What You Need To Know About The Risk Of Hematoma After A Facelift

During the cosmetic surgery consultation process and again before you enter the operating room, your plastic surgeon will explain the side effects and complications that can occur after a facelift. On the side effect front, bruising and swelling can be expected and usually begin to subside after the first couple of weeks. On the complication front, hematoma – a word that means ‘collection of blood’ – occurs after an estimated 0.2 to 8 percent of rhytidectomy (read: facelift) surgeries, making it the most common postoperative complication of the procedure.

Without proper attention, hematoma can negatively impact the healing and recovery process. So, whether you're preparing for surgery or just got home, what should you keep an eye out for? Here’s what you need to know about the causes, symptoms, and prevention of hematoma after a facelift.

What Causes a Hematoma?

Hematoma occurs most often in the first 24 hours after surgery, says Mark M. Hamilton, MD, a double board certified facial plastic and reconstructive surgeon in Indianapolis and board member of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The reason for this is that, “during a facelift, small blood vessels are disrupted in the process of lifting and tightening the skin,” explains Samuel Lin, MD, a board certified plastic and reconstructive surgeon and associate professor of surgery at Harvard Medical School. That disruption can cause a pooling of blood beneath the skin but outside of a blood vessel.

As your surgeon is wrapping up your facelift, they will check to make sure that the bleeding has stopped. But, in rare cases, “bleeding may restart or unnoticed bleeding may continue after the surgery ends,” Dr. Lin notes. The collection of blood that results becomes a hematoma. Some of the most noteworthy risk factors for bleeding and bruising after a facelift include:

• High blood pressure
• Taking blood thinners (including herbal medication, ibuprofen, and the like)
• Smoking
• Combining it with a neck lift

Additionally, male patients are at a higher risk of hematoma than females because they have more blood vessels and a stronger blood supply in their faces (learn more in our comprehensive guide to facelifts for men).

Symptoms of a Hematoma

While bruising is common after a facelift, patients should be aware of the difference between a hematoma and a standard bruise. After all, hematomas often look like very dark bruises. There are, however, a few key differentiators to keep in mind. A hematoma is a firm and swollen red, black, or blue lump that can grow in size over time. It may or may not be painful. On the contrary, a bruise is usually flat and slightly tender – though not hard – to the touch. In general, bruises are much less serious than hematomas.

If you suspect you may have a hematoma, contact your surgeon as soon as possible. “Smaller hematomas may be drained in the office,” Dr. Hamilton says, though they can also require a return trip to the OR “to remove the clot and control any bleeding.” In extreme cases, a hematoma can “expand and put pressure on the airway, interfering with the patient’s ability to breathe,” Dr. Lin cautions.

How to Prevent a Hematoma After a Facelift

The fact of the matter is, hematomas are not 100 percent preventable. But there are a few steps patients can take to reduce the likelihood. The first is establishing that you are in good overall health. Halting any medications that can impair the body’s natural clotting mechanism – including anticoagulants like Coumadin and Plavix – for at least two weeks before surgery is a must, says P. Daniel Ward, MD, double board certified facial plastic and reconstructive surgeon in Salt Lake City. He notes that if a patient is on those two meds, they may not actually be healthy enough for surgery to begin with. This assessment should occur during the consultation process.

In his practice, Dr. Hamilton tells patients to avoid alcohol for at least one week before surgery and to quit smoking for at least one month prior, as the former thins the blood and the latter can cause bleeding and impact the healing process. In case it’s not obvious, laying off both post-op will only help your facelift recovery.

There are also steps that can be taken after surgery to mitigate the risk of both hematoma and bruising. If provided, you’ll want to wear a gentle compressive dressing or strap as per your surgeon’s guidelines. Additionally, you’ll be advised to avoid activities that raise your blood pressure – such as exercise. Since hematomas are most likely to occur within the first 24 hours, getting as much rest as possible and keeping any movement mindful will be key.

The Takeaway

Hematoma is the most common complication patients experience after a facelift, and, as with any procedure, risks and rewards must be weighed. While every case is unique, Dr. Ward agrees that there usually isn’t a reason for healthy individuals to skip out on the surgery for fear of hematoma. Instead, patients should feel empowered to call their surgeon if they have concerns about how they are healing. “We’re doing this to help care for our patients and make them feel better – we don’t want them to suffer,” Dr. Ward says. “Call us and make us earn our keep.”