Facelift Complication and Techniques to Minimize It.


A facelift is also known as a rhytidectomy in the medical literature. It is one of the most popular cosmetic surgical procedures performed and can consistently be found in the top five in the United States.

Although the satisfaction rate is very high, a facelift is not without known complication risks. One of the most common significant complications is a hematoma. In this case, a hematoma is a collection of blood underneath the skin. The incidence ranges but overall is less than 10% and varies in size and complexity.

Common reasons for hematoma formation are high blood pressure, anticoagulants, herbal supplements, and nonsteroidal antiinflammatory medications. Early post-operative vomiting may contribute to hematoma formation as well.

For the most part, a hematoma is easily managed in the office without the need of the operating room. The facial skin overlying the hematoma is usually numb and this is advantageous to the patient and surgeon. The fluid can be easily milked out from behind the ear between sutures or directly aspirated with a syringe and needle. Again, this approach is typically very comfortable for mild to moderate hematomas. Some surgeons like to place drains for one to three days in attempt to drain any fluid such as blood. Commonly this does not stop the formation of a hematoma and the previously stated interventions must be employed. Patients do not enjoy the presence of drains and I find them mostly useless, therefore I do not place them. Personally, I leave a few millimeters between the sutures behind the ear so that fluid can be comfortably evacuated with minimally invasive techniques the day after surgery if needed. The gap between sutures is cosmetically insignificant and unnoticeable to the patient or any observer.

Operative techniques to diminish the rate of facelift hematomas were recently mentioned in the Plastic and Reconstructive Surgery Journal. The superwet technique was thought to decrease this risk and was promoted by the lead surgeon. I am in fully agreement with the use of this technique and I utilize it with every facelift procedure. It involves the placement of a significant amount of numbing fluid throughout the planned facial rejuvenation. The superwet fluid provides numbness, assists in creating a bloodless field, and establishes the dissection plane by gentle hydrodissection. A strong command of hemostasis is key to preventing a hematoma.

Employing the superwet technique also allows me to perform my facelifts under local anesthesia with light intravenous sedation administered by a board certified anesthesiologist. The absence of general anesthesia makes this procedure safe and shortens the recovery process in many ways.

A facelift is a very rewarding, safe, and popular cosmetic procedure. Choose a board certified Plastic Surgeon who specializes in facial rejuvenation procedures and demonstrates excellent before and after photos.

Justin Yovino MD FACS is a Beverly Hills double board certified Plastic Surgeon who specializes in facelifts.

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Beverly Hills Plastic Surgeon