Expanding hematoma in face-lift surgery: literature review, case presentations, and caveats

Postoperative expanding hematoma is the most common complication seen in face-lift surgery. It has been described in 0 to 15% of all cases, and if not promptly recognized and treated, severe ischemic flap changes, with resultant necrosis, can occur. In addition, postoperative hematoma can frequently occur after normal office hours, and an organized plan of action needs to be established to effectively deal with this unpredictable complication.

The objective of this article is to review the current face-lift literature and the author's experience, to present the salient features of postoperative hematoma, and to alert surgeons to the prompt recognition and treatment of major hematomas following face-lift surgery.

A review of the face-lift literature concerning postoperative expanding hematoma and its causes and treatment is presented. In addition, the author's experience and hematoma rate are reviewed, along with several case presentations.

It is well known that critical postoperative hematomas occur in face-lift surgeries. No predictable set of signs or symptoms has been identified to diagnose which patients present a risk of postoperative hematoma. Common themes in patients who have experienced hematoma following face-lift include male gender, preoperative medications that affect coagulation, perioperative and postoperative blood pressure spikes, postoperative activity, nausea, vomiting, and retching. The prompt recognition and treatment of postoperative face-lift hematoma are generally easily accomplished with common hemostatic techniques, and the surgical site most frequently heals without major complications.

Major expanding hematomas have been reported in 0 to 15% of facelift surgeries, with an average of 2 to 4%. There do not appear to be any common recognizable screening factors to determine who is at risk. Close attention needs to be paid to the preoperative medical history, medication regimens, perioperative blood pressures, postoperative activity, and nausea and vomiting. Because most hematomas occur in the first 12 hours after surgery, their recognition and treatment may be after normal office hours, requiring a preemptive and organized plan of action. Significant complications are uncommon when hematomas are promptly recognized and treated. In 140 consecutive face-lifts, the author's hematoma rate was 1.4%.