Hematoma is the most common complication after facelift surgery. In this condition, a pool of blood forms under the skin, causing persistent swelling, discoloration, and other untoward side effects.
If left untreated, large hematomas can coagulate and become a solid lump underneath the skin (leading to poor wound healing and “unnecessary” scarring), while small hematomas often heal on their own without the need for aspiration or surgical removal. A physical examination after facelift will determine the right course of action.
Many variables that contribute to hematoma can be controlled, making appropriate preparation, surgical techniques, and postop care indispensable to minimize one’s risk. Nevertheless, some factors are beyond the control of doctors and patients—For instance, male gender is known as a predisposing cause that about 8 percent of men experience this problem, as suggested by one study.
The hematoma rate in female patients, meanwhile, is 1-3 percent. They are less likely to experience this problem because their facial skin is less vascularized than men especially around the beard area.
Another factor associated with increased risk of hematoma is the use of blood-thinners such as aspirin, non-steroidal anti-inflammatory drugs, anticoagulants, and antiplatelet medications. For this reason, it is a common guideline to avoid them at least three weeks before surgery, or sometimes longer.
Some herbal supplements that can be easily bought over the counter have the same thinning effect on blood. The most common examples include ginkgo biloba, green tea, milk thistle, ginseng, and horse chestnut.
Tobacco products, smoking cessation treatments, and alcohol also have detrimental effects on blood clot formation, leading not just to increased risk of hematoma but also to a wide range of short- and long-term complications such as poor scarring, skin necrosis, and cosmetic results that are less than optimal.
To further avoid or minimize risk of hematoma and its subsequent complications, a normal blood pressure must be maintained before and after surgery. According to a study involving 229 facelift patients, those with uncontrolled hypertension were more likely to experience the problem compared with individuals whose blood pressure was well under control.
Because hypertension is an age-related medical condition, which is not uncommon in facelift patients who are typically aged 50 and above, many plastic surgeons choose to work with their patients’ general physician or specialist to make the elective surgery reasonably safe.
Postoperative factors such as rigorous activities, nausea/vomiting, coughing, and even stress are also known to increase hematoma risk. For this reason, it is a sacrosanct rule to maintain a normal blood pressure and heart rate during the initial healing stage to avoid the pooling of blood underneath the skin.