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Some plastic surgeons refer to the earliest phase of facelift recovery as the “alien” stage\u2014and 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.<\/p>\n
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. \u201cWhen we\u2019re doing facelift surgery, or any type of surgery where we\u2019re separating the skin from the deeper tissues, we\u2019re creating what we call a \u2018dead space\u2019 that has the potential to collect these fluids,\u201d says T. Gerald O\u2019Daniel, 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 (\u201cskin flaps\u201d in surgeon-speak) to stick back down to the underlying muscle and lay smoothly and evenly, as it should.<\/p>\n
In facelift surgery, a hematoma, which usually presents as a painful, bulging purple bruise, is \u201cthe most feared complication\u2014the most consequential,\u201d 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. \u201cIf you get this call in the middle of the night, you don\u2019t sleep on it, because it can be a life-or-death moment,\u201d he notes. In the neck, a large or expanding hematoma can obstruct the airway if it\u2019s not caught early and managed urgently. These kinds of catastrophic hematomas are rare, Dr. Nayak says, \u201cbut even minor hematomas create their own misery by dramatically slowing the healing process and making bruising and firmness linger a lot longer.\u201d 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.<\/p>\n
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. \u201cIf 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 \u201cmajor nuisance,\u201d according to Dr. Nayak, \u201cbecause they can make the skin drape incorrectly, causing it to wrinkle for many months over the area where the seroma accumulated.\u201d Seromas can also become infectious if the fluid sits for too long, notes Dr. Cabin.<\/p>\n
Aiming to prevent such complications, plastic surgeons have long relied on drains, but they\u2019re not without drawbacks. \u201cPatients don\u2019t 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\u2014they\u2019re just uncomfortable,\u201d Dr. O\u2019Daniel says. (This fact alone makes \u201cdrainless\u201d a huge selling point in plastic surgery.) Drains also require tending-to\u2014\u201cstripping\u201d to prevent clogs (pinching and sliding your fingers down the length of the tubes) as well as emptying the bulbs and measuring the output\u2014and have the potential to introduce infection, malfunction, and leave scars and track marks on the skin. What\u2019s more, their removal can be anxiety-provoking: \u201cPatients are always very nervous that it\u2019s going to hurt, but it doesn\u2019t\u2014it\u2019s just a weird sensation,\u201d 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, \u201cthey will not save you from hematomas,\u201d says Dr. Nayak. \u201cThe blood is just going to start coming out the drains as the face and neck fill up.\u201d<\/p>\n<\/div>\n