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Facelift Drains vs the Hemostatic Net: What Each Does for You

9 hours ago
7 min read

Updated: a few seconds ago

Quick answer. Facelift drains are thin tubes that carry fluid away from under the skin for a day or two. The hemostatic net (Auersvald net) is a temporary pattern of skin stitches that presses the lifted skin onto the deeper layer, so there is less space for blood to collect. In the only randomized trial to date comparing them, hematoma, seroma and swelling rates were similar. Neither replaces careful bleeding control.

Key takeaways

  • A hematoma (a collection of blood under the skin) is the most common early complication after a facelift.

  • Drains remove fluid that has already formed. The net tries to stop it forming by closing the "dead space" under the skin.

  • Drains alone did not lower the hematoma rate in a large older study. Studies of the net report lower rates, but mostly against non-randomized control groups.

  • The net can leave small red marks at the stitch points that usually fade within weeks to a few months.

  • Ask your surgeon about their own hematoma rate and their whole prevention plan, not only "drain or no drain".

What is a facelift drain and why do surgeons use it?

A facelift drain is a soft, narrow tube placed under the lifted skin, usually brought out behind the ear and connected to a small suction bulb. Fluid and blood are pulled into the bulb instead of pooling under the skin.

Drains also warn the team early if bleeding continues. In one randomized trial, drains were removed after about 48 hours on average (Ismail and Ghoraba, 2025).

The limitation is that a drain only removes fluid. It does not stop a vessel from bleeding. A large study of 678 facelifts found no difference in hematoma rate whether drains were used or not (Jones and Grover, 2004). Drains can also be uncomfortable, and removing them can disturb healing tissue.

  • Scarless facelift with revision rhinoplasty: before and 7 days after
  • Facelift and neck lift: early recovery

What is the hemostatic net (Auersvald net)?

The hemostatic net was described by two Brazilian plastic surgeons. At the end of the facelift, the surgeon places rows of running stitches that pass through the skin and into the layer beneath, the SMAS (superficial musculoaponeurotic system) and platysma muscle. The stitches pin the skin flat against the deeper tissue, like quilting.

In their first report of 525 patients, 17 of 120 patients without the net developed a hematoma within 72 hours (14.2%). None of the 405 patients with the net did (Auersvald and Auersvald, 2014). Rates of skin ischemia and skin loss did not rise significantly with the net.

Which works better against hematoma?

A single-surgeon review reported a hematoma rate of 0.6% in 304 patients with the net, compared with 3.9% in 359 earlier patients without it (Janssen et al., 2023). But the control group was operated on between 1999 and 2004, and the net group between 2017 and 2022, when other parts of the technique had also changed.

The strongest head-to-head evidence is one randomized trial of 160 women having a deep plane facelift. Half received drains and half received the net. There was no significant difference in hematoma or seroma rates. Seven patients in each group (8.8%) developed a seroma, and the only hematoma occurred in the net group (Ismail and Ghoraba, 2025).

A 2026 meta-analysis that pooled 13 studies and 3,264 patients found lower odds of hematoma with the net than with drain-based closure, with no difference in skin necrosis. Because most of that evidence is non-randomized, the authors call the result hypothesis-generating rather than proof (Kodalak et al., 2026).

Video: Scarless facelift with revision rhinoplasty: before and 7 days after. Watch on YouTube

Does either one reduce swelling?

Not in a measurable way. In the randomized trial, the degree of swelling was similar in both groups, and most patients (58.1%) had only mild swelling (Ismail and Ghoraba, 2025). Revision facelifts and operations with an open neck lift had more swelling in that study.

If a clinic says a drain or a net will "prevent swelling", ask for the evidence.

What are the downsides of each?

  • How it works — Surgical drain: Suction removes fluid after it forms — Hemostatic net: Stitches close the space where fluid would collect

  • Hematoma evidence — Surgical drain: No clear benefit from drains alone in a large series — Hemostatic net: Lower rates in several series; similar to drains in one randomized trial

  • Swelling — Surgical drain: Similar to net in randomized trial — Hemostatic net: Similar to drains in randomized trial

  • Removal in the randomized trial — Surgical drain: About 48 hours — Hemostatic net: About 48 hours

  • Main drawbacks — Surgical drain: Discomfort, tube removal, can disturb tissue — Hemostatic net: Temporary red marks at stitch points, adds operating time

Applying the net can take up to 30 minutes (Ismail and Ghoraba, 2025), and it leaves small red dots where the stitches passed. In a study of 300 Asian patients, 90% of these marks faded within one month and none left permanent pigmentation (Wongkietkachorn and Wongkietkachorn, 2024). Pooled data suggest the marks can take up to three months to settle in some people (Kodalak et al., 2026).

Some surgeons use both a drain and a net. Others use neither.

Video: Facelift and neck lift: early recovery. Watch on YouTube

What else lowers hematoma risk?

Drains and nets are only part of the picture. Blood pressure control before, during and after surgery, stopping blood-thinning medicines and supplements on time, and careful sealing of vessels all play a role. One group reported that combining tranexamic acid (a medicine that reduces bleeding), fibrin glue, the net and strict blood pressure control brought its hematoma rate to about 0.3% over five years (Lazzeri Domar et al., 2025). That figure comes from one team without a control group, so it reflects the whole protocol, not the net alone.

What should you ask your surgeon?

  • What is your own hematoma rate over the last few years?

  • Do you use a drain, a net, both or neither, and why for my face?

  • Which medicines and supplements must I stop, and when?

  • If a hematoma happens, who sees me, and how fast?

Know the warning signs. Call your surgical team at once if one side of your face or neck becomes rapidly more swollen, tight or painful, or if bruising spreads quickly. Seek emergency help if you have any difficulty breathing or swallowing.

How Prof. Dr. Suleyman Tas approaches this

Prof. Dr. Suleyman Tas performs deep plane face and neck lifts under local anesthesia, with you awake and without general anesthesia. He operates on one patient per day and performs the operation personally. Ask at your consultation which bleeding-control measures are planned for your face and why. Read more in what is a deep plane facelift and awake deep plane facelift.

You stay in Istanbul for about 10 to 14 days after surgery. Aftercare includes daily hyperbaric oxygen sessions and a private nurse. Online follow-up continues for one year. See facelift swelling and bruising: what is normal and deep plane facelift risks and complications.

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Frequently Asked Questions

Are facelift drains painful?

Drains are often described as uncomfortable rather than painful. The tube pulls slightly when you turn your head. Removal takes a few seconds and feels like a brief tug. Ask your surgeon how long the drain will stay in and who will remove it.

Does the hemostatic net leave scars?

The net leaves small red marks where the stitches entered the skin. In published series these usually fade within weeks, with most gone within one month and some taking up to three months. Permanent pigmentation was rare or absent in the studies reviewed.

Is a hematoma after a facelift dangerous?

A small hematoma may only need drainage with a needle. A large, fast-growing one is an urgent problem because it can press on the skin and, in the neck, on the airway. Most appear early after surgery. This is why close monitoring in the first hours and days after surgery matters.

Can I choose whether I get a drain or a net?

You can discuss it, but the decision should follow your anatomy and your surgeon's overall protocol. A surgeon with low hematoma rates using one method has good reason to keep using it. The more useful question is how the whole bleeding-control plan works, not which single tool is used.

Do drains or the net change how long I stay in Istanbul?

In the randomized trial, both were removed after about two days, so neither should change the length of your stay. Your stay depends on the extent of surgery and how you heal. At the Prof. Dr. Suleyman Tas Clinic, patients stay about 10 to 14 days.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

See More Before and After Results

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