Could a Neck Lift Cause a Blood Clot?

Question

Igot a blood clog in my neck after having a quick eye and neck lift. What seems to have caused this? My vision seems to have been affected as well. Please help.

George Yang, MD · Answer

Hi Betty,
I hope you haven't been waiting too long for an answer.  I just started participating on the Realself.  It is unfortunate when people have complications after a procedure.  Luckily, most of the time this problems will completely resolve itself and not affect your final result.
Your question: "What seems to have caused this?"
I'm not sure what is involved with a quick eye and neck lift, but in general necklifts involve lifting up skin on the neck in order to slide the skin back behind the ears and trim off the extra skin (Yuck) similar to when you make your bed, you might lift up the comforter prior to smoothing out the surface.  This is not unlike a face and necklift.  Because the skin is separated from the fat and muscles, this leaves a "pocket" where blood can potentially collect and form a blood clot. 
Prevention of Hematomas
The way that surgeons prevent a blood clot from occurring is one of three ways.

Compression Dressing
Drains
Tissue Glue

Compression Dressing. A compression dressing essentially looks like a gauze football helmet, which provides even pressure around the face and neck and squeezes the skin against the fat and muscle underneath.  This pressure helps to prevent bleeding as well as blood from collecting in this "space."  This pressure dressing can be removed by the surgeon during day 1-3 after the facelift/necklift.  The first thing that we check for is whether there was any formation of blood clots or hematomas.  This is also the cheapest method; the materials for the dressing costs the surgery center (~$40-60.)
Drains.  Drains look like silicone "light bulbs."  The way that they work is through suction, similar to the rubber bulbs to suction mucous out of noses that every newborn baby is sent home from the hospital with.  These silicone "bulbs" are connected to a silicone tubing which is inserted through the skin into the "pocket" and "sucks all of the air and fluids out of this "space" so that is heals together and doesn't collect a blood clot.  If the skin is directly on the fat or muscle underneath, your body will form its own "tissue glue" so it sticks together.  The same thing happens with the compression dressing.  Drains cost about ~$80-100 or more depending on the model, and many people will also get a compression dressing on top of the drain.
Tissue Glue.  Tissue glue is purified from blood products (human blood.)  The two brand name products are by Baxter and Johnson and Johnson, which are Tisseal and Evicel, respectively.  It is essentially concentrated clotting factors which are later activated by a calcium solution that it is mixed with.  Similar to Epoxy, the glue does not activate until you mix the two components together.  There is great interest with Tissue Glue "facelifts."  A few recent studies in the past several years have shown that the hematoma rate or blood clot formation rate is lower with tissue glue.  But the added benefit is there seems to be less bruising and swelling and some patients surveys in these studies show that they have a sense of well being, and less discomfort.  Some surgeons swear by it and will no longer perform facelifts and necklifts without tissue glue.  Other surgeons think that it is an overkill and don't want to risk using any outside blood products for fear of blood borne diseases (however small the risk.)  This is the most expensive option costing $250-400 depending on the amount of glue used by the surgeon. 
After removal of the compression bandage and/or drains, usually the surgeon will switch the patient over to a face and neck compression dressing to help with swelling and healing.  Since the skin was separated from the fat and muscle underneath, the compression helps as the tissues heal together, and help to prevent any potential fluid collections which might occur.  I tell my patients to wear it for about a month (on and off.)  Other surgeons may recommend only 2 weeks while others may tell their patients to wear it for up to 8 weeks.  There is no right answer.
You wrote, "My vision seems to have been affected as well."
I don't know what is going on in your particular case, but the most common reason for blurry vision is if you are using an eye ointment on your eyelid incisions.  Since the antibiotic ointments are petroleum based, they are not recommended for eyelid incisions.  Instead many surgeons will instruct their patients to use a "eye-safe" lubricant, such as Lacrilube, or generic version.  This is safe for the eye itself, and is used on the eyelid incisions.
What commonly happens is the ointment travels from the incisions where you applied the ointment and travels into the eye.  Since the Lacrilube is very viscous, this ointment will make your vision blurry.  I have found this the most common reason for blurry vision.  Hopefully it is as simple as this.
This online post is not a replacement for seeing your own surgeon, and you really need to be seen by your surgeon or at least reassured by your own surgeon that nothing more serious with your vision is occurring.  If there is something more serious, such as a scratch to the cornea, then your surgeon may request a consultation with an ophthalmologist that he or she works with.
I wish you a speedy recovery, and hope you find this response helpful.
Best,
Dr. Yang

Babak Azizzadeh, MD, FACS · Answer

You need to go see your opthamoligst for the vision issue immediately.  Are you sure it is a blood clot?  A hematoma can occur under the skin after a necklift, however a blood clot is unlikely.

Steve Laverson, MD, FACS · Answer

These questions must be directed urgently to your primary surgeon. Visual changes after eyelid surgery, particularly some transient blurry vision, are common, but need to be addressed thoroughly. Clotted blood beneath neck skin is also a common problem after necklift, and may require secondary (minor) surgical evacuation if large enough. Can compromise airway (very serious) if arterial.

Scott Trimas, MD · Answer

It is uncommon to get a blood clot after a neck lifting procedure. However, it is not uncommon to get a small hematoma that solidifies which can mimic a blood clot. When it liquefies, it can usually be easily removed with a needle but often requires several sessions to drain it all out. Alternatively sometimes it can be expressed through the incision sites. Finally, it occurs as a result of some minor oozing or bleeding after the procedure and usually accumulates that way. If it is a true blood clot, it forms in one of the small veins in your neck due to pressure but generally resorbs on its own.

Ankit Desai, MD · Answer

What you describe is a hematoma or blood collection. A hematoma may require surgical evacuation if it is large enough to cause skin compromise. Often small hematomas can resolve on their own. Anytime surgery is performed, their is a chance of bleeding. To help minimize bleeding complications, we typically utilize compression garments as well as medications that are injected and often taken orally. To learn more visit our website below.

Otto Joseph Placik, MD · Answer

There is a big difference between a hematoma and a blood clot which is generally intended to mean clot within a vessel and is commonly responsible for strokes, heart attacks or pulmonary embolism from deep vein thrombosis. This may require emergent therapy or months of blood thinning medication. There are some superficial veins in the neck which may be tied off or cauterized to minimize bleeding which can cause some insignificant blood clots.
Hematomas occur relatively commonly after facial surgery due to the excellent blood supply and are more common in males. These are  easily treated by draining or evacuating the clot.
You should not be discussing this on a message board and should seek immediate consultation with your physician for changes in vision. Minor changes are common after eyelid surgery and can be related to swelling.

Cap Lesesne, MD · Answer

You should see an ophthalmologist immediately for a thorough exam.If you are near sighted it is not from the surgery and the neck "clots" are probably anatomically unrelated to visual changes,but the eyelid surgery maybe.

	Neck "clots" maybe simple bruising which will resolve.Do not apply heat as that will prolong recovery.

	Good luck'

Chris Thiagarajah, MD · Answer

It is possilble that you have a blood clot that may resolve or need to be evacuated. In some cases if you have a large enough blood clot that compromises the carotid artery you could have visual loss. You need to have your surgeon and ophthalmologist check it out.

Olivia Hutchinson, MD · Answer

Any surgery carries the risk of a bleeding complication, and it is possible to have a blood clot in the neck following neck lift. Altered vision after blepharoplasty should be addressed by your plastic surgeon or an ophthalmologist.

Peter A. Aldea, MD · Answer

Betty,
You mentioned 3 potential things; I'll try and address them all.
We we perform surgery, we cut skin and other structures and cause bleeding. That bleeding is stopped as it is caused by using a cautery pencil and by tying bleeding vessels (IE HEMOSTASIS).
But, in the recovery phase a patient's blood pressure may go up (coughing, vomiting etc) and bleeding from a previously controlled vessel may resume. Such bleeding causes a blood clot (HEMATOMA) in the area which may either have to be evacuated in the operating room or by removing a few stitches.  In my experience I have NEVER seen a small hematoma affect vision or cause blindness.
Rarely, in patients who are prone to forming blood clots (familial tendency, malignant tumors, taking estrogens or birth control pills, smoking, obesity, operations on the long bones or pelvis, operations over an hour) a clot may form in a leg or pelvis vein (DVT). Such clots MAY move to the lung (Pulmonary Embolus) and may rarely even cause death. It is very important to have patients wear leg pumps to lower such risks on cases under general anesthesia.
Finally, I am not clear how your neck surgery could technically have affected your vision without causing other symptoms. For a facial vein to Carry a clot to the back of the retina is an EXTREMELY rare complication worthy of being reported in a surgical journal. If the work in the neck damaged a nerve affecting your pupil (Horner's syndrome) you would have other associated symptoms as well.
Peter A Aldea, MD

Could a Neck Lift Cause a Blood Clot?

Answers (17)

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