Methods for Minimizing Bleeding in Facelift Surgery: An Evidence-based Review

Abstract

INTRODUCTIONFacelifts are in the top five aesthetic procedures performed in plastic surgery. In 2019, almost 124,000 facelifts were performed in the United States per the American Society of Plastic Surgery. 1 Bleeding and hematomas arise in facelift surgery secondary to disrupted vascular and lymphatic networks as skin flaps are elevated, which may lead to postoperative complications and unsatisfactory patient outcomes. 2 Hematoma is the most common postoperative complication in facelifts with a reported incidence from 0.2% to 8%. 3 The pressure of an expanding hematoma on the overlying skin flaps may decrease arterial perfusion, cause venous congestion, and increase inflammation that may lead to skin irregularities. While expanding hematomas require immediate re-exploration, minor hematomas of smaller volume may be aspirated. Predisposing risk factors to hematoma in facelift surgery include male gender, history of hypertension, and coagulopathy. 4 Multiple methods have been developed, and new evidence continues to be generated about how to best manage bleeding in facelifts. This literature review aims to summarize evidence-based methods in minimizing bleeding and postoperative hematoma in facelift surgery. METHODSAn evidence-based review of methods used to minimize bleeding in facelift surgery was conducted using the PubMed database adhering to PRISMA guidelines (Fig. 1). Inclusion criteria entailed randomized controlled trials, prospective/ retrospective cohort and case-control studies, and case series. Exclusion criteria included (1) lack of availability Disclosure: Dr. Jeffrey Janis receives royalties from Thieme and Springer Publishing.

Office-based Plastic Surgery—Evidence-based Clinical and Administrative Guidelines

“…5,24 Intraoperative events, such as hypothermia or bleeding, increase postoperative morbidity, and equipment should be ready to prevent and treat such incidents. 16,24,[49][50][51][52] The CDC establishes sterility and disinfection protocols adopted by many hospitals; officebased practitioners should use such a model as well. 53 Ultimately, meticulous adherence to proper sharps and sterile technique is best for ensuring surgical safety.…”

Tranexamic Acid in Tumescence for Cervicofacial Rhytidectomies

“…4 To minimize postoperative bleeding, surgeons have resorted to various measures such as tissue or fibrin glues, pressure dressings, drains, wetting solution infiltrate, and tranexamic acid (TXA). 5 Hematomas, both major and minor, have a reported occurrence of 0.2%-8%. 5 This event often results in longer recovery times and can lead to a diminution of patient satisfaction.…”

“…5 Hematomas, both major and minor, have a reported occurrence of 0.2%-8%. 5 This event often results in longer recovery times and can lead to a diminution of patient satisfaction. 5 As mentioned above, TXA is a medication used in minimizing blood loss during facelift procedures.…”

“…5 This event often results in longer recovery times and can lead to a diminution of patient satisfaction. 5 As mentioned above, TXA is a medication used in minimizing blood loss during facelift procedures. The effectiveness of TXA has been widely accepted across several fields, but the mode of administration differs.…”

Safety and Outcomes in Multiplane Facial Rejuvenation with Tranexamic Acid: A Cohort Study

“…[5][6][7][8][9][10][11][12][13] The development of hematoma is one of the most important complications of facial surgery, with a reported incidence of 1%-8%. [14][15][16][17] Moreover, significant intraoperative bleeding can lead to severe local and systemic complications. Several methods have been developed to decrease bleeding such as perioperative blood pressure management, compression dressings, drains, tissue sealants, and tranexamic acid (TXA), with variable results.…”