SMAS facelift - Hematoma rate of 6% - is this higher than average?

Question

I am discussing a SMAS facelift with a surgeon. He has said that haematoma requiring a return to theatre for all types of facelift is 6%. This is higher than average, right? Should I find another surgeon.

William Portuese, MD · Answer

There are many variables that can put patients at higher risk for hematoma after a facelift. They're hiring male facelifts, and  patients with unstable or high blood pressure. Taking great care to stop all bleeding prior to finishing the surgery is important in addition to using TXA which stops bleeding and placed in the lidocaine injection during the procedure and can be given through an intravenous approach.

Zoran Potparic, MD · Answer

It is very likely that an average hematoma rate after SMAS base face lift is in the range of 1-1,5% , at least based on recently published literature. This apply for all hematomas not only those that require return to OR. I hope this helps.

Stephen Prendiville, MD · Answer

Over the last 8 years, since implementing tranexamic acid in my facelift protocol, my major hematoma rate has been 4 out of roughly 1400 facelifts. If your surgeon is quoting a 6% rate, he is probably not using TXA. So yes, that is a high incidence of hematomas ( 60 per 1000).

Mert Demirel, MD · Answer

A hematoma is one of the more common early complications after facelift surgery, and it can sometimes require a return to the operating room. A quoted rate of 6% is not unheard of, but it is on the higher side compared with many published facelift ranges.
That does not automatically mean the surgeon is unsafe. It may reflect honesty, how they define hematoma, whether they include minor and major cases, whether they operate on higher-risk patients, male patients, revision cases, deep plane cases, smokers, or patients with blood pressure issues.
The more important question is what they mean by 6%. Is that their personal rate for hematomas requiring surgery, or a general literature statistic? Is it for all facelifts, including complex revisions and male patients, or for primary cosmetic SMAS facelifts similar to yours?
You should also ask how they reduce the risk: blood pressure control, stopping blood thinners/supplements, nicotine avoidance, careful hemostasis, drains if used, postoperative monitoring, nausea/pain control, and what their protocol is if a hematoma occurs.
I would not choose or reject a surgeon based on one number alone. But if the surgeon’s personal return-to-theatre hematoma rate is truly 6% for routine primary facelifts, it is reasonable to ask more questions and get another opinion.
My advice would be to say: “Can you clarify whether 6% is your own rate or a general rate, and how many required return to theatre?” If the answer feels vague or you lose confidence, a second consultation is appropriate before proceeding.

SMAS facelift - Hematoma rate of 6% - is this higher than average?

Answers (4)

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