# Hemostatic Net A temporary measure for the first few days, designed to help the tissues settle. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20%E2%80%9CHemostatic%20net%E2%80%9D%20page%20and%20would%20like%20to%20know%20which%20procedure%20is%20right%20for%20me.) Explore At a glance ## Hemostatic net in Londrina, Brazil: at a glance ### What is the Auersvald hemostatic net? It is a temporary set of running stitches that pass through the skin and hold it against the deeper tissues at the end of a facelift or neck lift. It reduces the space where blood can collect and helps prevent hematoma, the most common complication of a facelift. It is not a thread lift, it does not stay in your face, and it does not eliminate the risk. - Origin: described by André and Luiz Auersvald, with no hematomas in the first 72 hours in the treated groups, compared with an earlier group. - Evidence: a 2025 trial found no difference compared with drains; in a 2026 meta-analysis, no single measure was clearly superior. - Removal: 48 hours after surgery, at my office, by Amanda under my direction. - Drains: I use the net in every facelift and don’t use drains. - Marks: redness at the stitch sites is common and, in studies, fades within two to three months. - Warning signs: swelling that grows quickly or worsening pain means you should contact us right away. By [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/walter-zamarian/) · CRM-PR 17.388 · [RQE 15.688](https://www.walterzamarianjr.com/us/credentials/) What to expect ## Knowing what you will see helps you get through the first few days. Photos taken right after surgery can be alarming when nobody explains them. The net looks different from the stitches next to the ear, but it doesn’t mean something went wrong: it may be part of the plan from the start. I prefer to introduce this step before surgery, explain what it is for, and schedule its removal. That way, you and whoever is helping with your recovery know what to expect and don’t have to interpret every stitch on your own. This conversation also helps separate the temporary look of the early recovery period from the result we are aiming for. The visible stitches are not the final shape of your face. How it works ## Why holding the tissues together can help A hematoma, a collection of blood under the skin that was lifted during surgery, is the most common complication after a facelift and may require another procedure. In a 2026 meta-analysis of 31 studies and 8,841 deep plane facelift patients, the overall rate was 2.7%, and the rate of major hematoma was about 1%. [Meta-analysis on hematoma prevention](https://pubmed.ncbi.nlm.nih.gov/41203255/). During a facelift, tissues are released so they can be repositioned. At the end, there may be space between the layers that were operated on. The net brings these surfaces together with running nylon stitches (5-0 on the face and neck, 4-0 behind the ears) that pass through the skin and reach the SMAS and the platysma, aiming to limit the places where blood can collect and to help the tissues settle. The idea came from the quilting sutures used in abdominoplasty (tummy tuck) to prevent seroma: closing the space created during surgery so fluid has fewer places to collect. The net is placed at the end of the facelift, during the same operation. It doesn’t work like a drain: a drain lets fluid out and allows it to be monitored, while the net works by bringing the tissues together. Nor is it the same as the absorbable threads placed in the office for a cosmetic thread lift. The principle was first presented in a 2012 Brazilian paper by André Auersvald, Luiz Augusto Auersvald, and Maria de Lourdes Pessole Biondo-Simões. [Original paper in the Brazilian Journal of Plastic Surgery (RBCP), in Portuguese](https://rbcp.org.br/details/1026/pt-BR/rede-hemostatica--uma-alternativa-para-a-prevencao-de-hematoma-em-ritidoplastia). Origin ## The contribution of André Auersvald and his coauthors The 2012 study compared 120 earlier patients who did not have the net with 246 later patients who did. It found hematoma in 17 of the controls and in none of the net group during the first 72 hours. The comparison was with a historical group; patients were not randomly assigned to one treatment or the other. In 2014, André Auersvald and Luiz A. Auersvald published an expanded series: 525 patients in total, including the same 120 controls and 405 treated with the net. Again, there were no hematomas in the net group during the observation period. [2014 paper](https://pubmed.ncbi.nlm.nih.gov/23949130/). The two papers reflect the same experience as it evolved. I don’t add the groups together as if they were two fully independent samples. And “no cases in this series” doesn’t mean the risk disappears in any given surgery. ### Want to understand what your recovery will be like? At the consultation, I explain what the net does, the follow-up visits, and the aftercare, so you know what to expect at each stage. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20%E2%80%9CHemostatic%20net%E2%80%9D%20page%20and%20would%20like%20to%20know%20which%20procedure%20is%20right%20for%20me.) Evidence ## What later research has added In 2025, Ismail and Ghoraba published a randomized trial of 160 women undergoing deep plane facelifts: 80 received the net and 80 a drain. They found no statistically significant difference in hematoma, seroma, or swelling between the groups. One hematoma beneath the SMAS occurred in the net group and was treated surgically. [Clinical trial](https://link.springer.com/article/10.1007/s00266-025-04745-8). Other groups have also tested the technique. Janssen and colleagues compared 304 patients who had the net with 359 operated on years earlier without it, by the same surgeon: hematoma in 0.6% and 3.9%, respectively. The study is retrospective and compares different time periods. [Five-year experience](https://pubmed.ncbi.nlm.nih.gov/37040449/). A 2026 meta-analysis included eight studies and 1,617 patients who had the net during facelift, neck lift, or brow lift surgery. Hematoma occurred in 0.14 per 100 patients; red marks at the stitch sites occurred in 12.7 per 100 and faded within two to three months, with no persistent hyperpigmentation. [Meta-analysis on the hemostatic net](https://pubmed.ncbi.nlm.nih.gov/41936137/). The 2025 trial doesn’t erase the Auersvalds’ contribution. It helps define more precisely what we can say: the net is one way to manage this risk, but it has not been shown to always outperform drains or to prevent all bleeding. Later reviews combine results from different groups. When I interpret them, I consider how the studies were designed, changes in technique, and possible overlap between patient groups. What matters for you is why I use this measure in your case, not a promise of “zero hematomas.” My routine ## How I routinely handle the net ### Before surgery I explain the net and show you how it fits into your recovery. The person accompanying you is also welcome to go over the instructions. ### After surgery The team monitors the tissues, the dressings, and any signs of bleeding. The net is no substitute for an exam. ### At the follow-up visit I routinely have the net removed 48 hours after surgery at my office by Amanda, who is also a nurse, under my direction. In my practice, I place the net on the neck and in the preauricular and temporal areas, and sometimes in the brow area. We confirm the date and the aftercare before you leave the hospital. Don’t remove, cut, pull, or adjust the stitches at home. If something bothers you or seems different, let the team know so we can advise you. Marks and removal ## Does the net leave marks? And does removal hurt? The stitches can leave temporary marks, and changes in pigmentation were described in the original paper. Healing needs to be monitored; I don’t promise that your skin will show no signs at all. In the 2026 meta-analysis, the red marks faded within two to three months, and no persistent discoloration was reported. How removal feels varies from person to person. I explain what will be done and keep an eye on your comfort, without brushing it off as “it doesn’t hurt at all.” The net is temporary, and when it comes out is part of the plan, not something for the patient to decide at home. Afterward, stick to the care you were given. Skin-lightening products, massage, and picking at scabs too early may not suit this stage of healing. Other measures ## The net is one of several preventive measures Some factors raise the risk of hematoma after a facelift: being male, taking anticoagulants, high blood pressure around the time of surgery, and straining that increases pressure in the chest, such as vomiting. A review by Stewart and colleagues found benefit in preventive control of pain, nausea, and blood pressure, with a target below 140 mmHg, and in the use of fibrin sealants; drains and compression dressings had no significant effect on hematoma. [Review on hematoma prevention](https://pubmed.ncbi.nlm.nih.gov/37540899/). ### Fibrin sealant In a series of 605 patients operated on without drains (544 deep plane and 61 lateral SMASectomy), the minor hematoma rate dropped from 3.4% to 0.4% with fibrin glue. Male patients had more hematomas. [Zoumalan and Rizk series](https://pubmed.ncbi.nlm.nih.gov/18347237/). ### Tranexamic acid It is a medication that reduces bleeding. In the 2026 deep plane meta-analysis, no single measure among tranexamic acid, sealants, and the net was clearly superior. ### What you can control Telling us about all your medications and supplements, following the instructions on blood pressure and rest, and letting us know if you have nausea or vomiting are all part of prevention. In my practice, tranexamic acid is not routine: I use it when I see more bleeding than expected during surgery. For patients with high blood pressure, I prescribe clonidine to keep it under control. I only use a compression garment when there is more swelling after surgery, in about 5% to 10% of cases. That’s why I present the net as one part of a whole: medical evaluation, careful control of bleeding during surgery, blood pressure management, and monitoring in the first few days. No drains ## Using the net without drains in my practice I use the hemostatic net in every facelift I perform, without drains. This is my surgical routine; it doesn’t mean the net eliminates the risk of hematoma, or that another surgeon’s use of drains makes the surgery inferior. If a complication does occur, how it is assessed and treated will depend on the situation. Blood pressure, medications, bleeding control, and monitoring after surgery remain important. Having the net doesn’t mean you can exert yourself sooner, stop your medications, or ignore increasing swelling. I clear light exercise at one month and any physical activity, including contact sports, at two months. Safety comes from a series of decisions. I would rather you understand the whole picture than tie your peace of mind to a single device. Warning signs ## What is expected and what needs medical attention Swelling and bruising can be part of recovery. However, swelling that grows rapidly, a sudden, marked difference between the two sides, increasing pain or pressure, and significant bleeding need to be checked immediately, even with the net in place. If you have trouble breathing or swallowing, or a sudden change in vision, seek emergency care. Don’t wait for your scheduled visit, and don’t rely on messages alone to decide. My team will give you the contact channels and the follow-up schedule. The net is a measure for the first few days; care continues after it is removed. Follow-up ## Removal is one step, not the end of follow-up After removal, I check how you are healing, how the tissues are settling, and the contour of your face. Other stitches have their own schedule. Photos and checkups over the following months show your progress more consistently than isolated, very early pictures. If you are traveling to Londrina, your stay needs to allow for this care. Don’t book your trip home based only on the date the net comes out; we plan when you are cleared to leave and your follow-up visits according to your surgery and your exam. On the [patient journey](https://www.walterzamarianjr.com/us/patient-journey/) page, you can see who is involved at each stage and how I handle follow-up. Getting to know this process before surgery can make recovery easier to understand and organize. Questions ## Your questions deserve a careful answer. Does the hemostatic net stay in my face? No. It doesn’t stay in permanently like a supporting implant. It is a temporary set of external sutures that pass through the skin, and the team removes it at the scheduled time. Does the net guarantee I won’t have a hematoma? No. Early studies reported no hematomas in their series, but that doesn’t mean zero risk. A later trial recorded a hematoma in the net group. Who developed the technique? The early work is by André Auersvald and Luiz Augusto Auersvald; the 2012 Brazilian paper also lists Maria de Lourdes Pessole Biondo-Simões as a coauthor. When will the net be removed? I routinely have the net removed 48 hours after surgery at my office by Amanda, under my direction. The team confirms the time and the care needed for your comfort. Will I have less swelling because I had the net? I don’t promise that. The 2025 randomized trial found no significant difference in swelling between the net and drains. Recovery depends on the procedure as a whole. Are the hemostatic net and PDO threads the same thing? No. The net helps hold the tissues together temporarily after a facelift. Threads used for cosmetic lifting have a different purpose and do not replace this measure. Will the net leave marks on my face? It may leave red marks at the stitch sites. In a 2026 meta-analysis, they occurred in about 13 out of 100 patients and faded within two to three months, with no persistent discoloration reported. I monitor healing at your follow-up visits. Bring your questions about the first few days. I will explain why I include the net in your plan and how we organize its removal and your follow-up. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20%E2%80%9CHemostatic%20net%E2%80%9D%20page%20and%20would%20like%20to%20know%20which%20procedure%20is%20right%20for%20me.) References ## References and authorship By [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/walter-zamarian/) · CRM-PR 17.388 · [RQE 15.688](https://www.walterzamarianjr.com/us/credentials/) References reviewed on September 22, 2026. The sources below support the general information on this page. When I describe how I care for patients, I am describing my team’s routine; the guidance for your surgery will be individual. - [Auersvald A, Auersvald LA, Biondo-Simões MLP. Rede hemostática: uma alternativa para a prevenção de hematoma em ritidoplastia. RBCP, 2012;27(1):22–30.](https://rbcp.org.br/details/1026/pt-BR/rede-hemostatica--uma-alternativa-para-a-prevencao-de-hematoma-em-ritidoplastia) - [Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthetic Plastic Surgery, 2014;38:1–9.](https://pubmed.ncbi.nlm.nih.gov/23949130/) - [Ismail M, Ghoraba S. Hemostatic Net Versus Surgical Drain After Deep Plane Facelift Surgery: A Prospective Randomized Controlled Trial. Aesthetic Plastic Surgery, 2025;49:4572–4578.](https://link.springer.com/article/10.1007/s00266-025-04745-8) - [Azzi JL et al. Prevention of Hematoma in Patients Undergoing Facelift (Rhytidectomy): A Systematic Review and Meta-Analysis. Facial Plastic Surgery & Aesthetic Medicine, 2026.](https://pubmed.ncbi.nlm.nih.gov/41203255/) - [Janssen TJ et al. Hemostatic Net in Facelift Surgery: A 5-Year Single-Surgeon Experience. Aesthetic Surgery Journal, 2023.](https://pubmed.ncbi.nlm.nih.gov/37040449/) - [Ribeiro LF et al. Efficacy and safety of hemostatic net in facelift and rejuvenation surgeries (browlift and necklift): A systematic review and meta-analysis. JPRAS, 2026.](https://pubmed.ncbi.nlm.nih.gov/41936137/) - [Stewart CM et al. Evidence of Hematoma Prevention After Facelift. Aesthetic Surgery Journal, 2024.](https://pubmed.ncbi.nlm.nih.gov/37540899/) - [Zoumalan R, Rizk SS. Hematoma rates in drainless deep-plane face-lift surgery with and without the use of fibrin glue. Archives of Facial Plastic Surgery, 2008.](https://pubmed.ncbi.nlm.nih.gov/18347237/) ### Keep exploring - [Deep plane facelift →](https://www.walterzamarianjr.com/us/face/facelift/) - [Deep neck lift →](https://www.walterzamarianjr.com/us/face/neck-lift/) - [Your journey →](https://www.walterzamarianjr.com/us/patient-journey/) [← All facial procedures](https://www.walterzamarianjr.com/us/face/)