Benefits of a Hemostatic Net or Auersvald Net in Facelift Surgery

The world’s best facelift surgeons continue to refine facial surgery outcomes and reduce complications. A recent advancement is the hemostatic net technique, also referred to as the Auersvald net, pioneered by Brazilian plastic surgeons André and Luiz Auersvald. This risk-reducing approach involves placing a lattice of absorbable sutures beneath the skin during facelift procedures to support tissue adherence, limit fluid accumulation, and potentially eliminate the need for postoperative drains.

The technique has gained interest among surgeons performing deep plane, deep necklift and extended facelifts, with growing evidence suggesting it contributes to a more predictable and efficient healing process. As patients increasingly seek not just effective but also smoother recoveries, the role of techniques like the hemostatic net becomes particularly relevant.

This article explains the hemostatic net, who might benefit from it, the procedural steps involved, as well as the associated risks, aftercare guidelines, cost factors, and how to select a surgeon best qualified to perform your facelift.

What is a Hemostatic Net or Auersvald Net?

A hemostatic net is an internal support structure composed of a meshwork of absorbable sutures placed in a crosshatched pattern beneath the skin during certain surgical procedures, most commonly facelifts and neck lifts.

This net functions by compressing the tissue planes and assisting in the prevention of hematomas (bleeding) and seromas (fluid buildup), which are among the most common complications after facial surgery. It achieves this by applying gentle but consistent pressure across the dissected area, encouraging tissue bonding and reducing the formation of dead space.

Stabilisation of repositioned tissues during early healing is another critical function of the net. This helps preserve the intended facial contours and minimises the risk of displacement due to swelling or motion in the days following surgery. The result may be a more consistent and refined long-term aesthetic outcome.

Another advantage of this technique is the potential to reduce or even eliminate the need for surgical drains. Drains are often used to prevent fluid accumulation but can be uncomfortable and require additional care. In suitable cases, the hemostatic net may allow for a more streamlined recovery process without compromising safety.

This technique is particularly common in deep plane facelifts, which involve a more extensive dissection beneath the SMAS layer. The net helps reduce the considerable dead space created during these procedures, promoting faster and more reliable tissue adherence.

Dr. Auersvald first presented the concept in the 2010s after observing improved outcomes and fewer complications with the technique. Since then, it has been adopted and modified by surgeons worldwide as an adjunct to enhance both safety and results in selected facelift cases.

Who Might Consider This Procedure?

The hemostatic net is not routinely used in all facial surgeries. Its application is typically reserved for specific patient groups where enhanced tissue control and fluid management are especially beneficial.

Patients undergoing a deep plane or extended facelift are often considered ideal candidates. These procedures involve wide dissection and more extensive manipulation of the facial tissues, which inherently increases the risk of postoperative fluid collection. The net provides additional support, helping to stabilise the repositioned tissues and reduce potential complications.

Individuals with a history of hypertension, bleeding tendencies, or those who must stop blood thinners temporarily may also be suitable candidates. In such cases, the net may help control minor postoperative bleeding, enhancing safety and reducing the likelihood of hematoma.

Some patients prioritise a recovery without surgical drains, seeking a more comfortable postoperative experience. If the surgical plan and anatomy permit, the net may allow surgeons to achieve this by managing internal pressure and fluid control without the need for external drainage.

Those undergoing combined facial procedures, such as a facelift with a neck lift, platysmaplasty, or submandibular gland reduction, may also benefit. In such cases, the technique helps manage healing across multiple zones and supports the consistent integration of surgical outcomes.

The method is also beneficial for older patients or individuals with thin skin and less dermal collagen. In these patients, the net can help redrape skin more evenly and prevent small irregularities that may otherwise become more visible.

The decision to use a hemostatic net is ultimately based on the surgeon’s assessment of anatomy, procedural goals, healing potential, and patient preferences.

Procedure Overview

The hemostatic net is integrated into the surgical workflow of facelift procedures, typically during the latter stages.

Surgery begins with appropriate anaesthesia, which may involve either general anaesthesia or local anaesthesia with sedation. The incision lines are planned to be as discreet as possible and typically follow natural creases along the hairline, behind the ears, or beneath the chin.

Once the incisions are made, the surgeon proceeds with tissue dissection. In a deep plane facelift, the deeper structures beneath the SMAS layer are released and repositioned. This step allows for effective elevation of facial structures while preserving a natural appearance.

Hemostasis is established using cautery and other techniques to control bleeding. A clear surgical field is essential for accurately placing the net.

The hemostatic net itself is placed next. Using absorbable sutures such as Vicryl, the surgeon creates a lattice-like pattern on the redraped skin flap. These sutures span the undermined area, apply gentle compression, and help secure the repositioned tissues. The design of the net and suture spacing are adjusted to each patient’s anatomical needs.

Particular care is taken to ensure minimal tension at the closure sites to promote smooth healing and inconspicuous scarring.

A dressing or light compression garment is then applied. In many cases where the net is used, drains are omitted entirely. The patient is monitored during the initial recovery phase before discharge.

While the placement of the net adds time to the overall procedure, its benefits in minimising complications and supporting healing can make this additional step worthwhile.

Risks, Considerations, and Limitations of the Hemostatic Net

The hemostatic net technique offers notable benefits, but it is important to understand its limitations and potential risks.

The primary advantage is a reduction in hematomas and seromas. By compressing the tissue planes and reducing potential spaces for fluid collection, the net may significantly reduce the occurrence of these common complications. This also means fewer postoperative interventions, such as aspiration or drain management.

Improved tissue adhesion is another benefit. The network of sutures promotes closer contact between the skin and underlying tissues, helping to fix the lifted layers in their intended position and potentially improving the final aesthetic result.

In some cases, the use of the net can eliminate the need for surgical drains. This can improve the patient’s comfort, allow greater mobility during early recovery, and reduce the care burden associated with managing drains.

Skin redraping tends to be more uniform and stable using the Hemostatic net. The mild compression helps distribute tension evenly, reducing the likelihood of wrinkling, dimpling, or contour irregularities.

Recovery may also be faster in some cases. Reduced bruising and swelling allow patients to resume social activities sooner, which can improve the overall satisfaction with the surgical experience.

However, the technique is not without drawbacks. Temporary skin puckering or dimpling may occur due to the sutures. These changes are usually subtle and resolve within 7 to 14 days as the sutures are absorbed and the tissues settle.

The additional time required to place the net may prolong the surgical procedure slightly. This has minor implications for anaesthetic exposure and may increase surgical costs.

Outcomes are heavily surgeon-dependent. The effectiveness of the net relies on proper placement and appropriate suture tension. Inexperienced application may lead to uneven results or excessive skin pressure.

Though rare, absorbable sutures can trigger minor inflammatory responses. Patients with sensitivities to certain suture materials should notify their surgeon in advance.

Finally, this method is not applicable to every facelift. It is most suitable in procedures involving extensive dissection or where drains would otherwise be necessary. Superficial or minimal-access facelifts may not benefit from the use of a net.

Understanding these factors and discussing them with a qualified surgeon is essential in deciding whether this technique is suitable for your goals and anatomy.

Recovery and Aftercare

Recovery following a facelift that includes a hemostatic net is similar to that of a standard facelift but may present certain advantages. Patients typically experience mild skin surface irregularities, such as puckering or rippling, during the first week. These changes are expected and usually resolve as the absorbable sutures dissolve.

The reduced risk of fluid accumulation can lead to less swelling and bruising, especially in the early days after surgery. As a result, many patients report an easier transition back to normal activities. In cases where drains are omitted, patients also avoid the inconvenience and discomfort associated with managing them.

Aftercare involves adhering closely to the surgeon’s instructions. These typically include wearing a facial support garment as recommended, avoiding strenuous activity for several weeks, and maintaining head elevation while resting. Follow-up appointments allow the surgical team to monitor healing progress, remove any external sutures, and provide reassurance regarding any visible changes.

Patients should be informed about what is typical and what might indicate complications. Sudden swelling, increasing redness or pain, asymmetry, or fever should prompt immediate contact with the clinic. When these guidelines are followed, recovery with a hemostatic net is often straightforward and well tolerated.

Facelift Cost Considerations

The cost of a facelift that incorporates a hemostatic net varies depending on the surgeon, geographic region, and whether the technique is a standard part of the surgeon’s approach or considered an add-on. Some surgeons include this technique at no additional charge, while others may apply a surcharge to reflect the extra time and material required.

It is important for patients to ask for itemised quotes and confirm what is included in the surgical package. Factors such as anaesthesia fees, operating room time, and postoperative visits should also be clarified.

Facelift Before and After Photos

Choosing a Qualified Practitioner

Selecting a qualified plastic surgeon is critical, especially when considering advanced techniques such as the hemostatic net. Patients should look for a board-certified or specialist plastic surgeon who performs facelifts regularly and is familiar with the use of this method.

Experience with deep plane facelifts and complex facial anatomy is particularly valuable. Surgeons should be able to explain when and why they use the net and whether they adjust their approach based on individual patient needs.

Consultation is an opportunity to assess the surgeon’s communication style, review before-and-after photographs of patients treated with and without the net, and understand what postoperative care will involve. Accreditation of the surgical facility and anaesthesia team should also be verified.

Questions to Ask During a Consultation

Patients considering facelift surgery with the inclusion of a hemostatic net may benefit from asking the following questions during their consultation:

• Is this technique part of your standard approach to facelift surgery, or do you apply it selectively?
• In my case, what are the potential benefits and limitations of using a hemostatic net?
• Will this reduce or eliminate the need for drains?
• What changes should I expect in the first two weeks while the sutures dissolve?
• Are there any specific risks or complications associated with the net in my situation?
• How long will the puckering or dimpling typically last, and when can I expect to look socially presentable?
• Will using the net add cost to my surgery, and is this reflected in the quote?

These questions can help patients better understand the method, set realistic expectations, and feel confident in their surgical plan.

Final Thoughts

The hemostatic net, also known as the Auersvald net, represents a thoughtful advancement in facelift surgery that aims to improve outcomes and streamline recovery. By enhancing tissue stability, reducing fluid accumulation, and in some cases eliminating the need for drains, it has become a valuable tool in the hands of experienced surgeons.

While not appropriate for all patients or procedures, it offers particular benefit in deep plane and extended facelift cases. Understanding the technique, discussing it during consultation, and choosing a skilled provider are all essential steps in determining whether this approach aligns with your surgical goals.

Patients should approach this decision with careful consideration, guided by accurate information and open dialogue with their practitioner. When used thoughtfully, the hemostatic net may contribute to a safer procedure, smoother recovery, and more refined results.

Further Reading about Benefits of a Hemostatic Net or Auersvald Net

• Recovery After Facelift Surgery: An In-Depth Overview and Timeline
• Face Lift | Australia Cosmetic Clinics
• Face Lift in San Antonio | Dr Baumholtz