The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma

Abstract

The cervicofacial lift is a frequently performed procedure in plastic surgery. It is the reference technique for facial rejuvenation and restoration of the oval form of the face and it is essential to treat excess skin. One of the most frequent complications of this procedure is the formation of haematomas. The aim of this article is to analyze the incidence of bleeding in the standard cervicofacial lift carried out under pure local anaesthesia. The entire operation, including liposuction and tightening of the SMAS, can be done under local anaesthesia. A total of 1500 patients, who have undergone cervicofacial lift under pure local anaesthesia between November 1995 and January 2016, were included in the study. The incidence of early bleeding (in the first 15 days following the operation) was recorded and analyzed. Pre-intra-and postoperative monitoring of the arterial blood pressure revealed stable pressure in the peri-operative period. The mean difference in blood pressure when comparing the intraoperative to the postoperative periods was 7 mmHg for the systolic BP [range from 3 -25] and 4 mmHg [range from 2 -12] for the diastolic BP, with lower mean values in the postoperative period. We identified nine bleeding events in 1500 patients (0.6%). The cervicofacial lift under pure local anaesthesia does not radically modify the surgical technique. It allows better control of arterial blood pressure of patients throughout the surgical procedure and avoids fluctuations in blood pressure, which is one of the main causes of bleeding and haematoma formation. The infiltration of xylocaine adrenaline combined with the absence of hypotensive general anaesthesia diminishes the incidence of haematoma and ensures an early return home for the patients.

Complications associated with submental liposuction: a scoping review

“…Finally, to minimize the risk of hematoma formation after submental liposuction, it is recommended that when the procedure is performed under general anesthesia, the anesthetist should be alerted to maintain blood pressure at its normal pressure level or within 10% baseline, not generating hypotension, as this fact can mask bleeding and promote a hypertensive peak rebound after surgical procedure, providing formation of bruises ( 23 ). Therefore, when performed under local anesthesia, it has the advantage of patient cooperation in relation to positioning the head, as well as greater control of normal blood pressure levels ( 4 ). In this scoping review, only one study reported intravenous sedation as the method used to perform the surgical technique ( 12 ).…”

“…Thus, as performed and guided by most cases in literature, the hematoma was immediately drained in an attempt to decompress the upper airways, improving the patient's complaints of dysphagia and dysphonia. The most common complication after any plastic surgery is hematoma, and the main risk factor is elevated systolic blood pressure ( 4 ). In order to justify the relationship between hypertensive peak and hematoma formation, it was observed in studies that a preoperative blood pressure above 150/100 mmHg was associated with 2.6 times higher incidence of hematoma ( 24 ).…”

“…This approach can be performed at the hospital under general anesthesia or at an outpatient clinic, through association of sedation with local anesthesia or even under local anesthesia only, without systemic muscle relaxants or anxiolytic drugs. When performed under local anesthesia with conscious sedation, it has the advantage of the patient's cooperation in positioning his/her head, simplifying the procedure as there is no need for intubation and the trans and postoperative stability of blood pressure ( 4 ).…”

Epinephrine Infiltration and the Incidence of Bleeding Complications after Surgical Debridement of Pressure Ulcers with Negative Pressure Wound Therapy

“…While local anesthetics do not directly affect arterial blood pressure, the medications used in general anesthesia can induce a systemic reduction in arterial blood pressure to approximately 90 mmHg. Therefore, rebound hypertension is a concern after general anesthesia, but not after local anesthesia [18]. Debridement aggressiveness was another potential confounding factor not accounted for; even with the same primary endpoint (sharp surgical debridement of all visible necrotic tissues), radical debridement is more likely to cause serious bleeding complications than cautious conservative debridement.…”

Perioperative Approach to Reducing Hematoma during Rhytidectomy: What Does the Evidence Show?

“…16 In addition, Moris et al reported a low hematoma rate of 0.6 percent in patients treated without any sedation, and noted an increase in intraoperative and postoperative blood pressures (Level of Evidence: IV). 17 However, the latter study involved a single cohort and did not offer comparison to a control. In the study by Taghinia et al, the fact that intraoperative hypotension was coupled with postoperative hypotension in the dexmedetomidine group may explain why no differences in hematoma rates Giordano et al 39 Meta-analysis III Pooled data from 13 prospective and retrospective studies.…”