Could a Necklift Cause a Blood Clot?

Q: I got a blood clog in my neck after having a quick eye and neck lift. What seems to have caused this? My vision seems to have been affected as well. Please help.

A: The most common complication of Face and Necklifts are Hematomas.

I hope you haven’t been waiting too long for an answer. I just started participating on the Realself. It is unfortunate when people have complications after a procedure. Luckily, most of the time this problems will completely resolve itself and not affect your final result.

Your question: “What seems to have caused this?”

I’m not sure what is involved with a quick eye and neck lift, but in general necklifts involve lifting up skin on the neck in order to slide the skin back behind the ears and trim off the extra skin (Yuck) similar to when you make your bed, you might lift up the comforter prior to smoothing out the surface. This is not unlike a face and necklift. Because the skin is separated from the fat and muscles, this leaves a “pocket” where blood can potentially collect and form a blood clot.

Prevention of Hematomas

The way that surgeons prevent a blood clot from occurring is one of three ways.

  1. Compression Dressing
  2. Drains
  3. Tissue Glue

Compression Dressing. A compression dressing essentially looks like a gauze football helmet, which provides even pressure around the face and neck and squeezes the skin against the fat and muscle underneath. This pressure helps to prevent bleeding as well as blood from collecting in this “space.” This pressure dressing can be removed by the surgeon during day 1-3 after the facelift/necklift. The first thing that we check for is whether there was any formation of blood clots or hematomas. This is also the cheapest method; the materials for the dressing costs the surgery center (~$40-60.)

Drains. Drains look like silicone “light bulbs.” The way that they work is through suction, similar to the rubber bulbs to suction mucous out of noses that every newborn baby is sent home from the hospital with. These silicone “bulbs” are connected to a silicone tubing which is inserted through the skin into the “pocket” and “sucks all of the air and fluids out of this “space” so that is heals together and doesn’t collect a blood clot. If the skin is directly on the fat or muscle underneath, your body will form its own “tissue glue” so it sticks together. The same thing happens with the compression dressing. Drains cost about ~$80-100 or more depending on the model, and many people will also get a compression dressing on top of the drain.

Tissue Glue. Tissue glue is purified from blood products (human blood.) The two brand name products are by Baxter and Johnson and Johnson, which are Tisseal and Evicel, respectively. It is essentially concentrated clotting factors which are later activated by a calcium solution that it is mixed with. Similar to Epoxy, the glue does not activate until you mix the two components together. There is great interest with Tissue Glue “facelifts.” A few recent studies in the past several years have shown that the hematoma rate or blood clot formation rate is lower with tissue glue. But the added benefit is there seems to be less bruising and swelling and some patients surveys in these studies show that they have a sense of well being, and less discomfort. Some surgeons swear by it and will no longer perform facelifts and necklifts without tissue glue. Other surgeons think that it is an overkill and don’t want to risk using any outside blood products for fear of blood borne diseases (however small the risk.) This is the most expensive option costing $250-400 depending on the amount of glue used by the surgeon.

After removal of the compression bandage and/or drains, usually the surgeon will switch the patient over to a face and neck compression dressing to help with swelling and healing. Since the skin was separated from the fat and muscle underneath, the compression helps as the tissues heal together, and help to prevent any potential fluid collections which might occur. I tell my patients to wear it for about a month (on and off.) Other surgeons may recommend only 2 weeks while others may tell their patients to wear it for up to 8 weeks. There is no right answer.

You wrote, “My vision seems to have been affected as well.”

I don’t know what is going on in your particular case, but the most common reason for blurry vision is if you are using an eye ointment on your eyelid incisions. Since the antibiotic ointments are petroleum based, they are not recommended for eyelid incisions. Instead many surgeons will instruct their patients to use a “eye-safe” lubricant, such as Lacrilube, or generic version. This is safe for the eye itself, and is used on the eyelid incisions.

What commonly happens is the ointment travels from the incisions where you applied the ointment and travels into the eye. Since the Lacrilube is very viscous, this ointment will make your vision blurry. I have found this the most common reason for blurry vision. Hopefully it is as simple as this.

This online post is not a replacement for seeing your own surgeon, and you really need to be seen by your surgeon or at least reassured by your own surgeon that nothing more serious with your vision is occurring. If there is something more serious, such as a scratch to the cornea, then your surgeon may request a consultation with an ophthalmologist that he or she works with.

I wish you a speedy recovery, and hope you find this response helpful.


Dr. Yang