Hemostatic net in cervical and facial surgeries: evidence from a systematic review and meta-analysis

Gonçalves, Felipe Giraldo; Silva, Leonardo Dexheimer da; Sampaio, Emily Caroline da Fonseca; Almeida, Artur de Souza; Terada, Bruno Damico; Malacarne, Guilherme Azeredo; Friedmann, Ilan David; Moreira, Miguel Rodrigues; Gemperli, Rolf; Camargo, Cristina Pires

doi:10.1590/acb412326

ABSTRACT

Purpose: Hematoma remains the most frequent complication of cervicofacial surgeries. The hemostatic net (HN), a transcutaneous suture designed to minimize dead space and bleeding, has shown promise, but pooled evidence of its safety and efficacy is limited. Thus, we conducted this study to clarify the safety profile and complication rates associated with the use of HN in cervical and facial surgeries.

Methods: A systematic search of MEDLINE, Embase, Scopus, Cochrane, and Web of Science was performed through August 2025. Eligible studies involved adults undergoing cervical and/or facial surgery with HN, with no restrictions on suture caliber or spacing between stitches. The primary outcome was hematoma incidence; secondary outcomes included skin necrosis, seroma, infection, persistent skin marks, patient-reported satisfaction, and other adverse events.

Results: Eleven studies including 3,393 patients (2,748 HN; 645 controls) were analyzed. Single-arm meta-analysis of HN cases showed low pooled rates for hematoma (0.6%; 95% confidence interval 0.4–1.0; low certainty), skin necrosis (0.4%; 95% confidence interval 0.1–1.0; low certainty), seroma (1.5%; 95% confidence interval 0.6–4.0; low certainty), infection (0.1%; 95% confidence interval 0.0–25.5), and persistent skin marks (0.6%; 95% confidence interval 0.2–2.1). Comparative analyses showed no significant difference for hematoma (risk ratio = 0.15; 95% confidence interval 0.01–3.20; very low certainty) or seroma (risk ratio = 1.06; 95% confidence interval 0.41–2.75; low certainty). Patient-reported satisfaction data were scarce and nonspecific.

Conclusion: The HN is a safe technique with very low complication rates, though evidence of superiority over standard surgery remains inconclusive due to limited certainty of meta-analyzed data, heterogeneity of surgical procedures, and the paucity of patient-reported outcomes.

Key words
Rhytidectomy; Hemostasis; Systematic Reviews as Topic; Meta-Analysis as Topic

Introduction

Facial and cervical plastic surgeries ranked in 2024 as the most frequently performed group of aesthetic procedures worldwide, surpassing five million cases, mainly through eyelid surgery and rhytidectomy¹, which restore a youthful appearance by refining contours and correcting facial laxity²-⁶. This surgery alone accounted for over 1.7 million procedures worldwide, with 115,124 procedures performed in the United States of America¹^,⁷. Cervical and facial surgeries often involve extensive skin detachment. Therefore, postoperative hematoma represents a major clinical concern and remains the most frequent complication, potentially leading to venous congestion, permanent scarring, and flap necrosis if not promptly treated⁸-¹².

Despite advancements in perioperative care, including systolic blood pressure control⁸, surgical drains⁸^,¹³-¹⁶, compression dressings¹⁵^,¹⁷-¹⁹, and meticulous intraoperative hemostasis²⁰-²², hematoma continues to occur, with incidence reported in 0 to 15% of cases⁸^,²³. This variability underscores the absence of a consistently effective preventive strategy.

In this context, the hemostatic net (HN), a surgical technique developed by Auersvald et al.²⁴^,²⁵, has emerged as a novel approach to stabilize tissue planes, minimize dead space, and enhance hemostasis, thereby reducing the risk of postoperative bleeding⁸^,²⁶-²⁹. Although early reports suggest favorable outcomes, the evidence lacks pooled analyses to confirm its benefits over established methods and estimate the real-world incidence of complications following this technique⁸^,²⁷-³¹. To address this gap, the present systematic review and meta-analysis evaluated the efficacy of the HN in reducing postoperative complications following facial and cervical plastic surgeries.

Definition of hemostatic net

The HN, as originally described by Auersvald and Auersvald²⁴^,²⁵, consists of a continuous transcutaneous suture that anchors the skin flap to the underlying fibroconnective tissue of the superficial musculoaponeurotic system and platysma²⁴^,²⁸^,³¹. The suture is passed percutaneously in a crisscross fashion, producing an external grid with the characteristic appearance of a fishing net²⁴^,²⁸^,³¹. This external pattern corresponds to the internal fixation points, which stabilize the flap, obliterate dead space, and provide homogeneous compression across the undermined area⁸^,²⁴^,²⁶-²⁹^,³²^,³³. By limiting shear forces and securing the flap against deeper tissues, the technique enhances hemostasis, prevents fluid accumulation, and thereby reduces the incidence of postoperative hematoma and seroma⁸^,²⁴^,²⁶-²⁹^,³²^,³³.

Methods

This systematic review and meta-analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions³⁴ and the PRISMA Statement guidelines³⁵. The protocol was prospectively registered in PROSPERO under the number CRD420251143364.

Search strategy

A systematic literature search was performed for studies published up to August 2025 in MEDLINE, Embase, Scopus, Cochrane, and Web of Science databases. Search terms combined keywords related to HN in facial or cervical surgeries, including their synonyms and Medical Subject Headings (MeSH) terms.

Eligibility criteria

Inclusion criteria

The authors included studies that met the following criteria:

Involved adult patients (≥ 18 years old) of both genders, undergoing any cervical or facial surgery;
Reported the use of an external HN technique, following our previous definition (external transcutaneous running quilting sutures, regardless of suture caliber, timing of removal, spacing between stitches, or specific anatomical application);
Any follow-up duration was accepted;
Eligible study designs included randomized trials, observational studies, and case series.

Exclusion criteria

The authors excluded the following studies and patient groups:

Cadaveric or animal studies;
Studies using quilting sutures other than the external HN;
Individual case reports, reviews, editorials, and letters without original data;
Studies with overlapping populations. In cases in which multiple articles reported data from the same patient cohort, we included only the study with the largest sample size. An exception was made when one of the overlapping studies was a controlled trial and another was an uncontrolled study. In these situations, both were included in the systematic review, but only one was included in each quantitative analysis—the larger cohort was used for the single-arm meta-analysis, and the controlled study was used for the comparative meta-analysis, ensuring no overlapping at all.

Screening and study selection

The initial screening was conducted in Rayyan (Rayyan Systems Inc., Qatar), after deduplication in EndNote Online 20 (Clarivate, PA, United States of America). Two reviewers independently assessed titles and abstracts, with discrepancies resolved by a third reviewer. Full-text articles were also independently reviewed by the same two authors, and disagreements were resolved by the third one. No automation or artificial intelligence tools were applied at any step of the process.

Endpoints

The primary endpoint was the incidence of postoperative hematoma, while secondary endpoints included skin necrosis, seroma, infection, persistent skin markings, patient-reported satisfaction, and any other adverse events reported by included studies (such as congestion, transient neuromuscular deficits, and other ones). Complication outcomes were collected as defined in the original studies.

Data extraction

To extract the data from the articles, two independent authors used a predefined protocol. The variables included demographics, surgery details, HN techniques, follow-up, and clinical outcomes.

Articles quality assessment

Risk of bias was assessed according to study design: randomized controlled trials (RCTs) with the Cochrane RoB 2 tool³⁶; non-randomized controlled studies with ROBINS-I³⁷; and case series with the Joanna Briggs Institute (JBI) Checklist for Case Series³⁸. Two investigators performed all assessments independently, resolving disagreements by discussion and consensus.

Statistical analysis

For pooled proportion analysis, a single-arm model was conducted using the generalized linear mixed model. Pooled estimates were exposed with their respective 95% confidence intervals (95%CI). The comparative meta-analyses were performed using pooled risk ratios (RR) with 95%CI under random-effects models to account for clinical and methodological variability. Statistical significance was defined as a two-sided p < 0.05. Heterogeneity was assessed using the I² statistic, and values ≥ 30% were used as a prespecified threshold to trigger sensitivity analyses (leave-one-out [LOO] and meta-regressions) to explore potential sources of variability. All analyses were conducted in R (version 4.5.0; R Foundation for Statistical Computing, Vienna, Austria) using RStudio (Posit, PBC, Boston, MA, United States of America).

Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)³⁹ approach.

Results

Study selection and characteristics

After conducting the systematic search, 452 articles were initially identified. Following deduplication, 204 studies remained. After screening titles, abstracts, and full texts, 11 studies⁶^,⁸^,²⁸^,²⁹^,⁴⁰-⁴⁶ met the eligibility criteria and were included in this review (Fig. 1). Collectively, these studies encompassed 3,393 patients, of whom 2,748 were allocated to the HN group and 645 to the control group. A detailed summary of the baseline characteristics of the included studies is presented in Table 1, and the clinical endpoints reported are outlined in Table 2.

Figure 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only.

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Table 1
Baseline characteristics of patients in the included studies.

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Table 2
Clinical endpoints reported in the included studies.

Primary endpoint

The single-arm meta-analysis of postoperative hematoma included 10 studies⁶^,⁸^,²⁹^,⁴⁰-⁴⁶, totaling 2,343 patients treated with a HN after cervical and/or facial surgery. The pooled incidence was 0.6% (95%CI, 0.4–1.0%; I² = 0%; low certainty) (Fig. 2), with no heterogeneity.

Figure 2
Proportional meta-analysis of hematoma: hemostatic net only.

The comparative meta-analysis comprised five studies⁸^,²⁸^,²⁹^,⁴²^,⁴⁴ with 1,542 patients (897 with HN and 645 without). The initial pooled estimate revealed high heterogeneity and no significant difference between groups (RR = 0.15; 95%CI 0.01–3.20; p = 0.23; I² = 73.2%; very low certainty) (Fig. 3). A LOO sensitivity analysis showed that Ismail and Ghoraba’s8 omission yielded a significant effect favoring the HN (RR = 0.048; 95%CI 0.003–0.871; p = 0.04), while heterogeneity remained high (I2 = 70.8%) (Fig. 4).

Figure 3
Controlled meta-analysis of hematoma: hemostatic net versus control.

Figure 4
Leave-one-out hematoma: hemostatic net versus control.

Given the absence of heterogeneity in the single-arm analysis, we hypothesized that variability in the comparative analysis stemmed mainly from control arms, in which hematoma rates varied widely. This variability likely reflects differences across studies in perioperative management protocols, surgical technique, and hematoma definitions within the control groups, rather than inconsistency in the performance of the hemostatic net itself. A meta-regression using control-group hematoma incidence (Fig. 5) confirmed a significant association with the outcome (β = -36.5; standard error = 14.1; p = 0.009) and reduced the residual variance (τ²) to 0, indicating that this factor fully explained the heterogeneity. R² was not computed because the base model’s between-study variance was near 0.

Figure 5
Meta-regression of hematoma: hemostatic net versus control—control-group hematoma incidence as the covariate.

Secondary endpoints

The single-arm meta-analysis of skin necrosis included seven studies⁸^,²⁸^,⁴¹^,⁴²^,⁴⁴-⁴⁶, comprising 1,062 patients treated with HN. The pooled incidence was 0.4% (95%CI 0.1–1.0%; I² = 0%; low certainty) (Fig. 6), indicating no heterogeneity. The comparative meta-analysis for this endpoint encompassed four studies⁸^,²⁸^,⁴²^,⁴⁴ with 879 patients (593 with HN and 286 without). Among these, three studies reported zero events in both groups, so only a single study contributed meaningfully to the pooled effect estimate. Consequently, the pooled analysis favored the HN group (RR = 0.15; 95%CI 0.04–0.58; p = 0.006; low certainty) (Fig. 7), but heterogeneity statistics (I² and τ²) could not be calculated.

Figure 6
Proportional meta-analysis of skin necrosis: hemostatic net only.

Figure 7
Controlled meta-analysis of skin necrosis: hemostatic net versus control.

The single-arm meta-analysis of seroma included seven studies⁸^,⁴⁰-⁴²^,⁴⁴-⁴⁶, comprising 1,676 patients treated with HN. The pooled incidence was 1.5% (95%CI 0.6–4.0%; I² = 74.8%; low certainty) (Fig. 8), with high heterogeneity. Sensitivity analysis using the LOO method revealed that omitting Ismail and Ghoraba⁸ markedly reduced heterogeneity, yielding a pooled incidence of 1.1% (95%CI 0.7–1.7%; I² = 7.6%) (Fig. 9). The comparative meta-analysis encompassed three studies⁸^,⁴²^,⁴⁴ including 354 patients (188 with HN and 166 without) and showed no significant difference between groups (RR = 1.06; 95%CI 0.41–2.75; p = 0.90; I² = 0.0%; low certainty) (Fig. 10).

Figure 8
Proportional meta-analysis of seroma: hemostatic net only.

Figure 9
Leave-one-out seroma: hemostatic net only.

Figure 10
Controlled meta-analysis of seroma: hemostatic net versus control.

The single-arm meta-analysis of infection included five studies⁸^,⁴¹^,⁴³^,⁴⁴^,⁴⁶, with 317 patients treated with HN, and showed an incidence of 0.1% (95%CI 0.0–25.5%; I² = 0%) (Fig. 11). For persistent skin marks, the single-arm meta-analysis of seven studies⁶^,²⁸^,⁴¹^,⁴²^,⁴⁴^,⁴⁵ comprising 1,221 patients demonstrated an incidence of 0.6% (95%CI 0.2–2.1%; I² = 28.8%) (Fig. 12).

Figure 11
Proportional meta-analysis of infection: hemostatic net only.

Figure 12
Proportional meta-analysis of skin marks: hemostatic net only.

The qualitative synthesis of patient-reported satisfaction included data from four studies. Two of these addressed only patient concerns regarding the disappearance of skin marks after HN application, whereas the other two reported overall satisfaction with the surgical outcome rather than satisfaction specifically related to the net, as presented in Table 2.

Finally, all but one²⁹ study reported other adverse events. Occasional cases of ischemia, swelling, congestion, and transient neuromuscular disturbances were described among patients treated with HN. Table 2 provides a detailed overview of these additional events.

Quality assessment

Risk of bias was assessed using appropriate tools for each study design. For RCTs, the Cochrane Risk of Bias 2.0 tool³⁶ was applied: the study by Ismail and Ghoraba⁸ demonstrated a rigorous methodological process, being evaluated as low risk of bias (Fig. 13).

Figure 13
Traffic light plot: RoB 2.

Observational studies, such as retrospective cohorts and non-randomized prospective studies, were evaluated using the ROBINS-I tool³⁷. Most showed moderate risk of bias²⁸^,²⁹^,⁴⁵, mainly due to the absence of demographic data, while two studies, by Kachare et al.⁴¹ and Şibar et al⁴⁴, were evaluated as low risk (Fig. 14).

Figure 14
Traffic light plot: Robins-I.

Case series studies were assessed using the JBI Critical Appraisal Checklist for Case Series³⁸. All articles⁶^,⁴⁰^,⁴²^,⁴³^,⁴⁶ were considered as low risk of bias (Fig. 15).

Figure 15
Traffic light plot: Joanna Briggs Institute Checklist for Case Series.

Certainty of evidence

The GRADE³⁹ assessment is presented in Table 3. Because most of the included studies are non-randomized, the certainty of evidence could not be rated higher than low level of certainty.

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Table 3
Certainty of evidence: GRADE.

Discussion

Despite a broad range of preventive strategies, including strict blood-pressure control, optimized pain management, local infiltration of vasoconstrictor, careful patient selection, and the use of quilting sutures, hematoma remains the most common postoperative complication of facial and cervical surgeries¹⁷^,¹⁸^,²⁰^,²¹^,³²^,³³^,⁴⁷-⁵². Quilting sutures, first described as early as 3400 BCE²⁶ and introduced to plastic surgery in 1979⁵³, gained wide acceptance after Baroudi and Ferreira⁵⁴, demonstrated a significant reduction in seroma rates in abdominoplasty in 1998. By obliterating dead space, these stitches are hypothesized to lower the risk of both seroma and hematoma⁶^,⁸^,²⁶^,²⁸^,²⁹^,³²^,³³^,⁴⁰-⁴⁶^,⁵⁵-⁵⁸. In 2003, Pollock and Pollock⁵⁵ adapted this concept to rhytidectomy.

Seeking to avoid the potential skin irregularities associated with internal quilting, Auersvald and Auersvald²⁴^,²⁵ introduced the HN in 2012, a continuous external suture resembling a fishing net, and reported a dramatic reduction in hematoma incidence from 14 to 0%. Since then, numerous studies have evaluated this technique with varying results.

Two systematic reviews have addressed quilting suture. However, these reviews show some limitations. Ballan et al.⁵⁹ focused exclusively on quilting sutures in rhytidectomy and published before several pivotal studies were available. Caimi et al.⁶⁰ incorporated more recent data but limited inclusion to facelifts and only four series using external HN, which restricts generalizability⁶¹. To address these gaps, we performed a comprehensive systematic review and meta-analysis of 11 studies on HN⁶^,⁸^,²⁸^,²⁹^,⁴⁰-⁴⁶ spanning both cervical and facial procedures, whether aesthetic or reconstructive.

Hematoma remains a critical concern after cervicofacial surgery, carrying risks that range from aesthetic compromise to life-threatening airway obstruction when located in the cervical region¹⁷^,²³^,⁴⁷^,⁶²-⁶⁴. Preventing this complication is therefore paramount. In our analysis, the incidence of hematoma among patients treated with a HN was very low (0.6%), substantially below rates previously reported in patients without HN²³^,⁴⁷ and consistent with prior evidence on internal quilting sutures³²^,³³. This concordance suggests that the principal protective effect arises from mechanical obliteration of dead space rather than from whether the suture is external or internal.

In comparative analyses, the pooled estimate showed no significant difference in hematoma risk between patients with or without HN, except when the only randomized trial⁸ was excluded in LOO sensitivity analysis, which yielded a significant difference favoring net use. The dependence of statistical significance on the omission of this single RCT raises the possibility of publication bias in the non-randomized series. Such bias could not be formally assessed because funnel plots and Egger’s test are not recommended when fewer than 10 studies are available³⁴. Overall heterogeneity for this endpoint was high and persisted despite LOO analysis. Given the negligible heterogeneity observed in the single-arm analysis of patients receiving the HN, we hypothesized that variability originated primarily in the control groups, in which hematoma incidence ranged from 0 to 14%. Meta-regression using control-group hematoma incidence as a moderator confirmed this hypothesis: the residual between-study variance (τ²) dropped to 0, indicating that this single factor fully accounted for the observed heterogeneity.

Skin necrosis is another recognized concern in cervicofacial surgery, as in any procedure involving skin undermining. Nevertheless, facial procedures generally carry a lower risk of ischemia or necrosis because of the region’s rich vascularity⁶⁵^,⁶⁶. Theoretically, the external compression of a HN could compromise cutaneous blood supply or venous drainage, increasing the risk of ischemia or necrosis. However, recent evidence demonstrates that the net does not impair blood flow⁶⁷, a finding consistent with our single-arm meta-analysis, which showed a very low incidence of necrosis (0.4%) with no heterogeneity. Our comparative meta-analysis even suggested a reduced risk of necrosis in the HN group, though this result must be interpreted cautiously because only one study contributed events, while the other three reported none in either arm.

Seroma after cervicofacial surgery is generally rare⁴⁷^,⁶⁸, and our data confirm this. The single-arm analysis revealed a pooled incidence of 1.5% among patients treated with HN. Heterogeneity was initially high but dropped dramatically to 7.6%, and the incidence to 1.1%, after the exclusion of Ismail and Ghoraba⁸. This again raises concern about potential publication bias in the non-randomized studies and may also reflect differences in surgical techniques or in how seromas were diagnosed and reported.

Patient-reported outcomes (PROs) were poorly documented across the included literature. Only four of the 11 studies provided any PRO data: two simply noted nonspecific concerns regarding the disappearance of skin marks, and the other two reported overall satisfaction with the surgical result (gliding brow lift) rather than with the net itself. This paucity of PRO data is striking because PROs are widely recognized as essential in evaluating results of cervicofacial plastic surgery, whether aesthetic or reconstructive. Such measures capture dimensions not fully addressed by objective clinical metrics, such as satisfaction with appearance, psychosocial impact, quality of life, and overall well-being⁶⁹-⁷³. Given these gaps and the reported concerns about transient skin marks, we believe the development of a dedicated patient-reported satisfaction scale specific to the HN would substantially strengthen future evidence.

Infections are uncommon after face or neck lifts⁷⁴^,⁷⁵, and our findings mirror this pattern, with a pooled incidence of only 0.1% in patients treated with HN. Early postoperative skin marks are common, as noted by Wongkietkachorn and Wongkietkachorn⁶, but approximately 90% of patients are free of marks by the end of the first postoperative month. Our single-arm analysis found a low incidence of persistent skin marks (0.6%), indicating that the HN provides hemostatic benefits without imparting a meaningful long-term aesthetic risk.

This review has some limitations. The scarcity of RCTs in plastic surgery was well recognized by Song and Chung⁷⁶, and our meta-analysis included only one RCT⁸, which we rated as low risk of bias. For two outcomes, this trial acted as an outlier, raising concerns about potential publication bias among the non-randomized studies—which could not be formally evaluated in accordance with Cochrane³⁴ guidance. Furthermore, substantial clinical and technical heterogeneity was observed across the included studies. Technical aspects such as suture material and caliber, spacing between stitches, precise anatomical placement, and dissection plane varied widely and were inconsistently reported, precluding systematic analysis. Although these factors—and the inherently operator-dependent nature of the technique—may influence outcomes, their impact could not be formally evaluated in the present analysis. Similarly, the distinction between minor and major adverse events could not be consistently accounted for, as most studies did not differentiate between events requiring surgical reintervention and those managed conservatively in an outpatient setting, including but not limited to hematoma.

Importantly, GRADE³⁹ assessments indicated low to very low certainty for all analyzed outcomes, reflecting the predominance of non-randomized evidence, and the heterogeneity introduced into the controlled meta-analyses by historical control groups in some studies, as demonstrated by our meta-regression. Operative time was infrequently reported, and the potential impact of the hemostatic net on surgical duration remains unclear, warranting further investigation in future studies. Finally, while generally safe, the technique is not without inherent risks: all but one of the included studies documented adverse events beyond those formally analyzed, such as transient ischemia, congestion, swelling, and neuromuscular disturbances, likely reflecting the intrinsic challenges of an external quilting method applied without direct visualization of underlying structures and inevitably exerting some degree of skin compression, even when tension is low.

Conclusion

The HN appears safe, with consistently low rates of hematoma, skin necrosis, and other complications. However, proving its superiority over standard surgery remains challenging due to the overall low certainty of evidence and the heterogeneity between the analyzed surgical procedures. Moreover, the lack of PROs highlights the need to develop dedicated PRO instruments to assess satisfaction and quality-of-life impacts in patients undergoing cervicofacial procedures with HN.

Acknowledgements

Not applicable.

Research performed at Plastic Surgery and Regenerative Medicine Laboratory, School of Medicine, Universidade de São Paulo, São Paulo (SP), Brazil.
Funding
Not applicable.
Declaration of use of artificial intelligence tools
The authors declare that no artificial intelligence tools were used in the writing, analysis, or preparation of this manuscript.

Data availability statement

All data sets were generated or analyzed in the current study.

References

¹ International Society of Aesthetic Plastic Surgery. ISAPS international survey on aesthetic/cosmetic procedures performed in 2024: full report. Hanover; 2024 [cited 2026 Mar 16]. Available from: https://www.isaps.org/discover/about-isaps/global-statistics/global-survey-2024-full-report-and-press-releases/
» https://www.isaps.org/discover/about-isaps/global-statistics/global-survey-2024-full-report-and-press-releases/
² Auersvald A, Auersvald LA, Uebel CO. Subplatysmal necklift: a retrospective analysis of 504 patients. Aesthet Surg J. 2017;37(1):1–11. https://doi.org/10.1093/asj/sjw107
» https://doi.org/10.1093/asj/sjw107
³ Wan DM, Small KH, Barton FE. Face lift. Plast Reconstr Surg. 2015;136(5):676e–89e. https://doi.org/10.1097/PRS.0000000000001695
» https://doi.org/10.1097/PRS.0000000000001695
⁴ Auersvald A, Auersvald LA. Management of the submandibular gland in neck lifts: indications, techniques, pearls, and pitfalls. Clin Plast Surg. 2018;45(4):507–25. https://doi.org/10.1016/j.cps.2018.06.001
» https://doi.org/10.1016/j.cps.2018.06.001
⁵ Connell BF. Neck contour deformities. The art, engineering, anatomic diagnosis, architectural planning, and aesthetics of surgical correction. Clin Plast Surg. 1987;14(4):683–92.
⁶ Wongkietkachorn A, Wongkietkachorn N. The use of the hemostatic net in Asian population: hyperpigmentation and the duration required for hemostatic net marking to disappear. Aesthetic Plast Surg. 2025;49(3):627–34. https://doi.org/10.1007/s00266-024-04561-6
» https://doi.org/10.1007/s00266-024-04561-6
⁷ American Society of Plastic Surgeons. 2024 ASPS procedural statistics release [Internet]. Arlington Heights: American Society of Plastic Surgeons; 2024 [cited 2026 Mar 16]. Available from: https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf
» https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf
⁸ Ismail M, Ghoraba S. Hemostatic net versus surgical drain after deep plane facelift surgery: a prospective randomized controlled trial. Aesthetic Plast Surg. 2025;49(16):4572–8. https://doi.org/10.1007/s00266-025-04745-8
» https://doi.org/10.1007/s00266-025-04745-8
⁹ Moyer JS, Baker SR. Complications of rhytidectomy. Facial Plast Surg Clin N Am. 2005;13(3):469–78. https://doi.org/10.1016/j.fsc.2005.04.005
» https://doi.org/10.1016/j.fsc.2005.04.005
¹⁰ Baker DC, Stefani WA, Chiu ES. Reducing the incidence of hematoma requiring surgical evacuation following male rhytidectomy: a 30-year review of 985 cases. Plast Reconstr Surg. 2005;116(7):1973–85; discussion 1986–7. https://doi.org/10.1097/01.prs.0000191182.70617.e9
» https://doi.org/10.1097/01.prs.0000191182.70617.e9
¹¹ Baker TJ, Gordon HL. Complications of rhytidectomy. Plast Reconstr Surg. 1967;40(1):31–9. https://doi.org/10.1097/00006534-196707000-00004
» https://doi.org/10.1097/00006534-196707000-00004
¹² Batniji RK. Complications/sequelae of neck rejuvenation. Facial Plast Surg Clin N Am. 2014;22(2):317–20. https://doi.org/10.1016/j.fsc.2014.01.007
» https://doi.org/10.1016/j.fsc.2014.01.007
¹³ Perkins SW, Williams JD, Macdonald K, Robinson EB. Prevention of seromas and hematomas after face-lift surgery with the use of postoperative vacuum drains. Arch Otolaryngol Head Neck Surg. 1997;123(7):743–5. https://doi.org/10.1001/archotol.1997.01900070087014
» https://doi.org/10.1001/archotol.1997.01900070087014
¹⁴ Niamtu J III. Facelift drains and dressings: to be or not to be? Dermatol Surg. 2012;38(5):793–6. https://doi.org/10.1111/j.1524-4725.2011.02286.x
» https://doi.org/10.1111/j.1524-4725.2011.02286.x
¹⁵ Kleinberger AJ, Spiegel JH. What is the best method for minimizing the risk of hematoma formation after rhytidectomy? Laryngoscope. 2015;125(3):534–6. https://doi.org/10.1002/lary.24685
» https://doi.org/10.1002/lary.24685
¹⁶ Khansa I, Khansa L, Meyerson J, Janis JE. Optimal use of surgical drains: evidence-based strategies. Plast Reconstr Surg. 2018;141(6):1542–9. https://doi.org/10.1097/PRS.0000000000004413
» https://doi.org/10.1097/PRS.0000000000004413
¹⁷ Jones BM, Grover R. Avoiding hematoma in cervicofacial rhytidectomy: a personal 8-year quest. Reviewing 910 patients. Plast Reconstr Surg. 2004;113(1):381–7; discussion 388–90. https://doi.org/10.1097/01.PRS.0000097291.15196.78
» https://doi.org/10.1097/01.PRS.0000097291.15196.78
¹⁸ Beer GM, Goldscheider E, Weber A, Lehmann K. Prevention of acute hematoma after face-lifts. Aesthetic Plast Surg. 2010;34(4):502–7. https://doi.org/10.1007/s00266-010-9488-8
» https://doi.org/10.1007/s00266-010-9488-8
¹⁹ Tiourin E, Barton N, Janis JE. Methods for minimizing bleeding in facelift surgery: an evidence-based review. Plast Reconstr Surg Glob Open. 2021;9(8):e3765. https://doi.org/10.1097/GOX.0000000000003765
» https://doi.org/10.1097/GOX.0000000000003765
²⁰ Stewart CM, Bassiri-Tehrani B, Jones HE, Nahai F. Evidence of hematoma prevention after facelift. Aesthet Surg J. 2024;44(2):134–43. https://doi.org/10.1093/asj/sjad247
» https://doi.org/10.1093/asj/sjad247
²¹ Ganesh Kumar N, Sherif R, Schultz K, Hidalgo DA, Stuzin JM, Rohrich RJ. Role of selective neck sutures in face lifts. Plast Reconstr Surg. 2025;156(2):194e–7e. https://doi.org/10.1097/PRS.0000000000011968
» https://doi.org/10.1097/PRS.0000000000011968
²² Schroeder RJ II, Langsdon PR. Effect of local tranexamic acid on hemostasis in rhytidectomy. Facial Plast Surg Aesthetic Med. 2020;22(3):195–9. https://doi.org/10.1089/fpsam.2020.0061
» https://doi.org/10.1089/fpsam.2020.0061
²³ Niamtu J III. Expanding hematoma in face-lift surgery: literature review, case presentations, and caveats. Dermatol Surg. 2005;31(9 Pt 1):1134–44; discussion 1144.
²⁴ Auersvald A, Auersvald L, Biondo-Simões ML. Hemostatic net: an alternative for the prevention of hematoma in rhytidoplasty. Rev Bras Cir Plást. 2012;27(1):22–30. https://doi.org/10.1590/S1983-51752012000100006
» https://doi.org/10.1590/S1983-51752012000100006
²⁵ Auersvald A, Auersvald L. Rede hemostática para a prevenção de hematoma e seroma em cirurgia plástica. Arq Catarin Med. 2012;41(Suppl.1):86–8.
²⁶ O’Daniel TG, Kachare MD. Evolution of the surgical net. Facial Plast Surg. 2025;41(1):70–81. https://doi.org/10.1055/a-2334-4448
» https://doi.org/10.1055/a-2334-4448
²⁷ Pellini E, Finocchi V, Albanese R. Innovations in rhytidoplasty: 480 cases validating the efficacy of the inner hemostatic net. Aesthet Surg J. 2025;45(9):875–81. https://doi.org/10.1093/asj/sjaf108
» https://doi.org/10.1093/asj/sjaf108
²⁸ Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthetic Plast Surg. 2014;38(1):1–9. https://doi.org/10.1007/s00266-013-0202-5
» https://doi.org/10.1007/s00266-013-0202-5
²⁹ Janssen TJ, Maheshwari K, Sivadasan A, Waterhouse N. Hemostatic net in facelift surgery: a 5-year single-surgeon experience. Aesthet Surg J. 2023;43(10):1106–11. https://doi.org/10.1093/asj/sjad097
» https://doi.org/10.1093/asj/sjad097
³⁰ Nahai F, Bassiri-Tehrani B, Santosa KB. Hematomas and the facelift surgeon: it’s time for us to break up for good. Aesthet Surg J. 2023;43(10):1207–9. https://doi.org/10.1093/asj/sjad225
» https://doi.org/10.1093/asj/sjad225
³¹ Auersvald A, Auersvald LA. Commentary on: quilting sutures in rhytidectomy: a systematic review of the literature. Aesthet Surg J. 2020;40(11):1165–7. https://doi.org/10.1093/asj/sjaa014
» https://doi.org/10.1093/asj/sjaa014
³² Cabas Neto J, Rodriguez Fernandez DE, Boles M. Reducing the incidence of hematomas in cervicofacial rhytidectomy: new external quilting sutures and other ancillary procedures. Aesthetic Plast Surg. 2013;37(5):1034–9. https://doi.org/10.1007/s00266-013-0084-6
» https://doi.org/10.1007/s00266-013-0084-6
³³ Cabas Neto J, Fernandez D, Boles M. A new technique of external quilting sutures: their importance in preventing hematomas in cervicofacial rhytidectomies. Plast Reconstr Surg. 2013;131(1):121e. https://doi.org/10.1097/PRS.0b013e318272a1cc
» https://doi.org/10.1097/PRS.0b013e318272a1cc
³⁴ Higgins J. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.5. Cochrane Handbook for Systematic Reviews of Interventions; 2024.
³⁵ Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
» https://doi.org/10.1136/bmj.n71
³⁶ Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898
» https://doi.org/10.1136/bmj.l4898
³⁷ Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919
» https://doi.org/10.1136/bmj.i4919
³⁸ Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, Aromataris E. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth. 2020;18(10):2127–33. https://doi.org/10.11124/JBISRIR-D-19-00099
» https://doi.org/10.11124/JBISRIR-D-19-00099
³⁹ Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924. https://doi.org/10.1136/bmj.39489.470347.AD
» https://doi.org/10.1136/bmj.39489.470347.AD
⁴⁰ Auersvald LA, Auersvald A. Sternohyoid muscles plication and sternocleidomastoid muscles rejuvenation in neck lift: a retrospective study of 1,019 consecutive patients. Plast Aesthetic Res. 2021;8:4. https://doi.org/10.20517/2347-9264.2020.187
» https://doi.org/10.20517/2347-9264.2020.187
⁴¹ Kachare MD, Moore AC, Little J, O’Daniel TG. Establishment of safety of hemostatic net application utilizing laser-assisted fluorescence angiography with SPY-Q software analysis. Aesthet Surg J. 2023;43(6):623–30. https://doi.org/10.1093/asj/sjad007
» https://doi.org/10.1093/asj/sjad007
⁴² O’Daniel T, Auersvald A, Auersvald L. Hemostatic net in facelift surgery. MKG-Chir. 2019;12(2):78–85. https://doi.org/10.1007/s12285-019-0195-4
» https://doi.org/10.1007/s12285-019-0195-4
⁴³ Orra S, Bald M, Wagner G, Grotting JC. The gliding brow lift: an analysis of outcomes and maintenance of lift in a single surgeon’s practice. Aesthet Surg J. 2025;45(3):225–31. https://doi.org/10.1093/asj/sjae224
» https://doi.org/10.1093/asj/sjae224
⁴⁴ Şibar S, Erdal AI, Deniz E, Kılıç Ö, Tuncer S. Comparison of the effectiveness and safety of the “endoscope-assisted polypropylene mesh lift” and “gliding brow lift” techniques for the treatment of lateral brow ptosis. J Plast Reconstr Aesthet Surg. 2023;83:455–62. https://doi.org/10.1016/j.bjps.2023.04.079
» https://doi.org/10.1016/j.bjps.2023.04.079
⁴⁵ Sozer SO, Sibar S, Kachare MD. Progressive contouring of the platysma with barbed sutures. Aesthet Surg J. 2024;44(5):449–62. https://doi.org/10.1093/asj/sjad362
» https://doi.org/10.1093/asj/sjad362
⁴⁶ Viterbo F, Auersvald A, O’Daniel TG. Gliding brow lift (GBL): a new concept. Aesthetic Plast Surg. 2019;43(6):1536–46. https://doi.org/10.1007/s00266-019-01486-3
» https://doi.org/10.1007/s00266-019-01486-3
⁴⁷ Griffin JE, Jo C. Complications after superficial plane cervicofacial rhytidectomy: a retrospective analysis of 178 consecutive facelifts and review of the literature. J Oral Maxillofac Surg. 2007;65(11):2227–34. https://doi.org/10.1016/j.joms.2006.10.075
» https://doi.org/10.1016/j.joms.2006.10.075
⁴⁸ Prakasam S, Stein K, Lee MK, Rampa S, Nalliah R, Allareddy V, Allareddy V. Prevalence and predictors of complications following facial reconstruction procedures. Int J Oral Maxillofac Surg. 2016;45(6):735–42. https://doi.org/10.1016/j.ijom.2015.12.020
» https://doi.org/10.1016/j.ijom.2015.12.020
⁴⁹ Bassiri-Tehrani B, Abi-Rafeh J, Baker NF, Kerendi AN, Nahai F. Systolic blood pressure less than 120 mmHg is a safe and effective method to minimize bleeding after facelift surgery: a review of 502 consecutive cases. Aesthet Surg J. 2023;43(12):1420–8. https://doi.org/10.1093/asj/sjad228
» https://doi.org/10.1093/asj/sjad228
⁵⁰ Moris V, Bensa P, Gerenton B, Rizzi P, Cristofari S, Zwetyenga N, Guilier D. The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma. J Plast Reconstr Aesthet Surg. 2019;72(5):821–9. https://doi.org/10.1016/j.bjps.2018.10.046
» https://doi.org/10.1016/j.bjps.2018.10.046
⁵¹ Maricevich MA, Adair MJ, Maricevich RL, Kashyap R, Jacobson SR. Facelift complications related to median and peak blood pressure evaluation. Aesthetic Plast Surg. 2014;38(4):641–7. https://doi.org/10.1007/s00266-014-0353-z
» https://doi.org/10.1007/s00266-014-0353-z
⁵² Cason RW, Avashia YJ, Shammas RL, Savetsky IL, Rohrich RJ. Perioperative approach to reducing hematoma during rhytidectomy: what does the evidence show? Plast Reconstr Surg. 2021;147(6):1297–309. https://doi.org/10.1097/PRS.0000000000007943
» https://doi.org/10.1097/PRS.0000000000007943
⁵³ Mehta HK. A new method of full thickness skin graft fixation. Br J Ophthalmol. 1979;63(2):125–8. https://doi.org/10.1136/bjo.63.2.125
» https://doi.org/10.1136/bjo.63.2.125
⁵⁴ Baroudi R, Ferreira CA. Seroma: how to avoid it and how to treat it. Aesthet Surg J. 1998;18(6):439–41. https://doi.org/10.1016/S1090-820X(98)70073-1
» https://doi.org/10.1016/S1090-820X(98)70073-1
⁵⁵ Pollock H, Pollock TA. Management of face lifts with progressive tension sutures. Aesthet Surg J. 2003;23(1):28–33. https://doi.org/10.1016/S1090-820X(03)90020-3
» https://doi.org/10.1016/S1090-820X(03)90020-3
⁵⁶ Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000;105(7):2583–6; discussion 2587–8. https://doi.org/10.1097/00006534-200006000-00047
» https://doi.org/10.1097/00006534-200006000-00047
⁵⁷ Hudson DA. The quilting suture: its application in face lifts. Plast Reconstr Surg. 2010;126(2):72e–3e. https://doi.org/10.1097/PRS.0b013e3181de23fb
» https://doi.org/10.1097/PRS.0b013e3181de23fb
⁵⁸ Wongkietkachorn A, Wongkietkachorn N. Endoscopic gliding forehead lift: a brow shaping method to lift the medial and lateral brow. Aesthetic Plast Surg. 2025;49(20):5712–8. https://doi.org/10.1007/s00266-025-05027-z
» https://doi.org/10.1007/s00266-025-05027-z
⁵⁹ Ballan A, Jabbour S, El Rayess Y, Jabbour K, El Hachem L, Nasr M. Quilting sutures in rhytidectomy: a systematic review of the literature. Aesthet Surg J. 2020;40(11):1157–64. https://doi.org/10.1093/asj/sjz353
» https://doi.org/10.1093/asj/sjz353
⁶⁰ Caimi E, Pellicanò F, El Choueiri J, Vaccari S, Di Giuli R, Furlan S, Bucci F, Klinger F, Vinci V. Hemostatic nets in facelifts: a systematic review and meta-analysis of postoperative complications and patient outcomes. Aesthet Surg J Open Forum. 2025;7:ojaf082. https://doi.org/10.1093/asjof/ojaf082
» https://doi.org/10.1093/asjof/ojaf082
⁶¹ Gonçalves FGA, da Silva LD, Sampaio ECDF, Camargo CP. Response by Gonçalves et al. to “Hemostatic nets in facelifts: a systematic review and meta-analysis of postoperative complications and patient outcomes” by Caimi et al. Aesthet Surg J Open Forum. 2025;7:ojaf152. https://doi.org/10.1093/asjof/ojaf152
» https://doi.org/10.1093/asjof/ojaf152
⁶² AbuRahma AF, Avgerinos ED, Chang RW, Darling RC 3rd, Duncan AA, Forbes TL, Malas MB, Perler BA, Powell RJ, Rockman CB, Zhou W. The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease. J Vasc Surg. 2022;75(1Suppl.):26S–98S. https://doi.org/10.1016/j.jvs.2021.04.074
» https://doi.org/10.1016/j.jvs.2021.04.074
⁶³ Quick E, Byard RW. Postoperative cervical soft tissue hemorrhage with acute upper airway obstruction. J Forensic Sci. 2013;58(Suppl.1):S264–6. https://doi.org/10.1111/1556-4029.12026
» https://doi.org/10.1111/1556-4029.12026
⁶⁴ Shah-Becker S, Greenleaf EK, Boltz MM, Hollenbeak CS, Goyal N. Neck hematoma after major head and neck surgery: risk factors, costs, and resource utilization. Head Neck. 2018;40(6):1219–27. https://doi.org/10.1002/hed.25102
» https://doi.org/10.1002/hed.25102
⁶⁵ Schaverien MV, Pessa JE, Saint-Cyr M, Rohrich RJ. The arterial and venous anatomies of the lateral face lift flap and the SMAS. Plast Reconstr Surg. 2009;123(5):1581–7. https://doi.org/10.1097/PRS.0b013e3181a20544
» https://doi.org/10.1097/PRS.0b013e3181a20544
⁶⁶ Sepúlveda A, Sastre N. Necrotizing fasciitis of the face and neck. Plast Reconstr Surg. 1998;102(3):814–7. https://doi.org/10.1097/00006534-199809030-00028
» https://doi.org/10.1097/00006534-199809030-00028
⁶⁷ Henry G, Auersvald A, Auersvald LA, Ospital C, Boucher F, Mojallal A. Skin perfusion after hemostatic net: an anatomic and radiologic study in a cadaver model. Aesthet Surg J. 2024;44(3):245–53. https://doi.org/10.1093/asj/sjad286
» https://doi.org/10.1093/asj/sjad286
⁶⁸ Fang AH, Torre J. A systematic review of rhytidectomy complications and prevention methods: evaluating the trends. Ann Plast Surg. 2025;94(6Suppl.):S502–16. https://doi.org/10.1097/SAP.0000000000004272
» https://doi.org/10.1097/SAP.0000000000004272
⁶⁹ Dobbs TD, Gibson JAG, Hughes S, Thind A, Patel B, Hutchings HA, Whitaker IS. Patient-reported outcome measures for soft-tissue facial reconstruction: a systematic review and evaluation of the quality of their measurement properties. Plast Reconstr Surg. 2019;143(1):255–68. https://doi.org/10.1097/PRS.0000000000005112
» https://doi.org/10.1097/PRS.0000000000005112
⁷⁰ Imadojemu S, Sarwer DB, Percec I, Sonnad SS, Goldsack JE, Berman M, Sobanko JF. Influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: a systematic review. JAMA Dermatol. 2013;149(11):1325–33. https://doi.org/10.1001/jamadermatol.2013.6812
» https://doi.org/10.1001/jamadermatol.2013.6812
⁷¹ Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-reported aesthetic and psychosocial outcomes after microvascular reconstruction for head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2021;147(12):1035–44. https://doi.org/10.1001/jamaoto.2021.1563
» https://doi.org/10.1001/jamaoto.2021.1563
⁷² Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg. 2020;44(4):1210–5. https://doi.org/10.1007/s00266-020-01809-9
» https://doi.org/10.1007/s00266-020-01809-9
⁷³ Du H, Liang H, Qi Z, Jin X. A prospective investigation of patient satisfaction and psychosocial status following facial bone contouring surgery using the FACE-Q. Aesthetic Plast Surg. 2024;48(13):2365–74. https://doi.org/10.1007/s00266-024-03990-7
» https://doi.org/10.1007/s00266-024-03990-7
⁷⁴ Gupta V, Winocour J, Shi H, Shack RB, Grotting JC, Higdon KK. Preoperative risk factors and complication rates in facelift: analysis of 11,300 patients. Aesthet Surg J. 2016;36(1):1–13. https://doi.org/10.1093/asj/sjv162
» https://doi.org/10.1093/asj/sjv162
⁷⁵ Dauwe PB, Pulikkottil BJ, Scheuer JF, Stuzin JM, Rohrich RJ. Infection in face-lift surgery: an evidence-based approach to infection prevention. Plast Reconstr Surg. 2015;135(1):58e–66e. https://doi.org/10.1097/PRS.0000000000000824
» https://doi.org/10.1097/PRS.0000000000000824
⁷⁶ Song JW, Chung KC. Observational studies: cohort and case-control studies. Plast Reconstr Surg. 2010;126(6):2234–42. https://doi.org/10.1097/PRS.0b013e3181f44abc
» https://doi.org/10.1097/PRS.0b013e3181f44abc

Edited by

Section editor:
Everson Artifon https://orcid.org/0000-0003-1900-8777

Publication Dates

Publication in this collection
18 May 2026
Date of issue
2026

History

Received
30 Nov 2025
Accepted
02 Mar 2026

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹ International Society of Aesthetic Plastic Surgery. ISAPS international survey on aesthetic/cosmetic procedures performed in 2024: full report. Hanover; 2024 [cited 2026 Mar 16]. Available from: https://www.isaps.org/discover/about-isaps/global-statistics/global-survey-2024-full-report-and-press-releases/
» https://www.isaps.org/discover/about-isaps/global-statistics/global-survey-2024-full-report-and-press-releases/

[2] ² Auersvald A, Auersvald LA, Uebel CO. Subplatysmal necklift: a retrospective analysis of 504 patients. Aesthet Surg J. 2017;37(1):1–11. https://doi.org/10.1093/asj/sjw107
» https://doi.org/10.1093/asj/sjw107

[3] ³ Wan DM, Small KH, Barton FE. Face lift. Plast Reconstr Surg. 2015;136(5):676e–89e. https://doi.org/10.1097/PRS.0000000000001695
» https://doi.org/10.1097/PRS.0000000000001695

[4] ⁴ Auersvald A, Auersvald LA. Management of the submandibular gland in neck lifts: indications, techniques, pearls, and pitfalls. Clin Plast Surg. 2018;45(4):507–25. https://doi.org/10.1016/j.cps.2018.06.001
» https://doi.org/10.1016/j.cps.2018.06.001

[5] ⁵ Connell BF. Neck contour deformities. The art, engineering, anatomic diagnosis, architectural planning, and aesthetics of surgical correction. Clin Plast Surg. 1987;14(4):683–92.

[6] ⁶ Wongkietkachorn A, Wongkietkachorn N. The use of the hemostatic net in Asian population: hyperpigmentation and the duration required for hemostatic net marking to disappear. Aesthetic Plast Surg. 2025;49(3):627–34. https://doi.org/10.1007/s00266-024-04561-6
» https://doi.org/10.1007/s00266-024-04561-6

[7] ⁷ American Society of Plastic Surgeons. 2024 ASPS procedural statistics release [Internet]. Arlington Heights: American Society of Plastic Surgeons; 2024 [cited 2026 Mar 16]. Available from: https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf
» https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf

[8] ⁸ Ismail M, Ghoraba S. Hemostatic net versus surgical drain after deep plane facelift surgery: a prospective randomized controlled trial. Aesthetic Plast Surg. 2025;49(16):4572–8. https://doi.org/10.1007/s00266-025-04745-8
» https://doi.org/10.1007/s00266-025-04745-8

[9] ⁹ Moyer JS, Baker SR. Complications of rhytidectomy. Facial Plast Surg Clin N Am. 2005;13(3):469–78. https://doi.org/10.1016/j.fsc.2005.04.005
» https://doi.org/10.1016/j.fsc.2005.04.005

[10] ¹⁰ Baker DC, Stefani WA, Chiu ES. Reducing the incidence of hematoma requiring surgical evacuation following male rhytidectomy: a 30-year review of 985 cases. Plast Reconstr Surg. 2005;116(7):1973–85; discussion 1986–7. https://doi.org/10.1097/01.prs.0000191182.70617.e9
» https://doi.org/10.1097/01.prs.0000191182.70617.e9

[11] ¹¹ Baker TJ, Gordon HL. Complications of rhytidectomy. Plast Reconstr Surg. 1967;40(1):31–9. https://doi.org/10.1097/00006534-196707000-00004
» https://doi.org/10.1097/00006534-196707000-00004

[12] ¹² Batniji RK. Complications/sequelae of neck rejuvenation. Facial Plast Surg Clin N Am. 2014;22(2):317–20. https://doi.org/10.1016/j.fsc.2014.01.007
» https://doi.org/10.1016/j.fsc.2014.01.007

[13] ¹³ Perkins SW, Williams JD, Macdonald K, Robinson EB. Prevention of seromas and hematomas after face-lift surgery with the use of postoperative vacuum drains. Arch Otolaryngol Head Neck Surg. 1997;123(7):743–5. https://doi.org/10.1001/archotol.1997.01900070087014
» https://doi.org/10.1001/archotol.1997.01900070087014

[14] ¹⁴ Niamtu J III. Facelift drains and dressings: to be or not to be? Dermatol Surg. 2012;38(5):793–6. https://doi.org/10.1111/j.1524-4725.2011.02286.x
» https://doi.org/10.1111/j.1524-4725.2011.02286.x

[15] ¹⁵ Kleinberger AJ, Spiegel JH. What is the best method for minimizing the risk of hematoma formation after rhytidectomy? Laryngoscope. 2015;125(3):534–6. https://doi.org/10.1002/lary.24685
» https://doi.org/10.1002/lary.24685

[16] ¹⁶ Khansa I, Khansa L, Meyerson J, Janis JE. Optimal use of surgical drains: evidence-based strategies. Plast Reconstr Surg. 2018;141(6):1542–9. https://doi.org/10.1097/PRS.0000000000004413
» https://doi.org/10.1097/PRS.0000000000004413

[17] ¹⁷ Jones BM, Grover R. Avoiding hematoma in cervicofacial rhytidectomy: a personal 8-year quest. Reviewing 910 patients. Plast Reconstr Surg. 2004;113(1):381–7; discussion 388–90. https://doi.org/10.1097/01.PRS.0000097291.15196.78
» https://doi.org/10.1097/01.PRS.0000097291.15196.78

[18] ¹⁸ Beer GM, Goldscheider E, Weber A, Lehmann K. Prevention of acute hematoma after face-lifts. Aesthetic Plast Surg. 2010;34(4):502–7. https://doi.org/10.1007/s00266-010-9488-8
» https://doi.org/10.1007/s00266-010-9488-8

[19] ¹⁹ Tiourin E, Barton N, Janis JE. Methods for minimizing bleeding in facelift surgery: an evidence-based review. Plast Reconstr Surg Glob Open. 2021;9(8):e3765. https://doi.org/10.1097/GOX.0000000000003765
» https://doi.org/10.1097/GOX.0000000000003765

[20] ²⁰ Stewart CM, Bassiri-Tehrani B, Jones HE, Nahai F. Evidence of hematoma prevention after facelift. Aesthet Surg J. 2024;44(2):134–43. https://doi.org/10.1093/asj/sjad247
» https://doi.org/10.1093/asj/sjad247

[21] ²¹ Ganesh Kumar N, Sherif R, Schultz K, Hidalgo DA, Stuzin JM, Rohrich RJ. Role of selective neck sutures in face lifts. Plast Reconstr Surg. 2025;156(2):194e–7e. https://doi.org/10.1097/PRS.0000000000011968
» https://doi.org/10.1097/PRS.0000000000011968

[22] ²² Schroeder RJ II, Langsdon PR. Effect of local tranexamic acid on hemostasis in rhytidectomy. Facial Plast Surg Aesthetic Med. 2020;22(3):195–9. https://doi.org/10.1089/fpsam.2020.0061
» https://doi.org/10.1089/fpsam.2020.0061

[23] ²³ Niamtu J III. Expanding hematoma in face-lift surgery: literature review, case presentations, and caveats. Dermatol Surg. 2005;31(9 Pt 1):1134–44; discussion 1144.

[24] ²⁴ Auersvald A, Auersvald L, Biondo-Simões ML. Hemostatic net: an alternative for the prevention of hematoma in rhytidoplasty. Rev Bras Cir Plást. 2012;27(1):22–30. https://doi.org/10.1590/S1983-51752012000100006
» https://doi.org/10.1590/S1983-51752012000100006

[25] ²⁵ Auersvald A, Auersvald L. Rede hemostática para a prevenção de hematoma e seroma em cirurgia plástica. Arq Catarin Med. 2012;41(Suppl.1):86–8.

[26] ²⁶ O’Daniel TG, Kachare MD. Evolution of the surgical net. Facial Plast Surg. 2025;41(1):70–81. https://doi.org/10.1055/a-2334-4448
» https://doi.org/10.1055/a-2334-4448

[27] ²⁷ Pellini E, Finocchi V, Albanese R. Innovations in rhytidoplasty: 480 cases validating the efficacy of the inner hemostatic net. Aesthet Surg J. 2025;45(9):875–81. https://doi.org/10.1093/asj/sjaf108
» https://doi.org/10.1093/asj/sjaf108

[28] ²⁸ Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthetic Plast Surg. 2014;38(1):1–9. https://doi.org/10.1007/s00266-013-0202-5
» https://doi.org/10.1007/s00266-013-0202-5

[29] ²⁹ Janssen TJ, Maheshwari K, Sivadasan A, Waterhouse N. Hemostatic net in facelift surgery: a 5-year single-surgeon experience. Aesthet Surg J. 2023;43(10):1106–11. https://doi.org/10.1093/asj/sjad097
» https://doi.org/10.1093/asj/sjad097

[30] ³⁰ Nahai F, Bassiri-Tehrani B, Santosa KB. Hematomas and the facelift surgeon: it’s time for us to break up for good. Aesthet Surg J. 2023;43(10):1207–9. https://doi.org/10.1093/asj/sjad225
» https://doi.org/10.1093/asj/sjad225

[31] ³¹ Auersvald A, Auersvald LA. Commentary on: quilting sutures in rhytidectomy: a systematic review of the literature. Aesthet Surg J. 2020;40(11):1165–7. https://doi.org/10.1093/asj/sjaa014
» https://doi.org/10.1093/asj/sjaa014

[32] ³² Cabas Neto J, Rodriguez Fernandez DE, Boles M. Reducing the incidence of hematomas in cervicofacial rhytidectomy: new external quilting sutures and other ancillary procedures. Aesthetic Plast Surg. 2013;37(5):1034–9. https://doi.org/10.1007/s00266-013-0084-6
» https://doi.org/10.1007/s00266-013-0084-6

[33] ³³ Cabas Neto J, Fernandez D, Boles M. A new technique of external quilting sutures: their importance in preventing hematomas in cervicofacial rhytidectomies. Plast Reconstr Surg. 2013;131(1):121e. https://doi.org/10.1097/PRS.0b013e318272a1cc
» https://doi.org/10.1097/PRS.0b013e318272a1cc

[34] ³⁴ Higgins J. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.5. Cochrane Handbook for Systematic Reviews of Interventions; 2024.

[35] ³⁵ Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
» https://doi.org/10.1136/bmj.n71

[36] ³⁶ Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898
» https://doi.org/10.1136/bmj.l4898

[37] ³⁷ Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919
» https://doi.org/10.1136/bmj.i4919

[38] ³⁸ Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, Aromataris E. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth. 2020;18(10):2127–33. https://doi.org/10.11124/JBISRIR-D-19-00099
» https://doi.org/10.11124/JBISRIR-D-19-00099

[39] ³⁹ Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924. https://doi.org/10.1136/bmj.39489.470347.AD
» https://doi.org/10.1136/bmj.39489.470347.AD

[40] ⁴⁰ Auersvald LA, Auersvald A. Sternohyoid muscles plication and sternocleidomastoid muscles rejuvenation in neck lift: a retrospective study of 1,019 consecutive patients. Plast Aesthetic Res. 2021;8:4. https://doi.org/10.20517/2347-9264.2020.187
» https://doi.org/10.20517/2347-9264.2020.187

[41] ⁴¹ Kachare MD, Moore AC, Little J, O’Daniel TG. Establishment of safety of hemostatic net application utilizing laser-assisted fluorescence angiography with SPY-Q software analysis. Aesthet Surg J. 2023;43(6):623–30. https://doi.org/10.1093/asj/sjad007
» https://doi.org/10.1093/asj/sjad007

[42] ⁴² O’Daniel T, Auersvald A, Auersvald L. Hemostatic net in facelift surgery. MKG-Chir. 2019;12(2):78–85. https://doi.org/10.1007/s12285-019-0195-4
» https://doi.org/10.1007/s12285-019-0195-4

[43] ⁴³ Orra S, Bald M, Wagner G, Grotting JC. The gliding brow lift: an analysis of outcomes and maintenance of lift in a single surgeon’s practice. Aesthet Surg J. 2025;45(3):225–31. https://doi.org/10.1093/asj/sjae224
» https://doi.org/10.1093/asj/sjae224

[44] ⁴⁴ Şibar S, Erdal AI, Deniz E, Kılıç Ö, Tuncer S. Comparison of the effectiveness and safety of the “endoscope-assisted polypropylene mesh lift” and “gliding brow lift” techniques for the treatment of lateral brow ptosis. J Plast Reconstr Aesthet Surg. 2023;83:455–62. https://doi.org/10.1016/j.bjps.2023.04.079
» https://doi.org/10.1016/j.bjps.2023.04.079

[45] ⁴⁵ Sozer SO, Sibar S, Kachare MD. Progressive contouring of the platysma with barbed sutures. Aesthet Surg J. 2024;44(5):449–62. https://doi.org/10.1093/asj/sjad362
» https://doi.org/10.1093/asj/sjad362

[46] ⁴⁶ Viterbo F, Auersvald A, O’Daniel TG. Gliding brow lift (GBL): a new concept. Aesthetic Plast Surg. 2019;43(6):1536–46. https://doi.org/10.1007/s00266-019-01486-3
» https://doi.org/10.1007/s00266-019-01486-3

[47] ⁴⁷ Griffin JE, Jo C. Complications after superficial plane cervicofacial rhytidectomy: a retrospective analysis of 178 consecutive facelifts and review of the literature. J Oral Maxillofac Surg. 2007;65(11):2227–34. https://doi.org/10.1016/j.joms.2006.10.075
» https://doi.org/10.1016/j.joms.2006.10.075

[48] ⁴⁸ Prakasam S, Stein K, Lee MK, Rampa S, Nalliah R, Allareddy V, Allareddy V. Prevalence and predictors of complications following facial reconstruction procedures. Int J Oral Maxillofac Surg. 2016;45(6):735–42. https://doi.org/10.1016/j.ijom.2015.12.020
» https://doi.org/10.1016/j.ijom.2015.12.020

[49] ⁴⁹ Bassiri-Tehrani B, Abi-Rafeh J, Baker NF, Kerendi AN, Nahai F. Systolic blood pressure less than 120 mmHg is a safe and effective method to minimize bleeding after facelift surgery: a review of 502 consecutive cases. Aesthet Surg J. 2023;43(12):1420–8. https://doi.org/10.1093/asj/sjad228
» https://doi.org/10.1093/asj/sjad228

[50] ⁵⁰ Moris V, Bensa P, Gerenton B, Rizzi P, Cristofari S, Zwetyenga N, Guilier D. The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma. J Plast Reconstr Aesthet Surg. 2019;72(5):821–9. https://doi.org/10.1016/j.bjps.2018.10.046
» https://doi.org/10.1016/j.bjps.2018.10.046

[51] ⁵¹ Maricevich MA, Adair MJ, Maricevich RL, Kashyap R, Jacobson SR. Facelift complications related to median and peak blood pressure evaluation. Aesthetic Plast Surg. 2014;38(4):641–7. https://doi.org/10.1007/s00266-014-0353-z
» https://doi.org/10.1007/s00266-014-0353-z

[52] ⁵² Cason RW, Avashia YJ, Shammas RL, Savetsky IL, Rohrich RJ. Perioperative approach to reducing hematoma during rhytidectomy: what does the evidence show? Plast Reconstr Surg. 2021;147(6):1297–309. https://doi.org/10.1097/PRS.0000000000007943
» https://doi.org/10.1097/PRS.0000000000007943

[53] ⁵³ Mehta HK. A new method of full thickness skin graft fixation. Br J Ophthalmol. 1979;63(2):125–8. https://doi.org/10.1136/bjo.63.2.125
» https://doi.org/10.1136/bjo.63.2.125

[54] ⁵⁴ Baroudi R, Ferreira CA. Seroma: how to avoid it and how to treat it. Aesthet Surg J. 1998;18(6):439–41. https://doi.org/10.1016/S1090-820X(98)70073-1
» https://doi.org/10.1016/S1090-820X(98)70073-1

[55] ⁵⁵ Pollock H, Pollock TA. Management of face lifts with progressive tension sutures. Aesthet Surg J. 2003;23(1):28–33. https://doi.org/10.1016/S1090-820X(03)90020-3
» https://doi.org/10.1016/S1090-820X(03)90020-3

[56] ⁵⁶ Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000;105(7):2583–6; discussion 2587–8. https://doi.org/10.1097/00006534-200006000-00047
» https://doi.org/10.1097/00006534-200006000-00047

[57] ⁵⁷ Hudson DA. The quilting suture: its application in face lifts. Plast Reconstr Surg. 2010;126(2):72e–3e. https://doi.org/10.1097/PRS.0b013e3181de23fb
» https://doi.org/10.1097/PRS.0b013e3181de23fb

[58] ⁵⁸ Wongkietkachorn A, Wongkietkachorn N. Endoscopic gliding forehead lift: a brow shaping method to lift the medial and lateral brow. Aesthetic Plast Surg. 2025;49(20):5712–8. https://doi.org/10.1007/s00266-025-05027-z
» https://doi.org/10.1007/s00266-025-05027-z

[59] ⁵⁹ Ballan A, Jabbour S, El Rayess Y, Jabbour K, El Hachem L, Nasr M. Quilting sutures in rhytidectomy: a systematic review of the literature. Aesthet Surg J. 2020;40(11):1157–64. https://doi.org/10.1093/asj/sjz353
» https://doi.org/10.1093/asj/sjz353

[60] ⁶⁰ Caimi E, Pellicanò F, El Choueiri J, Vaccari S, Di Giuli R, Furlan S, Bucci F, Klinger F, Vinci V. Hemostatic nets in facelifts: a systematic review and meta-analysis of postoperative complications and patient outcomes. Aesthet Surg J Open Forum. 2025;7:ojaf082. https://doi.org/10.1093/asjof/ojaf082
» https://doi.org/10.1093/asjof/ojaf082

[61] ⁶¹ Gonçalves FGA, da Silva LD, Sampaio ECDF, Camargo CP. Response by Gonçalves et al. to “Hemostatic nets in facelifts: a systematic review and meta-analysis of postoperative complications and patient outcomes” by Caimi et al. Aesthet Surg J Open Forum. 2025;7:ojaf152. https://doi.org/10.1093/asjof/ojaf152
» https://doi.org/10.1093/asjof/ojaf152

[62] ⁶² AbuRahma AF, Avgerinos ED, Chang RW, Darling RC 3rd, Duncan AA, Forbes TL, Malas MB, Perler BA, Powell RJ, Rockman CB, Zhou W. The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease. J Vasc Surg. 2022;75(1Suppl.):26S–98S. https://doi.org/10.1016/j.jvs.2021.04.074
» https://doi.org/10.1016/j.jvs.2021.04.074

[63] ⁶³ Quick E, Byard RW. Postoperative cervical soft tissue hemorrhage with acute upper airway obstruction. J Forensic Sci. 2013;58(Suppl.1):S264–6. https://doi.org/10.1111/1556-4029.12026
» https://doi.org/10.1111/1556-4029.12026

[64] ⁶⁴ Shah-Becker S, Greenleaf EK, Boltz MM, Hollenbeak CS, Goyal N. Neck hematoma after major head and neck surgery: risk factors, costs, and resource utilization. Head Neck. 2018;40(6):1219–27. https://doi.org/10.1002/hed.25102
» https://doi.org/10.1002/hed.25102

[65] ⁶⁵ Schaverien MV, Pessa JE, Saint-Cyr M, Rohrich RJ. The arterial and venous anatomies of the lateral face lift flap and the SMAS. Plast Reconstr Surg. 2009;123(5):1581–7. https://doi.org/10.1097/PRS.0b013e3181a20544
» https://doi.org/10.1097/PRS.0b013e3181a20544

[66] ⁶⁶ Sepúlveda A, Sastre N. Necrotizing fasciitis of the face and neck. Plast Reconstr Surg. 1998;102(3):814–7. https://doi.org/10.1097/00006534-199809030-00028
» https://doi.org/10.1097/00006534-199809030-00028

[67] ⁶⁷ Henry G, Auersvald A, Auersvald LA, Ospital C, Boucher F, Mojallal A. Skin perfusion after hemostatic net: an anatomic and radiologic study in a cadaver model. Aesthet Surg J. 2024;44(3):245–53. https://doi.org/10.1093/asj/sjad286
» https://doi.org/10.1093/asj/sjad286

[68] ⁶⁸ Fang AH, Torre J. A systematic review of rhytidectomy complications and prevention methods: evaluating the trends. Ann Plast Surg. 2025;94(6Suppl.):S502–16. https://doi.org/10.1097/SAP.0000000000004272
» https://doi.org/10.1097/SAP.0000000000004272

[69] ⁶⁹ Dobbs TD, Gibson JAG, Hughes S, Thind A, Patel B, Hutchings HA, Whitaker IS. Patient-reported outcome measures for soft-tissue facial reconstruction: a systematic review and evaluation of the quality of their measurement properties. Plast Reconstr Surg. 2019;143(1):255–68. https://doi.org/10.1097/PRS.0000000000005112
» https://doi.org/10.1097/PRS.0000000000005112

[70] ⁷⁰ Imadojemu S, Sarwer DB, Percec I, Sonnad SS, Goldsack JE, Berman M, Sobanko JF. Influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: a systematic review. JAMA Dermatol. 2013;149(11):1325–33. https://doi.org/10.1001/jamadermatol.2013.6812
» https://doi.org/10.1001/jamadermatol.2013.6812

[71] ⁷¹ Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-reported aesthetic and psychosocial outcomes after microvascular reconstruction for head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2021;147(12):1035–44. https://doi.org/10.1001/jamaoto.2021.1563
» https://doi.org/10.1001/jamaoto.2021.1563

[72] ⁷² Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg. 2020;44(4):1210–5. https://doi.org/10.1007/s00266-020-01809-9
» https://doi.org/10.1007/s00266-020-01809-9

[73] ⁷³ Du H, Liang H, Qi Z, Jin X. A prospective investigation of patient satisfaction and psychosocial status following facial bone contouring surgery using the FACE-Q. Aesthetic Plast Surg. 2024;48(13):2365–74. https://doi.org/10.1007/s00266-024-03990-7
» https://doi.org/10.1007/s00266-024-03990-7

[74] ⁷⁴ Gupta V, Winocour J, Shi H, Shack RB, Grotting JC, Higdon KK. Preoperative risk factors and complication rates in facelift: analysis of 11,300 patients. Aesthet Surg J. 2016;36(1):1–13. https://doi.org/10.1093/asj/sjv162
» https://doi.org/10.1093/asj/sjv162

[75] ⁷⁵ Dauwe PB, Pulikkottil BJ, Scheuer JF, Stuzin JM, Rohrich RJ. Infection in face-lift surgery: an evidence-based approach to infection prevention. Plast Reconstr Surg. 2015;135(1):58e–66e. https://doi.org/10.1097/PRS.0000000000000824
» https://doi.org/10.1097/PRS.0000000000000824

[76] ⁷⁶ Song JW, Chung KC. Observational studies: cohort and case-control studies. Plast Reconstr Surg. 2010;126(6):2234–42. https://doi.org/10.1097/PRS.0b013e3181f44abc
» https://doi.org/10.1097/PRS.0b013e3181f44abc

Study ID	Patients enrolled (N)	Mean age (years old)	Female (N [%])	Smoking history (N [%])	Hypertension (N [%])	Study design	Intervention	Comparator	Surgeries	Drains (Y/N)	Dressings	HN technique	Days to remove hemostatic net	Follow-up
Ismail and Ghoraba⁸	Total: 160; HN: 80; D: 80	45.5	HN: 80 (100); D: 80 (100)	13 (8.1)	NR	RCT	HN	D	Facelift	Yes, D group	NR	3/0 prolene, entering the skin perpendicularly, transfixing at a 45-degree angle into the platysma, and emerging at the same angle approximately 1 cm	2	At least two weeks
Auersvald et al.²⁸	Total: 525; HN: 405; D: 120	HN: 55.4 (34–81); D: 55.4 (33–77)	HN: 369 (91); D: 109 (90.8)	HN: 46 (11.3); D: 24 (20)	HN: 28 (6.9); D: 11 (9.2٪	Cohort	HN	D	Facelift	Yes, D group	Occlusive dressing	5-0 mononylon; continuous sutures plunging into the SMAS-Platysma	2	3 months
Janssen et al.²⁹	Total: 663; HN: 304; D: 359	62.4 (38–86)	HN: 284 (93.4); D: 327 (91)	NR	NR	Cohort	HN	D	Facelift	Yes, D group	NR	5-0 polypropylene, 90° 1×1 cm	2	At least two days
Auersvald et al.³¹	HN: 1,019	50.6 (16–81)	925 (90.8)	NR	NR	Case series	HN	Not applicable	Facelift and necklift	No	NR	5-0 mononylon; continuous sutures plunging into the SMAS-platysma and emerging 0.8–1 cm from the entry	2–3	NR
Kachare et al.⁴¹	HN: 8	64 ± 19.6	1 (12.5)	6 (75)	5 (62.5)	Case series	HN	Not applicable	Cervicofacial flap reconstruction	No	NR	5-0 nylon, 1×1 cm	NR	9.3 (1–19) months
O'Daniel et al.⁴²	Total: 108; HN: 66; D: 42	NR	NR	NR	NR	Cohort	HN	D	Facelift	Yes, D group	NR	5 0 mononylon, platysma at 45 degrees, 1 × 1 cm	2–3	At least two days
Orra et al.⁴³	HN: 63	62.8 ± 7	59 (93.4)	6 (9.6)	13 (20.6)	Case series	HN	Not applicable	Gliding brow lift	NR	NR	4-0 prolene, 1×1 cm	2–3	8.3 (3–54) months
Şibar et al.⁴⁴	Total: 86; HN: 42; control: 44	HN: 50.8 ± 8.3; control: 51.2 ± 8.2	HN: 40 (95.2); control: 42 (95)	NR	NR	Cohort	GBL with HN	Endoscopic mesh lift without HN (control)	Brow lift	NR	NR	4-0 Polypropylene, 0.5 × 0.5 cm	2	HN: 17.3 (13–31) months; Control: 24.7 (13–40) months
Sozer et al.⁴⁵	HN: 337	61 (24–88)	304 (90.2)	NR	NR	Case series	HN	Not applicable	Neck lift	No	None	2-0 PDO, midline application followed by a lateral plication	3	12 months
Viterbo et al.⁴⁶	HN: 124	55.6 ± 7.9	114 (92)	NR	NR	Case series	HN	Not applicable	Gliding brow lift	No	None	4-0 nylon; 0.5–1.0 cm × 0.5–1 (height)	2	17 (3–35) months
Wongkietkachorn et al.⁵⁸	HN: 300	54.2 ± 10.0	275 (91.7)	15 (5)	33 (11)	Case series	HN	Not applicable	Gliding brow lift, facelift, or necklift	No	Gauze and bandages	5-0 prolene	3	At least one week

Authors	Hematoma (N)	Skin necrosis (N)	Seroma (N)	Infection (N)	Persistent skin marks (N)	Patient’s satisfaction	Other adverse events
Ismail and Ghoraba⁸	HN: 1; D: 0	HN: 0; D: 0	HN: 7; D:7	HN: 0; D: 2	NR	NR	Congestion: HN: 2; D: 2
Auersvald et al.²⁸	HN: 0; D: 17	HN: 3; D: 6	NR	NR	HN: 3; D: 0	NR	Ischemia: HN: 26; D: 11
Janssen et al.²⁹	HN: 2; D: 14	NR	NR	NR	NR	NR	NR
Auersvald et al.³¹	7	NR	11	NR	NR	NR	Weakness of the lower lip depressor: 79; salivary fistulae of SMGs: 4; sialoma of SMGs: 2
Kachare et al.⁴¹	0	0	1	0	0	NR	Swelling: 2
O'Daniel et al.⁴²	HN: 0; D: 0	HN: 0; D: 0	HN: 1; D: 0	NR	HN: 0; D: 0	One patient had concerns about the hyperemic appearance of the suture marks at two weeks post-operatively, which was successfully and quickly resolved with a singlepulsed-dye laser treatment	Hyperemia: HN: 1; D: 0
Orra et al.⁴³	1	NR	NR	3	3	NR	Temporal fullness: 3
Şibar et al.⁴⁴	HN: 0; Control: 0	HN: 0; Control: 0	HN: 0; Control: 0	HN: 0; Control: 0	1	Global aesthetic improvement scale assessment: HN: 1.79 ± 0.71; Control: 1.32 ± 0.58	Frontal nerve palsy (HN): 1; dog ear on the scalp (HN): 1; mesh irritation (control): 2; unilateral dysesthesia on the scalp (control): 1
Sozer et al.⁴⁵	1	1	4	NR	1	NR	Neck contour irregularity: 10; Residual platysmal or skin laxity: 18
Viterbo et al.⁴⁶	0	0	0	0	NR	Very satisfied: 20٪; satisfied: 49٪; non-satisfied and non-dissatisfied: 24٪; dissatisfied: 7٪; very dissatisfied: 0٪	Recurrence requiring revisional procedures: 6
Wongkietkachorn et al.⁵⁸	2	NR	NR	NR	0	Patients have expressed concerns about the duration required for the HN markings to disappear	Skin irregularities: 2

Certainty assessment							N of patients		Effect		Certainty	Importance
N of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Hemostatic net	Drains	Relative (95%CI)	Absolute	Certainty	Importance
Hematoma Controlled
5	Non-randomised studies	Not serious	Seriousa	Not serious	Not serious	None	3/897 (0.3٪)	31/645 (4.8٪)	RR = 0.15 (0.01 to 3.20)	41 fewer per 1.000 (from 48 fewer to 106 more)	⨁◯◯◯ Very low^a
Skin necrosis controlled
4	Non-randomised studies	Not serious	Not serious	Not serious	Seriousb	None	3/593 (0.5%)	6/286 (2.1%)	RR = 0.15 (0.04 to 0.58)	18 fewer per 1.000 (from 20 fewer to 9 fewer)	⨁◯◯◯ Very low^b
Seroma controlled
3	Non-randomised studies	Not serious	Not serious	Not serious	Not serious	None	8/188 (4.3٪)	7/166 (4.2٪)	RR = 1.06 (0.41 to 2.75)	Three more per 1.000 (from 25 fewer to 74 more)	⨁⨁◯◯ Low
Hematoma proportion
10	Non-randomised studies	Not serious	Not serious	Not serious	Not serious	None	14/2343 (0.6٪)	-	-	-	⨁⨁◯◯ Low
Skin necrosis proportion
7	Non-randomised studies	Not serious	Not serious	Not serious	Not serious	None	4/1062 (0.4٪)	-	-	-	⨁⨁◯◯ Low
Seroma proportion
7	Non-randomised studies	Not serious	Not serious	Not serious	Not serious	None	24/1,676 (1.4٪)	-	-	-	⨁⨁◯◯ Low