If You’re Considering a Facelift, Ask Your Surgeon This Question

16.03.2026, 15:20 allure.com

Some plastic surgeons refer to the earliest phase of facelift recovery as the "alien" stage—and 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.

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. “When we’re doing facelift surgery, or any type of surgery where we’re separating the skin from the deeper tissues, we’re creating what we call a ‘dead space’ that has the potential to collect these fluids,” says T. Gerald O’Daniel, 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 (“skin flaps” in surgeon-speak) to stick back down to the underlying muscle and lay smoothly and evenly, as it should.

In facelift surgery, a hematoma, which usually presents as a painful, bulging purple bruise, is “the most feared complication—the most consequential,” 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. “If you get this call in the middle of the night, you don’t sleep on it, because it can be a life-or-death moment,” he notes. In the neck, a large or expanding hematoma can obstruct the airway if it’s not caught early and managed urgently. These kinds of catastrophic hematomas are rare, Dr. Nayak says, “but even minor hematomas create their own misery by dramatically slowing the healing process and making bruising and firmness linger a lot longer.” 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.

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. “If 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 “major nuisance,” according to Dr. Nayak, “because they can make the skin drape incorrectly, causing it to wrinkle for many months over the area where the seroma accumulated.” Seromas can also become infectious if the fluid sits for too long, notes Dr. Cabin.

Aiming to prevent such complications, plastic surgeons have long relied on drains, but they’re not without drawbacks. “Patients don’t 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—they’re just uncomfortable,” Dr. O’Daniel says. (This fact alone makes “drainless” a huge selling point in plastic surgery.) Drains also require tending-to—“stripping” to prevent clogs (pinching and sliding your fingers down the length of the tubes) as well as emptying the bulbs and measuring the output—and have the potential to introduce infection, malfunction, and leave scars and track marks on the skin. What’s more, their removal can be anxiety-provoking: “Patients are always very nervous that it’s going to hurt, but it doesn’t—it’s just a weird sensation,” 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, “they will not save you from hematomas,” says Dr. Nayak. “The blood is just going to start coming out the drains as the face and neck fill up.”

Knowing that they can’t fully prevent hematomas and that they make the recovery process that much more arduous, ditching drains seems like a no-brainer—so why the controversy? Surgeons are creatures of habit, for one. Many learned to use drains as interns in residency and still consider them to be the standard of care. “When you ask them, ‘Why are you using a drain?’ They’ll tell you, ‘That’s the way I was taught,’” explains Sam Rizk, MD, a double board-certified facial plastic surgeon in New York City. It’s a comfort-zone thing—every advance comes with a learning curve—but also: If a surgeon has a low complication rate and attributes it, at least in part, to drains, well, then, if it ain’t broke and all that.

A closer look at a traditional drain.

There’s also a fair amount of debate over the safety and efficacy of popular drain alternatives, like fibrin-based tissue glue (an adhesive made from human plasma) and the surgical net (aka hemostatic net), a wild-looking web of temporary sutures that’s stitched through the surface of the skin to quilt together the layers of tissue that were separated during surgery, thereby closing the dead space under the skin to control bleeding and minimize fluid buildup. In addition to thwarting complications, glues and netting can also abate bruising and swelling after facelift surgery, curtailing patients’ recovery. Nevertheless, some surgeons question if these tools truly work as well as drains while others posit that they may cause issues of their own.

With more facelift surgeons educating their followers on drain alternatives, tuned-in patients have begun broaching the topic with their own doctors, says Dr. Pennington. “I have tons of people who DM me on social media or ask during consultation: ‘Do you use drains? Do you use the net?’” And every surgeon has their own take, informed by personal experience and published evidence. No single answer is necessarily right or wrong, Dr. Pennington adds, as each doctor will rely on “whatever yields the best, most consistent results in their hands.”

The type of facelift a surgeon performs—more specifically, the amount of skin that’s lifted off the muscle in each case—may also influence their stance on drains. There are two main categories of facelifts—deep plane and SMAS (an acronym for superficial musculoaponeurotic system)—and various iterations of each. While facelift surgeons quibble over semantics and what truly distinguishes one method from another, ultimately, all modern facelifts adjust the SMAS (muscle layer) in some way. But first, in order to access the SMAS, surgeons have to peel back the overlying skin. How much skin? is the million-dollar question. With some techniques, they’re lifting only a centimeter or two; with others, the separation of skin from muscle is extensive, resulting in larger skin flaps. “The more skin that’s elevated, the greater the risk for hematoma and seroma—and that’s true when using drains, tissue glue, and the surgical net, no matter what,” says Dr. O’Daniel.

The risk increases with the amount of skin that’s lifted, because that leaves a broader area vulnerable to fluid accumulation. During our interview, Dr. Nayak referred to the subcutaneous space directly under the skin as “the trouble layer,” since it’s most prone to bleeding and oozing. (Seromas and hematomas occur less frequently in the deep plane.) “But if you can minimize the amount of surface area at risk,” he says, “that changes the equation.” While Dr. Nayak is famous for his deep plane technique, earlier in his career, he performed a type of SMAS facelift that involved sizable skin flaps. During his SMAS era, he relied on drains, finding them “incomparable” in terms of preventing seromas on large skin flaps. As Dr. Nayak’s technique evolved, his skin flaps shrunk and he abandoned drains in favor of tissue glue and the surgical net. “You don't need a drain for small flaps; you can get away with glue or netting,” he says. But with bigger flaps, “the only thing I’d trust is suction drains to prevent seromas.”

Today, Dr. Nayak specializes in what’s commonly called a preservation-style deep plane face and neck lift, a modification to the extended deep plane, which Allure reported on in 2024. By keeping more skin connected to the deeper tissues—and yielding smaller skin flaps in the face and neck—the technique aims to minimize space for fluid to settle, lessening not only post-op complications, but also bruising, swelling, and trauma to the skin. (Quick caveat: While Dr. Nayak’s facelifts are drainless, he still uses drains for brow lifts. “I use a drain overnight for brow lifts, because the bruising is dramatically different if we pull away the little bits of bloody fluid in that first evening,” he says. “If you have just 12 hours of drain presence, almost nobody bruises.” Without the drain, however, brow lift patients “get a much higher rate and much greater amount of denser, darker, bluer, bigger raccoon eyes,” he says.)

Other surgeons shared similar stories of retiring drains in favor of glues and nets after adopting preservation facelift principles. “I used to use drains on every single facelift patient, and now I use them rarely,” says Dr. Pennington. Dr. Cabin quit using drains a year or two ago when he started routinely performing preservation facelifts. He now uses glue along with the net in every face and neck lift he performs and says “most of my patients prefer that to a drain