Reducing the incidence of hematomas in cervicofacial rhytidectomy: new external quilting sutures and other ancillary procedures.

[BACKGROUND] Despite the use of many different strategies and techniques and notwithstanding recent advances such as fibrin glue and short scar operations, hematoma remains the most common complication in rhytidectomies.

[METHODS] This study analyzed 383 patients who underwent cervicofacial rhytidectomies between September 2006 and March 2012. The patients were distributed into three groups.

[RESULTS] Group 1 comprised patients who had classic face-lifts with epinephrine in the anesthetic solution used to infiltrate the face and neck. The incidence of hematomas in this group was 12 % (24 of 200 patients). Group 2 comprised patients who underwent face-lifts without epinephrine in the solution used to infiltrate the midface and neck. The incidence of hematomas in this group was reduced to 3.6 % (3 of 83 patients). Group 3 comprised the remaining 100 patients, who underwent rhytidectomies with internal and external quilting sutures used in conjunction with other ancillary procedures listed in this report. The incidence of hematomas in this group was reduced to 0 %.

[CONCLUSIONS] The most important single procedure that reduced hematoma cases to zero in cervicofacial rhytidectomies was the use of quilting sutures in conjunction with other procedures. Furthermore, the use of these sutures did not cause flap ischemia or necrosis, and there was no adverse impact on the quality of the facial rejuvenation.