Facelift and Neck Lift Surgery in Cincinnati, Ohio

What is/are the Best Method(s) Used by Plastic Surgeons to Reduce the Risks of Bleeding in Facelift and Neck Lift Surgery?

Almost every surgical procedure in every surgical subspecialty has post-operative bleeding as a risk. This includes facial plastic surgery procedures. And while the risk of bleeding – also known as a hematoma – is low, it is something surgeons work hard to further reduce the risk of, especially with neck lift surgery and facelift surgery. The interventions discussed in this blog post include the use compression dressings, the placement of drains, hemostatic (Auersvald) netting, tissue glues (e.g., Tisseel©, Artiss©, and Platelet-Rich-Plasma [PRP]), and Tranexamic Acid (TXA). Current research does NOT indicate which intervention or combination of interventions is best to reduce the risk of bleeding. It is recommended to seek a fellowship-trained facial plastic surgeon when you have aesthetic concerns about your face or neck.

Meticulous Surgical Technique

Meticulous surgical technique that minimizes bleeding and addresses the source(s) of bleeding carefully and while minimizing the effects to surrounding tissue is likely the best method for reducing the risk of bleeding after surgery.

Blood Pressure Control

The major risk factor for bleeding is significantly elevated blood pressure. That is why optimal blood pressure control prior to surgery and maintenance of adequate blood pressure control can reduce the risk of bleeding. It is possible for an individual’s blood pressure to be higher than normal before surgery due to anxiety about the procedure. This typically dissipates as the patient relaxes and they receive anesthesia medications. Blood pressure post-operatively is typically affected by pain, nausea, and vomiting, which is why tailoring the pain control regimen and nausea control regimen can decrease the risk of bleeding in some individuals. However, our experience at Harmon Facial Plastic Surgery has been that extended deep plane facelift surgery generally does not cause significant pain and the anesthesia administered generally does not cause significant nausea when compared with other approaches.

Compression Dressings

Tight dressings around the face and neck have been used historically as a compression dressing meant to reduce the risk of bleeding. However, the use of this needs to be balanced against the risk of constricting the skin too much such that the skin loses adequate blood flow from compression. We at Harmon Facial Plastic Surgery do not use tight compression dressings after surgery for this reason.


Drains have also historically been used to reduce bleeding and bruising after surgery. And while this has not been definitively proven in the literature, the mechanism makes sense – as evidenced by the fact that fluid collecting in the drains is not collecting in the body. The drains generally remain in for a very short period. That is why we place drains post-operatively in all patients. Their upkeep is straightforward and simple. They generally cause little discomfort.

Hemostatic Netting

Hemostatic, or Auersvald, netting involves the placement of stitches/sutures in areas where skin has been lifted for 48 to 72 hours to temporarily secure the skin against the deeper tissue until it has had some time to heal. Patients with a history of significantly elevated blood pressure and/or individuals for whom more bleeding than usual is encountered in surgery may be a better candidate for such an intervention than others. This technique makes sense, but like all the interventions discussed, more research is required to determine whether it is one of the best approaches.

Tissue Glues

Tissue glues are products made with the patient’s own blood or that are procured from a company that serve to seal blood vessels and tissue layers to each other during surgery. Products made by the body include Platelet-Rich-Plasma (PRP) and other similar concentrations of blood components that are “activated” to form an adhesive gel. Those products procured by companies include, but are not limited to, Tisseel© and Artiss© fibrin sealants. It is important to note that tissue sealants procured from companies are made from blood products from other humans, similar to the use of cadaveric rib cartilage for nose (rhinoplasty) surgery. A 2016 meta-analysis evaluating the effectiveness of fibrin tissue sealant (e.g. Tisseel©, Artiss©, and PRP) demonstrated a statistically significant rate of reduction of hematoma for Artiss© only. Furthermore, the study demonstrated a statistically significant rate of reduction of hematoma for patient undergoing older, often less effective and less natural appearing methods of facelifting but not for deep-plane facelift surgery (1). Of note, Dr. Harmon utilizes the extended deep plane facelift approach. One may consider the use of tissue sealants on a case-by-case basis when one suspects an individual who may be at a higher-than-normal risk of bleeding after surgery.

Tranexamic Acid (TXA)

The origins of the use of TXA are in orthopedic, cardiac, and trauma literature. Relatively little has been published in the aesthetic surgery literature regarding the use of TXA to prevent bleeding. TXA has been given intravenously (IV), included in injected local anesthesia mixtures injected into the surgical site, and applied topically to the surgical site during surgery. The evidence is currently not clear whether there is one safest, most effective approach to the use of TXA. And, as with all medications, the potential benefits, risks, and alternatives need to be considered with the use of the medication to reduce bleeding. A review of the evidence demonstrates the current data shows an improvement in the intra-operative bleeding, operating time, and drain output, but no statistically significant difference in the rate of bleeding after surgery (2). It must also be noted that injecting or applying TXA topically is a United States Food and Drug Administration (FDA) off-label use of the medication.

There is No Method or Combination of Methods that is Considered the Definitive Treatment to Reduce Bleeding and Bleeding Can Occur Regardless of How the Patient is Optimized

Research remains non-specific as to which intervention or combination of interventions is best to reduce the already relatively low risk of bleeding during and after surgery. The Laryngoscope, one of the premier publications in the field of head and neck surgery, commonly publishes articles called “Best Practices” where contributors review the available literature to conclude about a common clinical question. Kleinberge A. and Spiegel J., in their article “What is the Best Method for Minimizing the Risk of Hematoma Formation After Rhytidectomy [Facelift]?” determined that “the current literature does not definitively support one particular method for reliably preventing post-operative hematoma after rhytidectomy” and “there is no replacement for meticulous surgical technique and adequate intraoperative hemostasis” (3). Larger, better designed studies are required to elucidate this. However, it is important to ask whether your surgeon has engaged with the medical literature and comes to their decisions about intra-operative and post-operative care in a thoughtful manner, weighing the potential risks and benefits of any and all of the above interventions. In the end, there is currently not one perfect method or methods. Each of the above methods could be implemented and the low risk of bleeding would remain. Seek someone who you trust understands how to evaluate and respond if something such as a bleed does occur.

Trust Your Face to a Facial Plastic Surgeon

It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.

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Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon’s credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching “plastic surgery near me.” Get in touch with us to learn more.

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This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.