Some plastic surgeons refer to the earliest phase of facelift recovery as the “alien” stage—and for good reason: Patients tend to look tight, pulled, lumpy, and distorted for days after surgery. Enhancing the extraterrestrial vibe are the two clear, plastic tubes (called drains) sprouting from their heads, through which all manner of blood and ooze exit the face, dripping into suction bulbs that dangle below their ears, storing the gunk. Surgeons typically stitch the open end of the tubes under the skin behind the ears, leaving them in place for up to five days. Need a visual? Behold: Designer Marc Jacobs, drains and all, following his 2021 facelift.
Drains serve an important purpose, clearing the tissues of fluids that could otherwise pool under the skin forming seromas and hematomas (collections of clear fluid and blood, respectively), which can threaten results, delay healing, and prolong recovery. “When we’re doing facelift surgery, or any type of surgery where we’re separating the skin from the deeper tissues, we’re creating what we call a ‘dead space’ that has the potential to collect these fluids,” says T. Gerald O’Daniel, MD, a board-certified plastic surgeon in Louisville, Kentucky. By actively evacuating fluids for several days post-op, drains collapse the space, encouraging any skin that was uprooted during surgery (“skin flaps” in surgeon-speak) to stick back down to the underlying muscle and lay smoothly and evenly, as it should.
In facelift surgery, a hematoma, which usually presents as a painful, bulging purple bruise, is “the most feared complication—the most consequential,” says L. Mike Nayak, MD, a double board-certified facial plastic surgeon in St. Louis, Missouri. It is, in fact, a surgical emergency that can require a return trip to the operating room. “If you get this call in the middle of the night, you don’t sleep on it, because it can be a life-or-death moment,” he notes. In the neck, a large or expanding hematoma can obstruct the airway if it’s not caught early and managed urgently. These kinds of catastrophic hematomas are rare, Dr. Nayak says, “but even minor hematomas create their own misery by dramatically slowing the healing process and making bruising and firmness linger a lot longer.” They can also lead to post-op infections, skin damage, and lumps and bumps. Hematomas occur more frequently in men (due, in part, to the more robust blood supply in their facial skin); other common risk factors include high blood pressure and post-op nausea and vomiting.
A seroma is an area of “soft and smooth swelling,” explains Jonathan Cabin, MD, a double board-certified facial plastic surgeon in Washington, D.C. “If you push on it, it feels fluctuant not tense, shifting a bit with compression. But the skin tends to look normal and the sensation is one of mild pressure or heaviness at worst, but usually not frank pain.” While less of a 911 scenario than hematomas, seromas are still a “major nuisance,” according to Dr. Nayak, “because they can make the skin drape incorrectly, causing it to wrinkle for many months over the area where the seroma accumulated.” Seromas can also become infectious if the fluid sits for too long, notes Dr. Cabin.
Aiming to prevent such complications, plastic surgeons have long relied on drains, but they’re not without drawbacks. “Patients don’t like drains, because they look weird and scary sticking out of the skin, and they can get caught on things, pull and pinch the skin—they’re just uncomfortable,” Dr. O’Daniel says. (This fact alone makes “drainless” a huge selling point in plastic surgery.) Drains also require tending-to—“stripping” to prevent clogs (pinching and sliding your fingers down the length of the tubes) as well as emptying the bulbs and measuring the output—and have the potential to introduce infection, malfunction, and leave scars and track marks on the skin. What’s more, their removal can be anxiety-provoking: “Patients are always very nervous that it’s going to hurt, but it doesn’t—it’s just a weird sensation,” says Lindsey Pennington, MD, a double board-certified facial plastic surgeon in Shreveport, Louisiana. (She generally removes drains after three to five days, with an accompanying shot of lidocaine, which allows her to painlessly close the wound with a single stitch.) Perhaps the biggest shortcoming of drains is that while they can stop seromas, “they will not save you from hematomas,” says Dr. Nayak. “The blood is just going to start coming out the drains as the face and neck fill up.”
