Revisiting Hematoma Rates In Male Patients After Facelift Surgery: A Matched Cohort Analysis

BACKGROUND: Prior studies have reported higher hematoma rates in male facelift patients, often attributed to thicker skin, more robust subcutaneous vasculature, elevated baseline blood pressure, and greater incidence of alcohol and tobacco use. This study aimed to evaluate postoperative hematoma rate and overall outcomes between matched male and female facelift patients treated by a single surgeon using standardized hematoma prevention protocols. METHODS: A retrospective analysis was performed on consecutive patients who underwent facelift surgery from 2014 to 2024. Male and female patients were matched by age, BMI, primary vs. secondary status, local tranexamic acid (TXA) use, and comorbidities (hypertension, diabetes, smoking). Operative characteristics and postoperative complication profiles were compared. RESULTS: 541 patients were included (34 male, 507 female). Minor hematoma occurred in 0% of males versus 2.0% of females (P=1), with no hematomas requiring operative evacuation. Males had longer operative times (456 vs 407 minutes, P<0.001) and higher EBL (≥100 cc 34.8% vs 2.9%, P<0.001). Propensity matching yielded 68 patients (34 male, 34 female). In the matched cohort, males again had longer operative time (457 vs 422 minutes, P<0.001) and higher EBL (≥100 cc 34.8% vs 6.9%, P=0.02). There remained no difference in hematoma rate between gender (0% vs 2.9%, P=1) and overall complications were similar. CONCLUSIONS: Despite increased operative time and EBL, male patients experienced similar hematoma rates compared to matched female counterparts. These findings suggest that, with modern surgical protocols, historical disparities in male facelift patient outcomes can be meaningfully reduced.