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Gender, Obstacles, and Perspectives in the Career of Plastic Surgeons in Italy: a Survey-Based Analysis.

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How to Optimally Prepare the Patient for a Facelift Procedure.

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Updated: Jan 17, 2026

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Step-by-Step Guide to Hematoma Prevention After Rhytidectomy: Lessons Learned from 40 Years of Experience.

Niccolò Lazzeri Domar1, Giovanni Botti2, Chiara Botti2

  • 1Department of Plastic and Reconstructive Surgery, Catholic University of Sacro Cuore, University Hospital A. Gemelli, Rome, Italy. n.lazzeridomar@gmail.com.

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|September 20, 2025
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Summary

A 40-year, 3000-case protocol significantly reduces facelift hematoma risk to 0.3%. This evidence-based approach integrates tranexamic acid (TXA), fibrin sealants, hemostatic nets, and blood pressure control for safer rhytidectomy outcomes.

Keywords:
Fibrin glueHematoma preventionHemostatic netHigh SMAS/Extended SMAS faceliftRhytidectomyTranexamic acid

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Area of Science:

  • Plastic Surgery
  • Surgical Complication Management

Background:

  • Postoperative hematoma is a major complication in rhytidectomy, historically reported at rates up to 15%.

Purpose of the Study:

  • To present a structured, experience-based protocol for hematoma prevention in cervicofacial lift procedures.
  • To detail a multimodal approach combining patient selection, surgical technique, and perioperative management.

Main Methods:

  • Retrospective analysis of over 3000 cervicofacial lift cases, focusing on the most recent 500 under a unified protocol.
  • Preoperative: Blood pressure control, avoidance of bleeding-risk medications. Intraoperative: Tranexamic acid (TXA) infiltration, fibrin sealants, hemostatic nets, modified High SMAS/Extended SMAS technique.
  • Postoperative: Pain, anxiety, and blood pressure management.

Main Results:

  • Systematic adoption of the multimodal protocol reduced hematoma rates to approximately 0.3% over the last five years.
  • Synergistic effectiveness demonstrated by the combination of TXA, fibrin glue, hemostatic nets, and blood pressure management.

Conclusions:

  • The protocol offers a reproducible and practical guide for minimizing hematoma risk in facelift surgery.
  • Evidence from a large sample size (3000+ cases) supports the protocol's safety and efficacy in achieving better surgical outcomes.
  • Standardized, multimodal approach leads to significantly safer rhytidectomy with reduced complication rates.