Minimizing Risk of Hematoma Formation after Rhytidectomy

The most commonly used adjunctive measures for minimizing the risk of hematoma formation in the postoperative setting are drain placement, application of tissue sealant, and use of compression dressings. In terms of drain use after facelift surgery, the majority of studies have failed to demonstrate a significant clinical benefit and do not support their routine use. The highest quality investigation, a prospective trial from 2007, did show a reduction in bruising with drain placement that the authors surmise may lead to more rapid return to regular activities and therefore greater patient satisfaction. When contemplating drain placement following rhytidectomy, this may be a factor to be considered against the potential downsides of this practice.

The literature for tissue sealant use is somewhat more controversial. As mentioned, a recent meta-analysis including three prospective randomized studies did not show a significant reduction in hematoma rate with tissue sealant use, although there was a trend toward improved outcomes. Until larger prospective studies are conducted, the routine use of tissue sealants during rhytidectomy is not clearly justified.

Last, although compression dressings have also not been shown to significantly improve outcomes following facelift surgery, a lightly placed pressure dressing may serve to enhance overall patient comfort and satisfaction in the early postoperative period. A recent study has demonstrated a reduction in hematoma rate with proactive control of pain, blood pressure, and vomiting in the acute postoperative setting. Although it is difficult to advocate a specific pharmacologic regimen based on the findings of this single investigation, the results highlight the importance of optimizing the patient environment both during and after surgery to minimize the risk of complications.

Taken together, the current literature does not definitively support one particular method for reliably preventing postoperative hematoma after rhytidectomy. Best practice recommendations based on available evidence include optimization of blood pressure throughout the perioperative period, meticulous surgical technique, and intraoperative hemostasis, as well as the use of a light compression dressing in the first 24 hours after surgery. Pain and nausea should also be adequately controlled in the postoperative setting to prevent abrupt increases in blood pressure and agitation at the surgical site. In higher-risk patients defined by hypertension, male gender, recent aspirin or NSAID use, extended anterior dissection, and smoking, consideration may be given for the use of tissue sealant and/or drain placement in attempts to reduce the incidence of postoperative edema, ecchymosis, and fluid collections, although this is not clearly dictated by current literature. (Laryngoscope. 2015;125:534–536).