A Composite Internal Stabilization Strategy associated with Absence of Postoperative Hematoma After Facelift: A 561-Patient Comparative Series

BACKGROUND: Postoperative hematoma remains the most common complication following rhytidoplasty, with reported incidences ranging from 0.5% to 8%. Various preventive strategies have been proposed, including blood pressure control, drains, progressive tension sutures and quilting techniques, which have been widely adopted to reduce dead space and improve flap adherence. The authors developed an internal hemostatic network (IHN), combining established suturing principles into a composite technique designed to eliminate dead space and stabilize the facial flap. METHODS: A retrospective comparative cohort study was conducted. The study group included 356 consecutive facelift procedures (2018-2025) performed using the IHN technique with progressive tension and quilting sutures, without drains or compressive dressings. A control group consisted of 205 patients (2011-2017) who underwent conventional rhytidoplasty with SMAS plication or SMASectomy and suction drains. The primary outcome was postoperative hematoma requiring surgical evacuation. Secondary outcomes included hospital stay and postoperative complications. RESULTS: No major hematomas requiring surgical evacuation, seromas, or flap necrosis occurred in the study group. Three patients (0.8%) developed small localized blood collections requiring simple aspiration; none progressed or fulfilled the predefined definition of postoperative hematoma. Transient facial nerve weakness occurred in 10.4% of patients, predominantly involving the marginal mandibular branch, with complete recovery after a mean of 7 weeks and no permanent deficits. All patients were discharged on the day of surgery (mean stay 5 hours). In the control group, 12 hematomas (5.9%) required surgical evacuation. Fisher's exact test demonstrated a statistically significant reduction in hematoma incidence with the IHN technique (p < 0.00001). CONCLUSIONS: The internal hemostatic network was associated with absence of postoperative hematoma in this retrospective comparative series. By minimizing dead space and stabilizing the flap without drains or external compression, the technique may reduce morbidity and facilitate faster recovery.Level of Evidence: III, retrospective comparative cohort study.