What kinds of massive bleeding can occur during facial contouring surgery?

Hello, this is Director Jo Hyun-woo of 3D Plastic Surgery Clinic.

Usually, patients think facial contouring surgery is a very major operation.

Of course, compared with the eyes or nose, it can be seen as a large surgery with a wider scope and a longer operating time.

However, facial contouring surgery, when performed safely, is not especially large or risky.

Today, let’s look at what situations can occur during facial contouring surgery.

Excluding emergency situations caused by anesthesia during facial contouring surgery, the emergency situation that can occur is massive bleeding.

Massive bleeding during cheekbone surgery

In fact, there is not much bleeding during cheekbone surgery, but when cutting the cheekbone, there can occasionally be a lot of bleeding.

It is a surgery that almost never touches an artery, but sometimes a vein can tear and cause significant bleeding.

The deep facial vein shown here behind the cheekbone is the only blood vessel that can be injured during cheekbone surgery.

As the deep facial vein passes behind the cheekbone, it forms a venous network called the pterygoid plexus, and bleeding can occur in this area.

If only the bone is cut precisely, the blood vessel is not easily injured, but if the surgery goes deeper, there is a possibility that the vessel may be damaged.

I have also had one case where there was a lot of bleeding. Since this vessel is a vein, it stops quickly as long as it is compressed properly.

So you do not need to worry too much during surgery.

Jaw angle surgery and massive bleeding

In fact, the risk of massive bleeding is higher in jaw angle surgery than in cheekbone surgery.

I think there are two major blood vessels that can be injured during jaw angle surgery.

The first is the retromandibular vein, which can bleed when cutting the angle of the jaw.

This vein is quite thick and lies 바로 behind the jaw angle bone, so the blood vessel can be damaged when cutting the bone.

When I was in residency training, my professors often told me to be careful of this vessel,

and in actual surgery, it is often wrapped with gauze before cutting the bone to prevent vessel damage, so it does not seem to be a vessel that is frequently injured.

This is also a vein, so if it is compressed properly, the bleeding stops quickly.

If bleeding does not stop well, there is also a way to ligate the vessel, so you can think of it as bleeding that can be resolved quickly.

The second vessel that requires caution is an artery called the facial artery.

In fact, it is probably the blood vessel that needs the most caution in contouring surgery.

This is also the case most often associated with major bleeding accidents and life-threatening problems.

As you can see in the photo above, the facial artery wraps around the lower jaw bone and turns inward to the inside of the jawbone.

If the artery is damaged on the inner side of the jawbone while cutting the bone, the vessel can retract inward and bleed heavily without the possibility of ligation.

If this happens, it is resolved in three ways.

More important than the bleeding itself is how to stop it.

The most important thing in vessel injury is compression.

Even an artery can stop bleeding if it is compressed for a long time.

If the vessel can be found after the bleeding stops, tying off the end of the vessel with a suture reduces the risk of bleeding again.

However, there are cases where even strong compression does not stop the bleeding.

When I was at a university hospital, there was a patient whose bleeding was so heavy that blood pooled in the mouth to the point of filling it every second, making compression difficult.

In such cases, after applying as much pressure as possible, the patient is quickly transferred to a university hospital for embolization.

Embolization is a procedure in which a glue-like substance is inserted through the blood vessels starting from the leg to block bleeding from the injured vessel.

These days, with the development of interventional radiology procedures, such treatments can reportedly be performed without much difficulty.

If I were faced with such a case, I would first apply compression and then boldly try embolization.

Stopping the bleeding as quickly as possible seems necessary to prevent future problems from massive bleeding.

I have not yet experienced such massive bleeding, but since it is a situation that can definitely occur, I always simulate and prepare for it.

Today, we looked into the causes of massive bleeding that can occur during contouring surgery.

Most cases can be stopped with compression, but if not, they can be managed through other treatment methods.

If you undergo surgery with a specialist who knows the proper treatment methods, even an emergency situation can be handled without major problems, so I hope you will not worry too much and can proceed with surgery.

Thank you.