Late bleeding after rhytidectomy from injury to the superficial temporal vessels

Five healthy, normotensive women, whose mean age was 49.8 years, developed expanding hematomas between 8 and 10 days (average 9 days) after rhytidectomy. In each patient, the bleeding vessel could be identified: In two, it was the parietal branch of the superficial temporal artery; in two, it was the parietal branch of the superficial temporal vein; and in one, it was the superficial temporal artery immediately before its branching. Contributing factors may have been sudden physical exertion in four of the five patients and in another salicylate ingestion. Several measures can help avoid late bleeding from the superficial temporal vessels or their branches; not using a too potent vasoconstrictive agent (epinephrine) in the local anesthetic so that the vessels will be easier to visualize; not injecting the local anesthetic too deeply or incising to deeply; dividing and ligating the superficial temporal vessel and its major branches if injured; using bipolar coagulation on small branches; and instructing patients repeatedly not to engage in strenuous activity or to ingest salicylates for at least 2 weeks after operation.