisfaction with the surgical experience were achieved, unexpected complications, including 10 cases of seroma and 5 cases of skin necrosis, occurred early in the series. These complications were traced to problems in the preparation and application of the fibrin sealant, including failure of the sealant material to dissolve properly during preparation, improper patient positioning, inconsistent application of the sealant, and timing of the application. Once these problems were identified and rectified, no further complications occurred. Conclusions: Fibrin sealant can be used effectively in facial aesthetic surgery. Careful attention to the preparation and application of the sealant will prevent postoperative complications.