I am considering a facelift, however I'm concerned about hematomas. Can you tell me the causes of these after facelifts? Are there things that I can do to prevent one from happening? Do they have anything to do with the expertise of the surgeon?
How to Avoid Bruising After Facelift?
Doctor Answers 45
Bruising can be reduced after facelift!
Everyone experiences some bruising after face lift type of procedures. This is true for even the smaller or "mini lift" surgeries as well. While all bruising can not be eliminated here are some steps to reduce the bruising and speed your recovery.
Before the procedure avoid platelet inhibitors such as aspirin, Motrin, Advil, aleve etc. Tylenol is OK. Obviously intended blood thinners such as Plavix and coumadin need to be stopped ahead of your procedure. Also avoid excess vitamin supplements. Vitamin E in particular is a blood thinner. Your doctor can provide you with a list of medications, vitamins and supplements to avoid. I tell people to stay away from these agents about 10 days to two weeks before surgery.
I recommend patients use arnica montanica during the perioperative period. This is now available in convenient capsules that you begin taking the evening before surgery and continue to do so for a few days after the procedure. The bruising seems to disappear about 3-4 days earlier in the patients using the arnica.
Following surgery, I also recommend elevating the head, using cool compresses and avoiding strenuous activities. You should also avoid alcohol after surgery. Alcohol is a vasodilator, meaning it opens the blood vessels and this can contribute to more bruising.
Combining the above, most patients are able to participate in social act ivies about 10 to 14 days after their surgery.
How to reduce bruising after a facelift
Some bruising after a facelift is to some extent inevitable. However the extent of bruising can be minimized, sometimes dramatically. Many "small things" actually add up to a significant difference in the postoperative course.
Every facelift patient in our practice goes to a licensed aftercare facility. The registered nurses at the aftercare make sure the blood pressure does not get too high, a primary cause of bleeding after surgery. In addition to increasing patient comfort and well being, the RN at the aftercare has specific medicines to reduce anxiety, control blood pressure, control postoperative pain
Meticulous, speedy surgery
When surgery is meticulously performed by a very experienced facelift expert, the bleeding is minimal. If surgery can be performed before the local anesthetic wears off, bruising is minimized. It is pleasantly surprising how many patients who considered themselves "bruisers" actually can have an uneventful recovery. The timing and skill of developing an expert technique takes many years and thousands of surgical cases. A seasoned surgical team is also vital to perform dressings in a standardized, consistent, safe, protective fashion.
Board certified doctor anesthesiologists
Having an anesthesiologist with hospital credentials who has specialized in cosmetic surgery is important, in my opinion. They have specialized skills to avoid nausea, high blood pressure, risks during surgery. It does make a difference.
We no longer routinely use drains with facelift surgery. The amount of bruising has been greatly reduced with this technique. Remember if there is a drain between the skin and the deep tissues, the tissues cannot stick together in all the locations where the drain is. When the drain is removed, it can further separate the layers as it comes out. The tissue thromboplastin, natural clotting mechanisms cannot stick the skin down because the layers are actually separated by a plastic drain. Of course if the patient has oozing in surgery, a drain may be necessary, but the chance of this is low in our practice.
Every facelift patient receives a stress test before surgery and a thorough workup from their doctor. The doctor is asked to optimize the patient's health and blood pressure well in advance of the surgery. The patient doesn't take medicines that promote bleeding.
These factors above may all seem trivial, but they are not. If any single step above is missed, the patient will be at higher risk for a complication, including excessive bruising and all the sequelae of that down the road (firmness under the skin, unevenness of results). There is a world of difference between on one hand a medically prepared patient having a procedure in expert hands, recovering in an aftercare facility, and on the other a sloppily prepared patient with borderline hypertension who goes right home after their surgery with a novice or untrained surgeon, nauseated from a clumsy anesthetic.
Tips to Minimize bruising
The reality is that a well done Facelift requires a relatively large area of soft tissue mobilization. The degree of tissue mobilization often equates to the degree of bruising a patient experiences. In my anecdotal experience, a longer procedure generally correlates with more bruising. Therefore, if you are having multiple procedures done (Facelift, brow lift, eyelid surgery), the extent of bruising is likely to be greater. However, If you are in the hands of an experienced Facelift surgeon, there isn't too much correlation with the degree of bruising and who is doing it.
Facts on hematomas after Facelift: 1) A hematoma is a clinically significant bruise because it represents a clot of blood underneath the skin that can threaten the viability of the skin. 2) Hematomas require drainage in order to preserve skin viability and prevent adverse scarring. 3) Hematomas can and do happen in virtually every surgeons hands. 4) Previous posts have outlined scenarios where a hematoma is more likely to happen. However, the occurrence of this problem can be unpredictable.
Things a patient can do to minimize bruising and/or hematoma: 1) Avoid aspirin and other medications in the non steroidal anti-inflammatory class for 2 weeks prior to surgery. 2) Avoid vitamin E containing products, fish oil, St. John's Wort, Ginkgo, and other exotic and /or other homeopathic treatments for a similar period. In my practice, a list of medications to avoid is provided. 3) If you have high blood pressure and it is not controlled, you need to have this issue dealt with prior to surgery. 4) If you have a history of frequent nose bleeds, easy bruising, heavy periods, this needs to be disclosed preoperatively. 5) Activity restrictions after Facelift are real. If you are too active, the chances of forming a hematoma increase exponentially. Follow your surgeon's activity restrictions.
Things a Surgeon can do to prevent hematoma: 1) Compressive dressing. In my practice, a dressing is placed immediately after surgery, then replaced on the 1st postoperative day. After this period, an elastic strap is worn. This is my preference and works well with my patient population. 2) Some Surgeons place drains in the patient and achieve good results. Drain placement is likely to vary between Surgeons' training, experience, and preference. 3) Postoperative Arnica Montana. This is a homeopathic medication which helps minimize bruising. 4) Use of postoperative anti nausea agents and use of narcotic pain medication only when absolutely necessary. Narcotic medications tend to induce nausea and emesis. Pstoperative vomiting increase blood supply to the face and therefore increase risk of hematoma.
Good luck with your surgery!
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Bruising and Hematoma after Face Lift Surgery
Bruising is very common and not considered a complication with this plastic surgery. A hematoma is a collection of blood under the skin which should normally be drained is a complication. Hematoma is the most common complication with face lift surgery, with an overall estimated incidence of less than 5%. Most hematomas occur within 24hours after the face lift surgery, but may occur several days afterward too.
The most significant risk factors for bleeding with face and neck lift surgery are the following:
- platsymaplasty or neck surgery
- blood thinners, including herbal medication, ibuprofen, aspirin, and similar medications
While experience plays a role, it is not as important risk factor as those outlined above. The best face lift surgeons in the world still get hematomas.
By following the strict presurgical and postsurgical care instructions of your plastic surgeon, you will reduce the chance you will develop a hematoma after your cosmetic surgery. Best of luck.
Bruising after a facelift
Reducing Bruising and Avoiding Hematoma After a Facelift
During a normal recovery from a facelift some bruising is expected. It usually occurs low in the neck and resolves over 7 - 10 days. Bruising can be reduced by the following measures:
1. Stop all blood thinning medications, supplements and herbal products prior to surgery. Your plastic surgeon should supply a list but the most common include aspirin, NSAID's like Advil, Motrin or Aleve, Ginkgo, Garlic, Ginseng and many more
2. Use Arnica Montana before and a few days after surgery. In my experience this herbal product does reduce bruising.
3. Closely follow your pre-op and post-op instructions concerning reduced activity levels, avoiding lifting and straining, keeping your head elevated at night as well as using ice packs on schedule.
Hematoma formation or development of a blood collection under the skin is unusual and happens in less than 5% of facelift patients. They usually occur in patients with the following predispositions:
1. Men because they have more vascular facial skin due to the beard hair and they have a tendency to become too active too soon.
2. Poorly controlled high blood pressure. Elevate blood pressure just after surgery can causes previously sealed blood vessels to open and bleed
3. Blood Thinning Medications, especially aspirin, which inhibits the normal platelet function needed for clotting following surgery. Aspirin should be stopped a full 2 weeks before surgery
4. Smoking. Nicotine reduces the blood supply to the skin edges and raises the blood pressure. This is all bad for facelift recovery
While the men out there can’t change this risk factor, the other 3 can be controlled. Making sure your high blood pressure is well controlled before surgery, stopping smoking 3 weeks prior to surgery and avoiding blood-thinning medications will reduce your risk greatly. Always take your normal blood pressure medicine the morning of surgery (check with your doctor if it is a diuretic).
As for men, they should be especially cautious to avoiding lifting, straining and vigorous physical activity for a full 3 weeks following facelift surgery.
Bruising after Facelift Surgery
You will always have some bruising after a facelift. A hematoma, which is a localized collection of blood, is not a life-threatening complication but can compromise skin circulation and significantly delay post-operative healing. All experienced facelift surgeons have a list of pre-operative instructions regarding dietary and medicinal intake. A pre-operative medical evaluation is usually required. There are also post-operative instructions re activity, diet, and medicines. With due diligence, hematomas are very rare.
This is a multifactoral issue and there are things that I do in the operating room to decrease the rate of hematoma and there are things we as of you to try to decrease the chance of it happening. Hematoma is rare but the rate is no 0%.
So blood pressure control before, during and after surgery is a must as is pain control. Those two things are what commonly lead to hematomas after surgery. Stopping any medications that can increase your bleeding 2 weeks before surgery will also decrease the rate as well. Things like aspirin, motrin, aleve and others.
Bruising after a facelift can be minimal.
Bruising after a facelift can be minimal, but it depends on the approach. Bruising and even hematomas are more likely with more invasive facelift techniques such as a SMAS lift or a deep plane facelift. These are much less likely with a MACS lift, since there is less undermining of the skin where most vessels are. I have many patients with very little or no bruising after a MACS lift, and have not seen a hematoma in over 200 patients. However, hematomas are not very common after any facelift, since all surgeons try to minimize this risk during surgery. Factors that increase your risk of this include, high blood pressure and blood thinning medications and some dietary supplements. You should always talk to your surgeon prior to surgery about what you can do to minimize any risks associated with your surgery.
How to avoid bruising and hematoma after facelift?
Like all complications, bruising and hematomas cannot be avoided entirely but they CAN be reduced to a very low rate.
The cause of hematoma can be divided to factors which are either related to you, those related to the surgeon and those related how you do in the first 3 days or so after surgery.
if you have a family history of easy bruising and bleeding you must tell your surgeon and you should be tested to se if you have a disorder that must be treated before you can have surgery. If you take one or several of HUNDREDS of blood thinning medication, supplements or herbs - you WILL bleed. Most people do not know that almost all headache and muscle pain pills (EXCEPT for Tylenol and Celebrex) cause bleeding, A single aspirin can cause bleeding as far out as 3-4 weeks. But, the same is true with things like GINGER, Vit. E, Garlic, Licorice, etc etc. Most surgeons have "bleeding sheets" that list all the things you should NOT take. If you have ANY questions - please ask.
SURGEON ANETHESIA FACTORS
There is NO subtitute for gentle technique where every cut vessel is gently cauterized, where blood pressure is controlled both during the surgery, in the waking up process and afterwards in recovery room. Post operative pain, anxiety , vomiting - ALL increase your blood pressure and can cause bleeding. So - prevention of nausea (and drugs CAUSING nausea like Nitrous oxide - a favorite of older anesthesiologists because it is cheap and otherwise safe) is VERY important.
TAKE IT EASY after surgery. Any lifting, straining, yelling, getting anxious etc may raise your pressure and cause bleeding.
We also routinely use homeopathic dosing of Arnica to reduce buising. It has worked well in our office. Ask your surgeon about it.
If you do all of this you are VERY unlikely to suffer bruising or a hematoma.
I hope this was helpful.
Peter A Aldea, MD, FACS
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.