Hemostatic Net in Facelift Surgery: A 5-Year Single-Surgeon Experience

Limited Incision Facelifts: A Contemporary Review of Approaches and Complications

Limited incision facelifts (LIFs) have gained popularity as an alternative to traditional facelift procedures. While surgical techniques vary, these approaches share a common goal: to rejuvenate the face while minimizing scar visibility. Previous studies also suggest that the reduced tissue dissection in LIFs can lead to decreased postoperative swelling, shorter recovery periods, and fewer complications. In this systematic review we delved into the literature on LIFs, shedding light on the various surgical approaches and their respective safety profiles. A systematic review was conducted by independent evaluators who followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A random-effects model was utilized to summarize complications data, and meta-regressions were conducted to analyze associations with operative variables. The analysis encompassed a total of 20 articles, comprising data from 4451 patients. The vast majority (84%) of these patients underwent either local wide-awake surgery or conscious sedation, while the remaining 16% underwent general anesthesia. Our analysis revealed an overall complication frequency of 3.2%, with hematoma being the most common complication (2%), followed by temporary nerve injury (0.2%), and skin necrosis or wounds (0.06%). Notably, hematomas rarely required operating room interventions. Use of drains or tissue sealants was associated with an 86% decrease in complications. Limited incision facelifts can be performed with a low complication rate, utilizing a variety of techniques. Utilization of tissue sealants and drains may limit hematoma formation, which is the most common complication.

Evidence of Hematoma Prevention After Facelift

Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation, such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed that identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size of fewer than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text, with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia rather than general anesthesia, and strict blood pressure control of at least <140 mmHg were found to significantly reduce hematoma formation. Quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors, and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunct measures have been shown to reduce postoperative hematoma formation in facelift procedures.

LEVEL OF EVIDENCE: 3

Systolic Blood Pressure Less Than 120 mmHg is a Safe and Effective Method to Minimize Bleeding After Facelift Surgery: A Review of 502 Consecutive Cases

BACKGROUND

Hematoma is the most common complication after facelift surgery. Hypertension is the major risk factor for hematoma following facelift. Measures taken to reduce systolic blood pressure perioperatively significantly reduce the risk of hematoma. There is evidence that treating systolic blood pressure of 140 mmHg or above reduces hematoma; there were no studies to date in which systolic blood pressures below 120 mmHg had been evaluated.

OBJECTIVES

To assess the safety and efficacy of maintaining systolic blood pressures of 120 mmHg or less postoperatively to reduce hematoma after facelift.

METHODS

A retrospective chart review of a single surgeon's series of facelift procedures from January 2004 to July 2018 was undertaken. Implementation of a more stringent perioperative blood pressure protocol (maintaining a systolic blood pressure of less than 120 mmHg postoperatively) was initiated in January of 2013, dividing patients into 2 groups.

RESULTS

A total of 502 consecutive patients who underwent a facelift by F.N. were included in the study. A total of 319 patients underwent a facelift before 2013, and a total of 183 patients underwent a facelift in 2013 or later. Overall, a total of 13 hematomas occurred during the entire 15-year study period (2.59%), of which 12 occurred before the implementation of a strict blood pressure regimen (3.76%), and only 1 occurred after the new protocol (0.5%). There were no adverse events related to the lower blood pressure.

CONCLUSIONS

Treating systolic blood pressure greater than 120 mmHg postoperatively is a safe and effective method for reducing the risk of hematoma after facelift.

Nerve Injury and Peripheral Nerve Functional Loss From Injection and Suture Needles: An Experimental Study on Rats

BACKGROUND

During invasive procedures involving needles, there is a chance of damage to peripheral nerves. Therefore, a method for experimentally simulating these situations is needed.

OBJECTIVES

In this study we aimed to evaluate peripheral nerve lesions caused by the entry and exit of an injection needle, nerve transfixion through a suture stitch, and the injection of saline solution and lidocaine into the nerve.

METHODS

After obtaining approval from the Animal Ethics Committee, we randomly divided 36 Wistar rats, weighing approximately 250 g each, into 6 groups (control, sham, suture, needle, saline, and lidocaine groups), with 6 animals in each group. All procedures were performed on the left paws of the rats. After the procedure, walking track analysis was performed to assess the walking function of rats for 8 weeks. Four months after the procedures, we performed bilateral electrophysiological studies (measuring the latency and amplitude of the electrical impulse in the peroneal nerve). Subsequently, the rats were euthanized, and bilateral tissue samples were collected from the peroneal nerve and tibialis cranialis muscle for morphometric histological analysis.

RESULTS

In the walking track analysis, all groups showed normalization of walking functionality after 13 days. There was little histological change between the groups, and no functional loss related to the procedures was observed.

CONCLUSIONS

Procedures involving the infusion of local anesthetic or saline solution, or suture needles, are safe with regard to peripheral nerve function loss. Accidents tend not to cause nerve impairment.