- This study addressed whether male facelift patients still experience higher hematoma rates compared to females under modern surgical protocols.
- Researchers conducted a retrospective analysis of 541 facelift patients, including a propensity-matched cohort of 34 males and 34 females.
- In the matched cohort, males and females showed no difference in hematoma rate (0% vs 2.9%, P=1), despite males having longer operative times.
- The authors concluded that male patients experienced similar hematoma rates to matched female counterparts, despite increased operative time and estimated blood loss.
- These findings suggest that standardized surgical protocols can reduce historical disparities in male facelift patient outcomes.
Facelift Complications: Re-evaluating Hematoma Risk in Male Patients
Hematoma remains the most frequent early complication of rhytidectomy, an adverse event that can compromise aesthetic outcomes and necessitate further intervention [1, 2, 3, 4]. Clinicians have traditionally considered male patients to be at higher risk for this complication, citing anatomical and physiological factors such as thicker skin, more robust subcutaneous vasculature, and higher baseline blood pressure [5]. While hemostatic adjuncts like tranexamic acid and meticulous surgical techniques have improved safety profiles broadly [1, 3, 6], the specific risk for male patients under modern protocols has remained a clinical question, influenced by factors like diabetes mellitus which can elevate risk in other surgical contexts [7]. A recent retrospective study now directly challenges the long-held assumption of inherently greater hematoma risk in men.
Challenging Historical Assumptions: Study Design and Patient Matching
To determine if the historical disparity in hematoma rates persists with contemporary surgical techniques, investigators analyzed outcomes in male versus female facelift patients. The study employed a retrospective design, analyzing a decade of consecutive facelift surgeries performed between 2014 and 2024. Critically, all procedures were performed by a single surgeon using standardized hematoma prevention protocols, a design choice that minimizes variability from surgical technique and ensures consistency in care. To isolate the effect of gender from other potential confounders, male and female patients were carefully matched based on age, body mass index (BMI), primary versus secondary surgery status, use of local tranexamic acid, and comorbidities including hypertension, diabetes, and smoking status. This rigorous matching process allowed for a direct comparison of operative characteristics and postoperative complication profiles.
Initial Cohort Findings: Operative Differences and Hematoma Rates
An initial analysis of the full cohort of 541 patients (34 male, 507 female) revealed no significant difference in the primary outcome. Minor hematoma occurred in 0% of male patients compared to 2.0% of female patients (P=1), and no patient in either group required operative evacuation for a hematoma. However, this initial comparison did reveal significant intraoperative differences. Male patients had longer operative times (mean 456 vs. 407 minutes; P<0.001) and were substantially more likely to have a higher estimated blood loss (EBL), with 34.8% of men losing ≥100 cc of blood compared to just 2.9% of women (P<0.001). These findings confirmed inherent surgical challenges in the male patient population, prompting a more granular, matched-pair analysis to control for baseline differences.
Matched Cohort Analysis: Mitigating Gender-Based Disparities
To create a more direct comparison, the researchers then used propensity matching, a statistical method that balances covariates between groups to approximate the conditions of a randomized trial. This yielded a precisely matched cohort of 68 patients (34 male and 34 female). Even within this carefully balanced group, the intraoperative differences remained. Males still required longer operative times (mean 457 vs. 422 minutes; P<0.001) and had a higher incidence of EBL ≥100 cc (34.8% vs. 6.9%; P=0.02). The central finding of the study, however, is that these operative challenges did not translate to worse postoperative outcomes. In the matched analysis, the hematoma rate remained statistically identical between genders (0% for males vs. 2.9% for females; P=1), and the rates of overall complications were also similar. These results carry a direct clinical message for patient counseling and surgical planning. While male facelift patients do present with characteristics that increase operative time and blood loss, the study demonstrates that these factors do not necessarily lead to a higher rate of postoperative hematoma when modern, standardized prevention protocols are employed. The findings suggest that the historical perception of significantly elevated hematoma risk in men may be outdated, allowing clinicians to provide more accurate risk assessments for male patients considering rhytidectomy.
References
1. AlEnazi AS, Obeid AA, Alderaywsh A, et al. Impact of Tranexamic Acid on Bleeding Outcomes and Complication Rates in Facelift: A Systematic Review and Meta-analysis. Aesthetic Surgery Journal. 2024. doi:10.1093/asj/sjae156
2. Fang H, Torre JDL. A Systematic Review of Rhytidectomy Complications and Prevention Methods. Annals of Plastic Surgery. 2025. doi:10.1097/sap.0000000000004272
3. Caimi E, Pellicanò F, Choueiri JE, et al. Hemostatic Nets in Facelifts: A Systematic Review and Meta-Analysis of Postoperative Complications and Patient Outcomes. Aesthetic Surgery Journal Open Forum. 2025. doi:10.1093/asjof/ojaf082
4. Azzi J, Hadian A, Zabihi-Pour D, et al. Prevention of Hematoma in Patients Undergoing Facelift (Rhytidectomy): A Systematic Review and Meta-Analysis.. Facial Plastic Surgery & Aesthetic Medicine. 2025. doi:10.1177/26893614251393166
5. Vishwanath N, Darras O, Mandelbaum M, et al. Revisiting Hematoma Rates In Male Patients After Facelift Surgery: A Matched Cohort Analysis.. Plastic and reconstructive surgery. 2026. doi:10.1097/PRS.0000000000013209
6. Kolasiński J, Reysner T, Kolenda M, Kołacz S, Domagalska M. A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery. Perioperative Medicine. 2024. doi:10.1186/s13741-024-00406-7
7. Zhang X, Hou A, Cao J, et al. Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review. Frontiers in Endocrinology. 2022. doi:10.3389/fendo.2022.841256