A Systematic Review of Rhytidectomy Complications and Prevention Methods: Evaluating the Trends

Facelift, also known as rhytidectomy, is one of the most common aesthetic surgical procedures performed by plastic surgeons. The goal around finding the ideal facelift revolves around cosmetic outcome, ability to maintain long term results, and minimizing complications. Known complications in facelift surgery include hematomas, seromas, neurapraxia, and unfavorable scars. With the growing popularity of facelifts and the constant evolution, our study aims to evaluate the complications and interventions reported since 2000 and examining any changes and trends.

A systematic review was performed through PubMed using keyword search in the following combinations: "facelift," "face lift," "complication," "management," "perioperative," and "prevention." The search was restricted from publication years 2000 until day of search (August 2024). The search was designed to find studies that reported facelift-related complications rates and studies that analyzed interventions to help reduce facelift complications.

A total of 59 articles were found to meet the inclusion criteria for analysis of complications. Twenty-seven articles were included in the study from 2000 to 2012, whereas 32 articles from 2013 to 2024. A total of 39 studies were included for the analysis of interventions. From 2012 to 2024, hematoma remained the most common reported complication (27% of all complications), followed by unfavorable scarring (24%), neurapraxia (22%), and seroma (7%). Neurapraxia and unfavorable scar complications were reported twice as much, whereas seroma complications decreased by half in studies from 2012 to 2024. Hematoma rates remained similar. The use of fibrin glue/sealant was the most analyzed intervention, followed by use of TXA, quilting sutures, and blood pressure control.

The rates of complications in rhytidectomy are low. When compiling all the reported complications, hematomas made up 1/3 of all complications with similar reports from 2000 to 2012 compared to 2013 to 2024. Unfavorable scarring and neurapraxia reports doubled in the latter half of the study, whereas seroma reports decreased by half. This could be attributed the use of tissue sealants and local pharmacologic agents. Complications can occur, and it remains essential to recognize the complications and prevention methods available.