Avoiding regret with incisional Facelift: identifying ways to prevent hematoma, scarring, and early relapse

Regret after incisional Facelift often stems from hematoma in the immediate postoperative period, changes in scarring and earlobe shape, and earlier-than-expected relapse of results. The most common complication is hematoma, which involves factors you can prepare for before surgery, such as blood pressure and smoking. Hematoma is a collection of blood that accumulates beneath the skin.

What is the most common problem?

Hematoma. Textbooks describe it as the most common complication of Facelift, requiring immediate intervention.[1]The incidence varies across studies, ranging from 0.6–14.2%.[2]

Risk factors include being male, having high blood pressure, taking pain relievers (NSAIDs), and smoking.[2]Among these, elevated blood pressure after surgery is the greatest factor.[3]

How is hematoma prevented?

Blood pressure management is central. A review of 36 studies found that blood pressure management before and after surgery, tissue adhesive to aid hemostasis, and tranexamic acid (a medication that reduces bleeding) were helpful in reducing hematoma.[4]By contrast, compression bandaging did not show a clear benefit.[4]

As a guideline, maintaining systolic blood pressure below 150 mmHg is recommended.[5]Surgery that simultaneously addresses neck sagging has also been reported to increase hematoma risk.[5]Always inform your surgeon beforehand of your usual blood pressure and any medications you take.

How much does smoking affect outcomes?

It has a significant impact. Nicotine constricts blood vessels and reduces skin blood flow, making smoking a relative contraindication to avoid before Facelift.[6]Smokers are reported to experience skin necrosis (death of a portion of skin) 12.5 times more often than non-smokers.[6]

Textbooks also identify high blood pressure and smoking as risk factors that should be addressed before surgery.[7]The duration of smoking cessation is a point you should discuss with your doctor before deciding on surgery.

Why do scars and the shape of earlobes change?

One cause is pulling the skin too strongly. According to medical textbooks, if the skin tension is too strong, facial distortion, unnatural changes in wrinkle direction, scar widening, and earlobe deformity can occur.[1]

Issues addressed in revision surgery also include hairline displacement, hair loss, conspicuous or wide scars, and distortion in front of or on the earlobes.[7]Rather than the strength of the lift, it is important to confirm where to incise, which layer to lift, and how to lift it.

How much should I worry about nerve paralysis?

Most are temporary. In a summary of 27 studies involving 6086 people, overall complications occurred in 8.33%, with the most common being temporary facial nerve paralysis and skin necrosis.[8]Permanent nerve paralysis occurred in only 1 case overall.[8]

However, the author notes that the quality of the summarized studies was low to moderate, and the figures should be understood with a range of uncertainty.[8]

How quickly does the effect diminish?

The speed of reversal varies depending on facial type. In a review of 78 people who underwent a deeper-layer lift method (deep plane technique), all showed early recurrence of nasolabial fold and jawline sagging between 6–12 months.[9]

The author concludes that this method is not suitable for all faces and should be selected under more limited conditions.[9]Conversely, another summary reported that many people remained satisfied long-term without recurrence of sagging,[8]and results differ depending on the study.

What to confirm before treatment

There are three benchmarks for decision-making. The first is your own conditions related to hematoma and skin problems, such as blood pressure, medications you take, and smoking.[3][2][6]The second is the location of the scar and how much the skin will be pulled.[1]The third is your facial type and how long the effects of the chosen method are likely to last.[9]

The appropriate method varies depending on the degree of sagging and skin thickness. Confirm with your doctor during the examination how deep your face should be treated.