Risk of haematoma
The risk of haematoma refers to the risk of unusually heavy bleeding or secondary bleeding, which may jeopardise the outcome of cosmetic surgery.
The fear of complications is a constant companion before any cosmetic operation. One of the most common, yet also most manageable, risks is the Risk of haematoma – the risk of unusually heavy bleeding or post-operative bleeding. A healthy amount of bruising is normal, but a large haematoma can jeopardise the outcome of the operation and may require a further operation.
The good news is that the risk can be drastically reduced through careful planning and the right preparation. In this Glossary article, we explain the medical background, which factors increase your personal risk of bleeding, and how you and your surgeon can work together to ensure maximum safety.
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Important note
This article is for information purposes only and is not a substitute for a medical diagnosis or advice. If you are unsure, or if you require a personalised treatment plan, it is essential that you consult a qualified specialist.
Definition: What is meant by the risk of a haematoma?
The Risk of haematoma In surgery, this refers to the probability of uncontrolled bleeding occurring during or after a surgical procedure, resulting in a haematoma requiring treatment (Haematoma) leads to.
It is determined by patient-specific factors (such as blood clotting), the type of surgical procedure and the medication taken. Accurately assessing this risk is a key part of pre-operative preparation and the anaesthesia briefing.
Patient factors: What increases your personal risk?
The risk of post-operative bleeding varies from person to person. The following factors play a key role:
- High blood pressure (hypertension): This is one of the biggest risk factors. High blood pressure in the blood vessels makes it difficult for the body to stop the bleeding naturally. If blood pressure rises suddenly after the operation (e.g. due to pain or anxiety), blood vessels that have just been sealed may burst open again.
- Coagulation disorders: Congenital or acquired disorders in which the blood does not clot quickly enough (e.g. haemophilia or von Willebrand syndrome).
- Age and tissue structure: As we get older, our blood vessels become more fragile, which can slightly increase the risk of bleeding.
- Nicotine consumption: Smoking damages the blood vessels and impairs microcirculation, which not only massively increases the risk of haematoma but, above all, the risk of severe wound-healing complications.
Medicines and dietary supplements as a risk factor
The use of certain substances is the most common preventable cause of an increased risk of haematoma.
⚠ Vital: Be completely open during the preliminary discussion
Never fail to tell your surgeon and anaesthetist about any medicines you are taking – even if they seem completely harmless to you!
The following groups increase the risk and often need to be discontinued before surgery
- Anticoagulants (blood thinners): Medicines such as Marcumar, Eliquis or Xarelto. In this case, a detailed plan for switching is absolutely essential.
- Antiplatelet agents: The best-known example is ASS (aspirin). It often prevents blood platelets from clumping together for several days or even weeks.
- Over-the-counter painkillers (NSAIDs): Ibuprofen and diclofenac also affect blood clotting. Paracetamol is the safer alternative, but should only be taken after consulting a doctor.
- Dietary supplements & vitamins: High-dose vitamin E, ginkgo, ginseng, garlic supplements and fish oil capsules (omega-3) can have a blood-thinning effect and significantly increase the risk of haematoma.
Surgical factors: How the doctor minimises the risk
Your surgeon will use various techniques to manage the risks during the procedure:
Careful haemostasis
Blood vessels are immediately cauterised using an electric current (electrocoagulation) during the operation.
Tumescent local anaesthesia
During procedures such as liposuction, a fluid containing highly diluted adrenaline is injected. Adrenaline causes the blood vessels to constrict very sharply, which minimises blood loss during the operation.
Insertion of drains
To prevent unavoidable wound exudate and small amounts of blood from accumulating to form a large haematoma, fine drains are often inserted to drain the fluid away.
The risk of secondary bleeding (reactive haemorrhage)
The risk of secondary bleeding (reactive haemorrhage)
Reactive post-operative bleeding is particularly treacherous. During the operation, the surgeon often keeps the blood pressure artificially low, and adrenaline (from the anaesthetic) constricts the blood vessels. If the effect of the adrenaline wears off a few hours after the operation and the patient’s blood pressure returns to normal, small blood vessels that had previously been sealed off may suddenly reopen. This leads to secondary bleeding, which causes a rapidly enlarging, painful haematoma.
Residual risk and financial protection
Even with perfect preparation and a flawless operation, there remains a certain residual risk of a severe haematoma. If this occurs, swift action is often required. A surgical revision (surgical evacuation of the haematoma in the operating theatre) is then necessary to relieve the pressure on the tissue (e.g. the wound edges or an implant) and to safeguard the outcome of the operation.
As cosmetic procedures are elective treatments, your health insurance provider may, in the event of complications, require you to contribute towards the costs of any necessary follow-up treatment in accordance with Section 52(2) of Book V of the Social Code (SGB V). A policy taken out in advance Consequential Costs Insurance It is therefore an essential part of your pre-operative preparations. It protects you from the enormous unforeseen costs associated with such an emergency revision.
Checklist: How to reduce your risk of a haematoma before surgery
- Medication Review Stop taking blood-thinning medication (such as aspirin) in good time (usually 10–14 days beforehand), after consulting your doctor.
- Taking a break from supplements Please avoid taking dietary supplements such as fish oil, ginkgo, garlic and high-dose vitamins for two weeks before the operation.
- Check your blood pressure Have your blood pressure checked beforehand and, if necessary, ensure it is properly controlled by your GP.
- Giving up nicotine Stop smoking at least four weeks before your operation to improve your vascular health.
- Post-operative rest It is essential that you avoid physical exertion, bending down and heavy lifting during the first few days after the operation to prevent spikes in blood pressure.
Frequently Asked Questions (FAQ)
No. The risk varies considerably depending on the procedure. For operations involving large surgical incisions (e.g. tummy tucks, facelifts) or in areas with a rich blood supply, the risk is naturally higher than for smaller, minimally invasive procedures.
The most critical period is the first 24 to 48 hours following the procedure. During this time, you must take it very easy and wear the prescribed compression garments.
The use of homeopathic arnica preparations to prevent swelling and bruising is widespread. However, you should always check with your surgeon to find out whether you may take such preparations and, if so, when you may start taking them.
If your blood pressure is extremely high before the procedure and cannot be lowered with medication, the anaesthetist will cancel or postpone the operation for your own safety, as the risk of a haematoma would simply be too great.