Minimizing Risk of Hematoma Formation after Rhytidectomy

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Background

Since its introduction in the early 1900s, rhytidectomy, or “facelift,” has been one of the most commonly performed cosmetic procedures in facial plastic and reconstructive surgery for treatment of the aging face. Despite tremendous advancements in surgical technique and technology, the risk of hematoma remains significant as the most frequently encountered postoperative complication. The rate of hematoma after rhytidectomy ranges from 0.2% to 8% in the literature and is generally accepted to develop on average in around 3% to 4% of cases. The most well-described risk factors are high blood pressure and male gender, with males having more than double the complication rate as compared to females in some studies. Additional associations have been found with recent aspirin or nonsteroidal anti-inflammatory use, performance of anterior platysmaplasty, and smoking. Interestingly, large-scale studies have not demonstrated a significant relationship with facelift technique, revision surgery, anesthesia type, or patient age and comorbidities other than hypertension.

Hematomas may range in severity from minor bruising necessitating only conservative management to large expanding collections that require aggressive surgical drainage and may even pose a threat to the airway in extreme cases. Potential adverse sequelae include increased patient discomfort, need for additional intervention, higher infection rate, and the risk for delayed wound healing, skin flap necrosis, and scarring. Numerous methods have been employed over the years in attempt to prevent hematoma formation after facelift; however, there still exists a significant variation in clinical practice. The most commonly used techniques are drain placement, compression dressings, and the use of tissue sealants. This review describes the evidence available from current literature to support a best practice for minimizing the risk of hematoma formation following rhytidectomy.

Best Practice

The incidence of hematoma following rhytidectomy remains significant despite a variety of preventative methods including drains, tissue sealants, tumescent infiltration, compression dressings, and pharmacologic interventions. Although definitive risk factors for hematoma formation have been identified, such as the presence of elevated preoperative systolic blood pressure and male gender, the occurrence of this complication is still largely random and unpredictable, which can be frustrating to both patient and surgeon.

Certainly, there is no replacement for meticulous surgical technique and adequate intraoperative hemostasis in reducing the risk of postoperative hematoma after rhytidectomy. If proper hemostasis is not achieved prior to closure, there is no drain or dressing that can reliably prevent postoperative complications from occurring.