Prevention of acute hematoma after face-lifts

Acute hematoma remains one of the most frequently encountered complications after face-lift surgery. Several risk factors inherent to the patient and omission of certain intraoperative regimens are considered to cause hematoma. Significant risk factors include high blood pressure and male gender. Possible intraoperative regimens for the prevention of hematoma include tumescence infiltration without adrenaline, clotting of raw surfaces with fibrin glue, usage of drains, and application of compression bandages. However, little attention has been paid to postoperative measures. To examine whether different regimens in the postoperative phase can influence the incidence of hematoma, all face-lift patients who underwent surgery by a single surgeon in two different clinics (n = 376) with two different postoperative regimens were evaluated over the course of 3 years. In group 1 (n = 308), all postoperative medication was administered on request including medication for pain control, blood pressure stabilization, and prevention of nausea and vomiting as well as postoperative restlessness and agitation. In group 2 (n = 68), this medication was administered prophylactically at the end of the operation before extubation. The hematoma rate was 7% in group 1 and 0% in group 2. This study showed that the prophylactic use of medications (e.g., analgesics, antihypertonics, antiemetics, and sedatives) during the postoperative phase is superior to making drugs available to patients on request and can decrease the occurrence of acute hematoma in face-lift patients.