Face and Neck Lift Article 7

Complications of Facelift

Hematoma is most common. Its incidence has been recorded in various series as ranging from 1% to 8%, with an average of about 4%. Discontinuation of medications such as aspirin and other non-steroidal anti-inflammatory drugs is paramount. If the patient has high blood pressure, the blood pressure must be well controlled prior to the facelift surgery. The patient’s intraoperative and postoperative elevations in blood pressure and the occurrence of nausea and vomiting will be prevented to the extent possible.

Hematoma occurs in a disproportionately higher percentage of male face lift patients. In addition to the usual measures of hemostasis, blood pressure and pain control, careful observation must be intensified with the male face lift patient.

Acute hematomas

Acute expanding hematomas usually occur in the first 6 hours of the postoperative period. When the patient complains of pain and develops sudden increasing swelling often accompanied by increasing ecchymosis in the periorbital area, a hematoma is almost always present, and the dressings should be removed for better inspection. If, as is common, the hematoma is localized in the postauricular and lateral neck area, an initial attempt should be made immediately in the recovery room to evacuate the hematoma with suction and to control the bleeding by applying local firm pressure for a time.

A long 3- to 4-mm-diameter liposuction cannula accomplishes the evacuation well when it is passed down between the postauricular sutures. The suction effectively removes the collected blood, and the pressure applied to the wound area combined with control of blood pressure elevation solves the problem most of the time.

Late Hematomas

Late hematomas typically occur between days 7 and 10 after a face lift. The bleeding is almost always arterial from an injured branch of the superficial temporal artery that reopens because of an abrupt elevation in blood pressure that dislodges a clot off the area of injury. Patients must be cautioned about their activity for a full 2 weeks; they are required to abstain from any exertional activity that would elevate blood pressure, including sex. Surgical exploration of a late hematoma is almost always mandatory to locate and to ligate the bleeding arterial branch.