Deep plane facelift - What determines the need for haemostatic suturing vs. drains?

Each surgeon will develop routines that he or she is comfortable with, and they should be able to discuss them with you. For example, I never use hemostatic suturing because I'm trying to place less holes in a patient's face, not more. We often use drains and remove them the next day. If a patient is bleeding minimally throughout the case, we may not use any drains. With proper surgical technique and patient selection, necrosis of the skin should be a very rare complication. For example, if a patient smokes, the risk is higher. Ultimately, if necrosis occurs, it will heal with whitish skin most of the time. That's why it's important to find a plastic surgeon who specializes in facial procedures for your facelift.

1. In a deep plane facelift, the choice between hemostatic suturing and drains depends on the surgeon’s technique, extent of dissection, and the patient’s bleeding risk. Hemostatic suturing helps seal vessels and reduce dead space, often minimizing the need for drains. However, drains may still be used in cases with higher risk of fluid accumulation. Both methods are effective, but careful suturing may offer fewer complications and more comfort post-op.
2. Skin necrosis after a deep plane facelift is rare when performed by an experienced surgeon, but risk increases with smoking, poor vascular supply, or excessive tension. Necrosis can negatively affect scar quality and healing, potentially leading to wider or more noticeable scars. Prompt management reduces long-term impact.
Erman AK, Dr. MD, Plastic Reconstructive & Aesthetic Surgeon