Evolution of hypertension management in face lifting in 1089 patients: Optimizing safety and outcomes

Background: Hematoma continues to be the most common complication after rhytidectomy. Perioperative hypertension is a known risk factor, and meticulous control of this has been shown to significantly reduce the incidence of postoperative hematoma development, thus improving outcomes and decreasing patient morbidity. Despite this, there are few well-described hypertension management regimens in the literature today. Methods: A retrospective chart review of 1089 patients undergoing rhytidectomy performed by a single surgeon was conducted. A predetermined antihypertensive protocol was used in all patients that included the routine use of transdermal clonidine. A target systolic blood pressure of 140 mmHg or less was the goal of therapy, and close hemodynamic monitoring was used throughout the entire perioperative phase. The incidence of postoperative hematoma was then assessed. Results: The overall incidence of postoperative hematoma was 0.9 percent (10 patients). Of these patients, five were female (0.05 percent) and five were male (5.2 percent). Preoperatively, 170 patients were noted to be hypertensive, with a systolic blood pressure greater than 140 mmHg. Postoperatively, 355 patients were found to be hypertensive (p < 0.001). Of the patients who developed a postoperative hematoma, eight patients (80 percent) had documented hypertension (systolic blood pressure >140 mmHg) in the postanesthesia care unit (p = 0.045). Male sex was found to be a significant risk factor for the development of hematoma (p < 0.001). Conclusions: Meticulous perioperative blood pressure control significantly reduces the rate of postoperative hematoma formation. The use of a specific protocol developed by our senior author and primary anesthesia provider contributed to our very low hematoma rates.