Hematoma remains the most common complication of
rhytidectomy and can lead to prolonged facial
edema and skin
necrosis. A number of ancillary procedures have been suggested to reduce
hematoma, including dressings, drains,
fibrin glue, tumescence, and
adrenaline. The aim of this study was to investigate the statistical effect of these parameters on
hematoma incidence in a large series of
face lifts. Over an initial 6-year period, 678 consecutive
face lifts were performed and included in the first part of the study. The effect of dressings, drains,
fibrin glue, and tumescence on
hematoma rate was investigated retrospectively. In the second part of the study, the specific effect of
adrenaline was analyzed while all other parameters were kept constant. The 229 patients with
adrenaline-containing infiltrations were compared with the 232 patients whose infiltration had no
adrenaline. Retrospective analysis of both groups was performed using Fisher's exact test. In the first part of the study investigating 678 consecutive
face lifts, no difference in
hematoma rate (4.4 percent overall) was observed with the use of dressings (p > 0.5), drains (p > 0.4),
fibrin glue (p > 0.6), or tumescence (p > 0.5). In the second part of the study, the specific effect of withdrawing
adrenaline in a comparative group of 461
face lifts significantly reduced the incidence of
hematoma requiring surgical evacuation (p < 0.0001). There was also a significant reduction in the incidence of minor
hematoma requiring only aspiration (p = 0.02). There was no change in the incidence of any other
face lift complications observed during this part of the study. This study found a significant reduction in the incidence of
hematoma following face lifting. Although many of the suggested ancillary methods used to reduce
hematoma did not produce any statistical reduction in the incidence of this complication, the exclusion of
adrenaline had a profound effect. The technique and implications with respect to safety and outcome are described.