The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts

Haematoma remains the most common complication of rhytidectomy and can lead to prolonged facial oedema or skin necrosis. The factors leading to haemat oma formation remain unclear, and studies establishing causal relationships are lacking. The aim of this study was to determine which parameters were significantly associated with haematoma formation in a consecutive series o f facelifts performed by two high-volume operators. The records of 1078 pat ients who underwent facelifting between 1994 and 1999 were reviewed and the parameters associated with haematoma formation were investigated using mul tivariate statistical analysis. In this series of 1078 patients, 45 haemato mas occurred (4.2%). Analysis revealed significant associations between hae matoma formation and anterior platysmaplasty (P = 0.009), systolic pressure (P = 0.02), gender (P = 0.03), aspirin or non-steroidal anti-inflammatory intake (P = 0.04) and smoking (P = 0.049). In addition the relative risk of each parameter was calculated. This allowed the haematoma risk for individ ual patients to be calculated and haematoma-prone patients were identified preoperatively. This is the first study to establish independent statistica l risk factors for haematoma after rhytidectomy and to present a scoring sy stem that calculates the haematoma risk preoperatively. The implications of these findings and possible measures for the prevention of haematoma are a lso presented. (C) 2001 The British Association of Plastic Surgeons.