Facelift Complications and Continuous Perioperative Blood Pressure Evaluation
Hematoma remains the most challenging complication of facelift and has been associated with male, hypertension, aspirin use, smoking, and high body mass index. Patients who underwent facelift were studied to determine rates of hematoma and other complications and to identify predictive and protective factors, including meticulous analysis of continuous perioperative blood pressure.
Methods/Technique:
Charts of patients who underwent facelift from 2003 to 2011 at our institution were retrospectively reviewed. Demographic, clinical, and procedural data were collected. All postoperative complications were recorded. Data from continuous blood pressure monitoring in the operating and recovery rooms were obtained from a perioperative database and stratified by median and peak values. Logistic regression was used for data analysis.
Results/Complications:
Of the 229 patients included, the majority were female (88.2%), mean age at presentation was 62 years, and 35.8% had hypertension. Postoperative complications occurred in 60 patients (26.2%). The most common complication was unfavorable scar (7.4%), followed by hematoma (6.5%). Male sex (P=.02), history of hypertension (P=.04), preoperative systolic blood pressure (SBP) more than 160 mm Hg (P=.04), and operating room peak SBP more than 165 (P=.04) were predictive factors for hematoma. Recovery room peak SBP more than 150 (P=.09) was also associated with hematoma. On multivariate analysis, only male sex and preoperative SBP more than 160 remained independent risk factors for hematoma.
Conclusion:
This study is unique in that it compares the rate of hematoma to continuous blood pressure data in the operating and recovery rooms stratified by median and peak values. Meticulous control of perioperative SBP is essential for a safe facelift. History of hypertension, increased SBP at admission, and increased perioperative peak SBP are predictors for postoperative hematoma. Plastic surgeons and anesthesiologists should be aware of these risk factors.