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What Is A Hematoma?

A hematoma is the most common complication of a facelift. A hematoma is a collection of blood under the skin. Hematomas typically occur when blood cells, which ordinarily stay enclosed in blood vessels, invade other body tissues. Blood pools under the skin, causing the area to discolor and swell. After a while, instead of draining, these pools of blood coagulate and form a hardened, lump like growth under the skin.

Why Does A Hematoma Happen?

There are various reasons that can explain the formation of a hematoma. It is important to note that a hematoma is the result of irregular/abnormal bleeding. Following a facelift, many tiny blood vessels are cut and sealed with electro-cautery. However, a break in a capillary that has been sealed can occur after the surgery. When the blood vessels break, the blood from theses capillaries can pool below the skin, thus creating a hematoma. A hematoma can also happen following a surgery due to a patient doing some activity or even experiencing stress that leads to an elevation in one’s blood pressure. During the post-op phase, your blood vessels are usually more sensitive and an elevation of blood pressure can cause the blood vessels to break in a localized area. This can cause the blood to accumulate under the skin and a hematoma to form. For this reason, strenuous activities must be avoided at all cost during the initial phase of post-op. Any action that might elevate your blood pressure (stress, exercise, etc.) can make those little blood vessels of yours pump blood into your system and expose you to a hematoma. For this reason, you should cease and desist from partaking in all of life’s daily activities that can elevate your blood pressure except for bathroom runs, getting up to eat, drink, take your medications, and going to any postoperative appointments with your doctor. In fact, you should leave as many responsibilities and tasks for your caregiver to perform on your behalf during the initial 24-48 hours of post-op when the probability of a hematoma is at its greatest. Interestingly, vomiting due to post-operative nausea has been a common cause for hematomas following a facelift. For this reason, you should take all the steps to avoid vomiting by drinking lots of fluids and sticking to bland, non-spicy foods during the first few days (a full discussion about Nausea is found in this Room). If you must vomit, please do not get up abruptly, but rather raise yourself off the bed slowly and open your mouth slowly without straining your face or opening the mouth widely. Additionally, you will need to avoid flexing, bending, or twisting your head and neck. For a detailed explanation of how to safely heave, as well as many activities which you should avoid and which ones are permitted, drive through the Activities, Movements & Behaviors: DOs & DON'Ts Room. Further, high emotional stress, and excessive anxiety or excitement can also raise your blood pressure and provoke a hematoma. For this reason, it is important to try to be as calm as possible during the initial phase of post-op.

Another reason for a hematoma has to do with to the ability of the blood to coagulate. If the blood is thin then it flows easily and can more easily pool under the skin and form a hematoma. On the other hand, if the blood clots well, then pools of blood are less likely to accumulate under the skin tissue and hematomas are less likely to occur. For this reason, it is important to avoid taking any medications or products that have anticoagulant (blood thinning) properties for at least 2-3 weeks following surgery because they can thin the blood and cause a hematoma. In fact, it is recommended to avoid taking anticoagulants for 2-3 weeks before the surgery as well. Taking anticoagulants during the weeks before and after surgery can thin the blood and expose you to the risk of developing a hematoma. Beyond increasing the likelihood of getting a hematoma, taking anticoagulants can cause excessive bleeding during surgery, interfere with blood clotting during post-op, and lead to more bruising than you would normally experience after surgery. Among the main anticoagulants to avoid include all medications and products containing aspirin and ibuprofen, and products containing vitamin E. It is important to note that normal everyday products such as alka seltzer may contain hidden amounts of aspirin or ibuprofen, so it’s important to educate yourself about all the products that you may and may not use. To learn about the many products that contain aspirin and ibuprofen, as well as to become aware of other types of medications that you may need to avoid before and after your surgery, go for a check-up in the Medication Don’ts tab of the Medications For The Journey Room.

What’s So Bad About A Hematoma?

Hematomas, if detected early, can usually be treated easily and have no harmful effects. If treated early, all you may have occur is that you are left with a longer lasting bruising discoloration that takes longer to disappear. Some hematomas are small enough that the surgeon may let them heal on their own without any kind of treatment. However, if a hematoma is left untreated for a period of time or does not heal correctly, the consequences can be cosmetically unsightly and may result in scarring. In very rare cases, if left untreated for a considerable period of time, a large hematoma can put pressure on the tiny blood vessels underneath the skin surface and thus decrease circulation to the affected tissues. If this occurs and the hematoma is left untreated for a certain period of time, the skin may die due to lack of blood and oxygen supply to the affected skin area. This rare condition whereby the skin literally dies is called skin necrosis and the affected skin is irreversibly damaged. In a considerable number of cases, skin necrosis resulting from a facelift is limited in its severity so long as it is treated early enough so that the necrosis doesn’t spread to other areas. The real harm that is done to you is the scarring that can result in the affected area. In a good number of cases, the scar will be minimal and superficial. Yet, skin necrosis can cause scarring that can be aesthetically unattractive or so unsightly to the point of requiring you to have further surgery done such as through a scar revision procedure. For these reasons, it is very important that you educate yourself about how to detect a hematoma so that if it occurs you will notify your doctor immediately. If you do so and your surgeon takes the appropriate action, a hematoma will not be harmful and should not evolve to the level of causing death to the skin (skin necrosis). A full discussion about the rare complication of Skin Necrosis is found in this room.

A hematoma can also be harmful to you because it can delay healing. The excess of blood in a hematoma will eventually coagulate and harden, which can interfere with the work of the red blood cells that carry oxygen to different parts of the body and face. Additionally, the white blood cells are also impeded from working properly with a hematoma, resulting in destroyed cells in the affected area not being easily removed. Consequently, there is a decrease of circulation to the injured areas. The decrease in blood circulation can also slow down the process of collagen synthesis (due to fibroblasts production needed to create supportive collagen being delayed) and protein production. This is clearly not good, because this may slow the process of wound healing and increase dimpling and hardening of your wound. Hematomas can also give rise to hyperpigmentation, which can cause the affected skin to darken. To learn more about hyperpigmentation, take a drive to the Irregular Scarring discussion in this room. Further, hematomas can also cause an infection. It is important to be seen by your surgeon, who may decide to give you appropriate medication to prevent any infection from occurring. Finally, because hematomas can cause swelling, they can create facial asymmetry and temporarily distort the shape of the face in the affected areas.

What Are My Chances Of Getting A Hematoma?

A hematoma is the most common complication after a facelift. Some studies have classified postoperative hematomas as minor or major. Minor hematomas that require only needle aspiration (which are fairly common), are thought to occur in 2-15% of facelifts. Major hematomas that require evacuation by aspiration of the clot under the flap occur in 1 to 8% of facelifts. Other studies have concluded that incidence of having hematomas being higher in men (7-9%) than in women (1-3%). As a matter of fact, the male face has a richer blood supply than a female face and consequently the chances of bleeding increase. However, the chances of developing a hematoma also increase if you smoke or drink alcohol, or if you take any anticoagulant medications. Further, partaking in too many strenuous activities during the initial phase of post-op increase your chances of getting a hematoma as they raise blood pressure. For this reason, you are advised to take it easy during the initial phase of recovery and avoid doing strenuous activities for at least the first 2 weeks of post-op. We encourage you to take a drive through the Activities, Movements & Behaviors: DOs & DON’Ts Room for a full exploration of all the activities, movements, behaviors and anything else that you should do and what you should stop doing before, during and after your eyelid surgery.

When Can A Hematoma Occur On The Journey?

The risk of hematomas is greatest during the first 12–15 hours after the surgery. However, hematomas can still occur anytime during the first two weeks of post-op. After this period, the probability of developing a hematoma decreases significantly because your healing process has usually caused your blood vessels to become stronger. As a result, your blood vessels are less likely to rupture easily and cause blood to pool and accumulate under the skin.

Where Can A Hematoma Occur?

Hematomas typically affect the tissue in the cheeks area and in front of the ears, on one or both sides. A large number of journeywomen who had hematomas reported having it in these areas. It is also possible to develop a hematoma on the neck.

What Are The Warning Signs?

You may have a hematoma if you experience a sudden pain or swelling developing in a localized region, or if the skin in a small area turns into a bluish-purplish color, or if you feel a tender, burning sensation, or if a small region feels appreciably warmer than the rest of your face and neck. This can be accompanied by difficultly with breathing or swallowing. The affected area can be painful, tender to touch and often described as “tight” and “hard.” It is also important to remember that normal swelling is soft to the touch whereas hematomas feel hard and become firmer over time.

Because hematomas can appear to be like swelling and bruising, you will need to know how to distinguish between these normal symptoms and the complication at hand. Under normal circumstances, swollen areas – like hematomas - may feel tender to the touch. In fact, most normal swollen areas will be at least slightly tender. However, if the tenderness becomes extreme or the swelling takes shape abruptly and quickly and is more painful than normal, then you may have a hematoma on your hands. If you at all suspect a hematoma, call your doctor. The earlier you catch a hematoma the safer you will be.

Like hematomas, bruises appear under skin, taking on a reddish, purplish hue in their initial stages. However, unlike hematomas, bruises disappear gradually over time. While it is not unnatural for new bruises to form at any time in your journey, if a bruise appears suddenly in a localized area during the initial days post-op and if it is extremely tender to the touch, and even painful, you should have your doctor look into the possibility of you having a hematoma. Unlike bruises that feel tender, a hematoma becomes more firm and increases in size. A regular bruise is spread out, while a hematoma gives the skin a spongy, rubbery and more lump-like feel. However, don’t freak out just because a regular bruise may be tender. Any of your normal bruises may feel tender to the touch. Of course, if the tenderness becomes extreme or a bruise occurs suddenly in a localized area, get in contact with your doctor as soon as possible. It’s better to be dismissed as a minor hypochondriac than to sorely regret not reporting a situation that your doctor should know about and possibly need to treat.

During the initial phase of post-op, hematomas can be difficult to detect visually because if they occur on the operative site where incisions were made, bandages will most likely cover them. For this reason, it is very important to know the non-visual, sensation-oriented symptoms of hematomas, so that you may be able to feel them early enough. If you have any suspicion of the formation of a hematoma, you should call your surgeon immediately who can generally remove the dressing and inspect you.

Healing 101: What Are The Healing Tips?

What Can You Do To Lessen Chances Of Getting A Hematoma?

The probability of getting a hematoma can be decreased if you follow some healing friendly tips. First, anticoagulants medications and products containing aspirin, ibuprofen, and vitamin E must be avoided for at least 2-3 weeks before and 2-3 weeks following surgery (for a full list of products to avoid, go for a check-up in the Medication Don’ts tab of the Medications For The Journey Room). Because alcohol is a blood thinner, you should stop drinking alcohol for 2-3 weeks before and 2-3 weeks after surgery. Smoking should also be stopped for 2-3 weeks before surgery and for 2-3 weeks following surgery. While stopping some of these habits is more easily said than done, keep in mind that consuming these products will lengthen your healing process and can put you at risk of developing various complications such as hematomas and skin necrosis. During the initial 2 weeks following surgery, you should also avoid any activity that is too strenuous because this can raise your blood pressure and increase your risk of getting a hematoma. We encourage you to take a drive through the Activities, Movements & Behaviors: DOs & DON’Ts Room for a full exploration of all the activities, movements, behaviors and anything else that you should do and what you should stop doing before, during and after your eyelid surgery. Further, it is especially important to remain elevated at a 30-45 degree angle during the initial days of post-op so that blood does not rush to the face. Keeping yourself elevated will not only promote optimal blood circulation and be beneficial for swelling, but it will also help you lower your chances of developing a hematoma.

What Are The Non-Surgical Treatments?

Once you have detected a hematoma, you should call your surgeon immediately. Usually, if the hematoma remains small, then no treatment will be needed and the body will reabsorb it. Massaging the affected area can also help to break down the clots and absorb them by the body. When massaging, you should use gentle upward sweeps. Some doctors recommend ultrasounds to break up bigger hematomas. In the early stages of post-op, you can apply cold packs in a timed sequence of 20 minutes of contact followed by 10 minutes of withdrawal. Later on (and upon swelling diminishing enough in your face), you can switch to using warm compresses since the warmth increases circulation and can help clots disintegrate faster. Since the non-surgical tips for hematomas are similar to those of bruising, you are encouraged to read up on our extensive Bruising discussion (in this Room) and consider the various tips and healing solutions that are discussed in this area.

What Are The Surgical Treatments?

Your surgeon may need to have you back to the office so he/she can remove the blood of the hematoma. Usually, smaller hematomas are removed through direct evacuation or using a needle to aspirate (remove) the blood through an existing incision in the ear that was previously made during the facelift (the post-auricular incision). As the anesthesia of the facelift is typically still effective, this procedure should not require additional anesthesia. After removing the hematoma, a pressure dressing may be applied. In certain cases, the surgeon can decide to make another stab wound with a smaller blade to remove the small clot. On the other hand, large hematomas require another trip back to the operating room. The surgeon will reopen the incision and remove the clot with saline irrigation. Then, the surgeon will coagulate the bleeding. This procedure necessitates anesthesia. In the case where you could not be operated on instantly, the surgeon would reopen the suture line and remove as much as he/she can of the clot to relieve the tension on the flap. After removing the hematoma, a pressure dressing would be applied. A drain may also be applied.

 

Notify your doctor immediately if you suspect that you're experiencing a hematoma

Stop smoking for a minimum of 2-3 weeks before surgery and then for at least 2-3 weeks after surgery

Stop drinking alcohol for 2-3 weeks before surgery and then for 2-3 weeks after surgery

Gently massage a small hematoma to help it break down and absorb faster

Apply warm compresses during later stages of healing to help disintegrate the hematoma

Tell your doctor about any type of medication you are considering taking before or after your surgery

Take aspirin and ibuprofen medications or products for 2-3 weeks before surgery and 2-3 weeks following surgery even if they might reduce your fever

 

Take any medications or products that contain aspirin or ibuprofen for 2-3 weeks before surgery and 2-3 weeks following surgery

Take Vitamin E for 2-3 weeks before surgery and 2-3 weeks following surgery

Do any activities that are too strenuous, stressful, or that can increase your blood pressure during the first two weeks of post-op
 




 

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