Hematomas requiring surgical evacuation following face lift surgery

This study evaluates hematomas requiring surgical evacuation following a face lift. Twenty-three hematomas occurred with 1236 consecutive face lifts (1.86 percent). All hematomas occurred within 48 hours. Fifty-seven percent were identified at less than 15 hours, 26 percent from 15 to 24 hours, and 17 percent from 24 to 48 hours. The incidence of hematomas for surgeons who performed more than 50 face lifts in this study varied from zero to 3.83 percent. This difference in incidence was statistically significant. A multivariant analysis of predetermined variables was done. Age, preoperative tests, medical history, gender, perioperative medications, type of anesthesia, number and combination of procedures, and treatment of the SMAS did not independently affect the incidence of hematomas. Preoperative and postoperative blood pressure did not affect the incidence. The incidence of hematomas with general anesthesia in this study was 7 of 630 (1.11 percent). In a similar 1973 study at this institution, the incidence with general anesthesia was 3.26 percent. This improvement was attributed to a change in anesthetic technique. Intraoperative hypotension was avoided in the current series. The incidence of hematoma in the local anesthesia group was 3.72 percent, and in the monitored intravenous sedation group it was 0.87 percent. Meticulous hemostasis, done with the patient's blood pressure in a normotensive state, appeared to be of primary importance.