I had a mid facelift and developed a hematoma 4 weeks ago. Advice? (photos)

You had a local hematoma that was aspirated. Some fn the blood came out, but there was some clots that had to liquify as time went by. This is why you had a second aspiration. Typically this needs to be done several times till it stops to accumulate. Then the remaining clots would form scaring under the skin. The good news is that these scars will eventually subside and everything would look good in the long run. Massaging some time helps the remodeling process. It is definitely a set back, but the end results are favorable. I hope this helps you. 

Hello.  Thank you for your question.  Although hematoma formation is uncommon after facelift, it is certainly a risk of the surgery that can potentially happen in any patient.  A hematoma is a collection of blood underneath the skin.  A compression wrap is typically utilized after facelift procedures to prevent bleeding and hematoma formation in the early postoperative period.  Some physicians also use drains to keep blood from accumulating under the skin.  Despite these measures, hematomas can still occur in the hands of any surgeon.  Once a hematoma occurs, the accumulated blood needs to be removed to allow normal healing.  This can be accomplished by needle aspiration or, less commonly, by surgical exploration and drainage.  If needle aspiration is performed, as it seems in your case, then only the blood that has liquified can be aspirated.  Clotted blood is generally too thick to pull up into a syringe.  The clotted blood will gradually liquefy over time.  Therefore, serial aspirations may be required over time to eliminate the hematoma completely.  Some scar tissue may certainly develop at the site of the hematoma, but this should resolve over time as your body heals and repairs.  Hematomas do not typically affect the long-term results of the procedure, and patients will generally still have a great result even after a hematoma.  I would encourage close follow-up with your surgeon over time to ensure that the hematoma resolves completely.  I wish you the best in your recovery and in achieving your aesthetic goals.

Any time a hematoma is involved, I always advise close follow up with your surgeon.  If you feel the hematoma is filling up again, it would be best to see your doctor again.  If you have any concerns, its important to  see your doctor and ask questions.

Hematoma after a facelift is rather uncommon occurrence.  An experienced facelift surgeon will do a number of steps to achieve low rate of hematomas – proper pre-operative preparation of the patient, immaculate surgical technique, proper management of the patient in the immediate postoperative period.  In most cases, hematoma can be managed without going back to surgery.  In most cases when hematoma is properly treated, the final outcome is the same as if no hematoma has occurred.  There are a number of steps that need to be taken, beyond the scope of this forum.  See your plastic surgeon for a detailed follow up treatment plan.  

Hello and thank you for your question. It is rather late after a facelift for you to keep getting hematomas. Make sure you are not taking any medications or supplements which might predispose you to more bleeding. It is difficult to give you more advice without examining you. Follow up closely with your plastic surgeon and he can guide you through your post op course 
I hope this helps and wish you all the best!

Inzhili Kitto, M.D.

Plastic Surgeon
Instagram @dr_Kitto

Sometimes it's challenging to aspirate a solid swelling of clotted blood within tissues, but if you have an ultrasound therapy treatment at the time, it will help to liquefy the clotted blood - 16 or 18 gauge needle.