Hemostatic Net in Facial Aesthetic Surgery: A Systematic Review and Meta-Analysis

Hematoma is the most frequent and consequential complication after rhytidectomy. The hemostatic net (HN)-a temporary transcutaneous lattice anchoring the flap to the SMAS-platysma-aims to eliminate dead space and minimize shear. Earlier reviews were limited by small samples and methodological heterogeneity. This updated systematic review and meta-analysis synthesizes all available evidence to quantify HN safety and efficacy in facial aesthetic surgery.

Following PRISMA 2020 and Cochrane guidelines (PROSPERO CRD420251149130), PubMed, Scopus, and Cochrane Library were searched through September 2025. Comparative and single-arm studies reporting hematoma, necrosis, seroma, or hyperpigmentation were included. Random-effects DerSimonian-Laird models generated pooled odds ratios (OR) and proportions with 95 % confidence intervals (CI).

Thirteen studies encompassing 3264 unique patients (2175 HN treated) met inclusion criteria; six were comparative. In cervicofacial rhytidectomy, HN reduced the odds of hematoma by 93% compared with drain-based closure (OR 0.07; 95% CI 0.02-0.24; P < .0001; I² = 25%). No difference in necrosis was observed (OR 0.73; 95% CI 0.20-2.63; P = .63; I² = 0%). Single-arm pooled rates were hematoma 1.09%, seroma 1.66%, necrosis 0.96%, and persistent hyperpigmentation 0.28%; these are descriptive estimates of incidence and do not support comparative inference. Sensitivity analyses confirmed robustness.

In cervicofacial rhytidectomy, HN was associated with lower odds of hematoma than drain-based closure, without an increase in skin necrosis. Single-arm analyses provide descriptive estimates of low absolute complication rates, including in gliding brow lift, but do not establish comparative effectiveness outside rhytidectomy. Pigmentary change at suture entry sites is the most frequent visible adverse event and, although usually self-limited, may take up to three months to resolve and warrants explicit preoperative counseling. Evidence derives predominantly from non-randomized studies, and pooled estimates should be interpreted as hypothesis-generating.

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