Prevention of Hematoma in Patients Undergoing Facelift (Rhytidectomy): A Systematic Review and Meta-Analysis.

Hematoma is a known complication of rhytidectomy, and improved understanding of its incidence and the impact of adjunctive measures is essential to guide evidence-based practice. Compare hematoma rates among patients undergoing deep plane facelift in those where either tranexamic acid (TXA), hemostatic nets, or tissue sealants are used. A review was conducted in Ovid MEDLINE, EMBASE, PubMed MEDLINE, Cochrane, and SCOPUS to identify studies that employed deep plane facelifts and reported hematomas. The primary outcome was hematoma rates. Secondary endpoints included rate of revision surgeries and use of preventative measures (hemostatic nets, tissue sealant, and TXA). Meta-analyses were conducted to determine the probability of postoperative hematoma and the effectiveness of preventative measures. Overall, 8,841 patients from 31 studies were included. Ages ranged from 31 to 84 years, and 85.2% (4,330/5,080) were women. Meta-analysis showed an overall hematoma rate of 2.7% (95% CI: 2.2-3.4%), with major hematomas at 0.97% (95% CI: 0.61-1.53%). Subgroup analysis showed major hematoma rates of 1.53% with TXA, 1.25% with sealants, and 1.23% with hemostatic nets. Evidence from this review suggests that deep plane facelifts have a 2.7% overall and 0.97% major hematoma rate, with no clearly superior adjunct among TXA, sealants, or hemostatic nets.