Why do some doctors use drains after a facelift and some don't?

I have been to several doctors for consultations and some say they use drains and keep their patients overnight and some say they don't need to use drains because they use some kind of glue. I'm confused how glue prevents the need for drains. I'm afraid if I'm sent home with drains I will be grossed out and faint.

Doctor Answers 25

Why do some doctors use drains after a facelift and some don't?

This is based on personal experience and training. Personally, I rarely place drains after a facelift but will if there is an unusual amount of oozing during surgery (uncommon). With regard to staying overnight after surgery, this would also be very uncommon following elective surgery. If you are otherwise healthy, I would be surprised if you required an overnight stay. I hope this information is helpful for you.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

A crescent lift just to correct symmetry of breasts.

I have been performing plastic surgery and facelifts for 40 years. Initially the procedures were very complex, recovery was long, and drains were always used. Most of the facelifts that I perform today are less involved, and according to the complexity of the patients individual problems, I may use general anesthesia or local anesthesia.
I always use tissue glue, which virtually eliminates bleeding and secures the skin flap to the underlying tissue after the SMAS has been sutured. However, if the patient's neck is quite saggy, I may use a drain in the neck for a day or two. Otherwise drains are not used. Every patient must be individualized. My efforts are toward doing the simplest procedure while still keeping the long-term reduction in appearance of the aging face.
I would suggest that when looking at your plastic surgeons pre-and post op photographs, ask to see patients with at least six months follow-up. Even one year would be better. If a patient's photographs were taken within the first several months, the postoperative swelling gives the patients an unrealistic better appearance because of the increased volume.
Thank you for your question.

E. Ronald Finger, MD
Savannah Plastic Surgeon
4.8 out of 5 stars 81 reviews

Use of drains in face lifts

Thank you for asking about your face lift.

Face lifts depend on the surgeon.
  • Their chief use is to be sure the skin adheres to underlying tissues.
  • Tissue glue can be used for the same reason but can ad cost and some risk.
  • An overnight stay is used if patients have no one to care for them after surgery, if they want an overnight stay or if there is a concern requiring an overnight stay.
  • I remove drains, if used, within 24 hours - with a house call if/as needed.
  • Drains are incorporated into the bandage. I have not found patient to have extreme reactions to them as you fear you may. 
Always see a Board Certified Plastic Surgeon
Hope you found this answer helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Facelift, drain or not to drain?

Thank you for your question.

Facelift surgery does not require use of drains. Many surgeons do, however, place small drains for a short time after surgery, with the goal of reducing bruising. I personally do not use drains for my facelift patients. Instead, I take a little extra time during the operation to ensure small areas of bleeding have been carefully cauterised. Drains do not always necessarily prevent possible bleeding complication. I do not use drains and have pioneered The Concept Facelift, having a 0% incident rate of hematoma.

It is important to focus more on the results of your surgeon as illustrated in their pre & post operative facelift patients. Do you like their results, will the surgeon meet your expectations, is the facility where you are going to have your surgery performed accredited? These might be much more important. I do not think the use of drains or not drains would reflect the surgeons ability.

All The Best

Drains or no drains

It's really the preference of the surgeon to determine whether drains are needed or not. Drains can minimize swelling and the risk of developing a seroma/hematoma.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Drains vs no drains

I have been doing face lifts for 25 years and have done over 2500 in my carear. When I started out I approached everything in an elaborate and complicated fashion. I used general anesthesia, I used drains, I watched people overnight, I did lots of blood tests and medical clearences. Now however, after all this time and experience and seeing the reality of this operation I take a MUCH simpler and safer route. For the past 5 years...........
   1) I do all my facelifts with oral sedation ( Valium, Ambien ) and local injections of Xylocaine. This reduces the surgery risk by 95% which is almost all related to the anesthesia. Bleeding and hematomas which are the more common complications and the main reason for using drains are totally unnecessary as the local anesthesia process almost completely eliminates any bleeding during and after the surgery.
   2) A full facelift with SMAS sutures under local anesthesia without bleeding or waiting for the general anesthesia process to be done takes me less than 90 minutes. And except for a few needle sticks is painless.
   3) The skin flaps are kept against the face for good healing by a minimally compressive soft dressing and by the lack of fluid and blood build up post surgery.
   4) The post operative period is mush more comfortable by this process as most post- operative nausea and discomfort is caused by the general anesthesia and sedation medications which take a couple of days to clear out of a  patients system.
   5) The advantages of this approach are so dramatic that I cannot believe I did not start doing this earlier in my carear; but like most surgeons I learned a process and it was hard to change.
   6) There is also a great cost savings as an added benefit.

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Drains are you safety net

If a surgeon chooses to use drains during your facelift surgery it is because he is looking out for you and feels they would add safety during your postoperative period.
There are advantages and risks to everything we choose to do.
If you have drains post-operatively do not let yourself think about them- treat them in the abstract.
Bettter yet, have your care-giver deal with them and don't look.
Drains are usually removed within the first 24-72 hours after a facelift.
While considering having an Aesthetic surgery procedure, or choosing the best surgeon for you, drains should be the least of your concerns.
Be well.

Andrea Basile, MD
Naples Plastic Surgeon
5.0 out of 5 stars 9 reviews

The use of drains after a facelift varies from surgeon to surgeon.

I personally use a drain for one night after a facelift. This is to generate negative pressure Allowing the elevated tissue to stick to the deeper tissue. The use is a matter of personal preference.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Drains and Facelifts

I agree that plastic drain tubes coming out of your skin are very weird, and we try not to use them when possible. I personally do not believe that drains prevent hematomas. However, drains may decrease the amount of bruising that some patients might have, particularly in patients who have a history of high blood pressure or other risks of bleeding. The use of fibrin "glue" is controversial as we naturally create fibrin in any surgical area. Please ask your chosen surgeon to explain their reasoning for the use of drains or "glue" so you can be an understanding participant in your surgery. 

Douglas Leppink, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 26 reviews

Drains or No Drains?

The answer to this question lies in the experiences and preferences of the Surgeon.  First several points must be understood about a facelift.  Since a large surface area is being lifted, the potential exists for excess blood and or lymphatic fluid to collect under the skin flaps.  This can be managed by use of a drain, compression, or a combination of both.  It is important to understand that drains do not prevent expanding hematomas.  A combination of meticulous technique, patient compliance with instructions, and a patient's inherent clotting ability are most important in prevention of this complication.  In my experience, I would place emphasis on the first two points, because a quickly performed facelift does not allow for adequate hemostasis and ignores the potential for late case bleeding.  Although many patients hear their postoperative instructions, they sometimes do not listen.  For these reasons, I spend the requisite amount of time to ensure a "dry" surgical field during a facelift, and my staff repeat the mantra of expected postoperative behaviors in an exhaustive fashion. I utilize mild compression with passive (Penrose) drains in the postauricular region.  The dressing is removed and replaced with a lighter dressing on the first postoperative day, and the penrose drains are removed on the second. I have utilized platelet gels, fibrin glues etc., and have not seen any difference from baseline with the exception of higher cost.  The major difference between dressings and drains is that taking care of active drains (Jackson Pratt) is beyond the experience and comfort levels of most patients.  In other words, patients hate drains and patients hate dressings, but seem to hate drains more.  An overnight stay facility is not a necessary consideration for most patients, who are usually more comfortable at home.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

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.