The hemostatic net: how much do the new reviews tell us?

The review published by Ribeiro and colleagues in 2026 brings together the outcomes of operations in which a hemostatic net was used. Haematoma, that is a collection of blood, was reported infrequently in these groups: to what extent does that show the net reduces such events? The review's search ended in May 2025; the year of publication does not mean all the data examined were collected in that year.¹

This article is about what the studies can say, not about how the technique is performed. An event being reported infrequently, being seen less often than with another method, and being said never to occur are separate claims. When a new review appears, it is worth asking which of those claims was actually investigated.

What problem does the hemostatic net address?

The hemostatic net aims to reduce the space between the skin and the tissues beneath it, using sutures that fix them together temporarily. The goal is to limit the area where blood could collect after surgery.² The sutures used for this are separate from those closing the surgical incision. There is a 2012 publication describing the technique and a 2014 publication reporting an extension of the same patient series; it would not be correct to treat 2014 as the year the technique was first described.^2,3

In the timetable given in the face lift and neck lift articles on this site, net sutures are removed at an outpatient visit after 2-3 days. The sutures closing the incision have a different purpose and a different removal time. That interval does not mean every mark on the skin disappears on the same day.

The net is not a step every surgeon uses, nor one that is obligatory in every face and neck lift. Using a hemostatic net or a drain does not remove the possibility of bleeding.⁴ In reading the research too, the aim of the technique and the outcome actually measured need to be assessed separately.

What does the 2026 meta-analysis measure?

Ribeiro and colleagues assessed 1617 people across 8 studies covering face, brow and neck rejuvenation surgery. The pooled estimate for haematoma was given as 0.14 per 100 observations, with a 95 per cent confidence interval of 0.00 to 0.58.¹ This shows that a low frequency of events was reported in the groups in which the net was used.

The analysis is single-arm, however. In other words, the outcomes of the groups that used the net are pooled together; no comparison with a group that did not use the net is made within the same calculation. This figure therefore does not say how much the net reduces the possibility of bleeding. Nor is it a rate belonging to face lifting alone. The review's total number of participants should not be read as though every complication was investigated in the same number of people.¹

The uncertainty is more visible in the outcomes given as 0. For persistent hyperpigmentation the estimate is 0 per 100 observations, but the 95 per cent confidence interval is 0 to 0.14. For sensory deficit the estimate is again 0 per 100 observations, with an interval of 0 to 0.33.¹ A confidence interval shows the statistical uncertainty around an estimate. The upper limit not being 0 makes concrete that the available data are not enough to say the event will never occur.

The distinction here is between "was not observed" and "does not occur". The first describes the data examined; the second is a guarantee that goes beyond those data. These intervals are not limits within which a particular person's risk is certain to fall. Reading a 0 in a table on its own leaves out the uncertainty shown plainly beside it.

Does comparison change the result?

In the randomised trial published by Ismail and Ghoraba in 2025, patients were allocated at random to a net or a drain group. There were 80 people in each group. Haematoma was reported in 1 person in the net group and 0 in the drain group; seroma, that is a collection of fluid, in 7 people in each group. No significant difference was shown between the groups.⁴

This study does make a direct comparison, but it compares the net with a drain rather than with no measure at all. Nor does the absence of a significant difference prove that the methods are definitely equivalent or that the net is ineffective. It says only that this study could not show a difference between these groups.

Older comparisons are built differently. In the 2014 series by Auersvald, within the first 72 hours, 17 haematomas were reported in the 120-person control group from the earlier period and 0 in the 405-person net group from the later period. The figure of 14.2 per cent belongs to that centre's control group from before the net; it is not a general haematoma rate for face lifting.³

In Janssen's study too, 304 net procedures from the 2017-2022 period were compared with 359 operations from 1999-2004; the haematoma rates were 0.6 per cent and 3.9 per cent respectively.⁵ When groups come from different years, it becomes harder to separate how much of the difference belongs to the net and how much to other practices that can change over time. A favourable association does not on its own show the net to be the cause.

The 2026 review by Gonçalves and colleagues also states that no definite conclusion about superiority can be reached. The authors give the reasons as the low certainty of the evidence, the differences between the procedures examined and the scarcity of patient-reported outcomes.⁶ The limits of comparative data have to do not only with the number of events but also with the procedures examined and the outcome measures used. A low rate and strong evidence of superiority are not the same information.

Do temporary marks mean scarless?

The removal of the net sutures and the fading of the redness at their entry points are separate processes. In the Ribeiro review the pooled estimate for hyperaemic marks is 12.70 per 100 observations. The reported marks are described as resolving within 2-3 months without progressing to persistent hyperpigmentation.¹ That interval conveys that visible marks may remain after the sutures have been removed; it does not give a timetable that ends on the same day for everyone.

In the 300-person series in an Asian population by Wongkietkachorn and colleagues, 90 per cent of the marks had disappeared within 1 month and some lasted up to 8 weeks. No persistent hyperpigmentation was observed.⁷ This series covers not only face lifting but brow and neck procedures as well. Turning the finding into a personal guarantee for all skin types and all operations goes beyond the limits of the study.

Here a temporary hyperaemic mark, persistent hyperpigmentation and a surgical incision scar are separate outcomes. One of them resolving does not mean the others were investigated or ruled out. A study following the colour of the net entry points, for example, does not support the conclusion that the operation will leave no incision scar. Nor does the absence of persistent hyperpigmentation say that no kind of scar formed at all.

The discussion of "scarless" in this site's article on the language of certainty therefore applies here too. What the research describes is the course of particular marks over a particular period of follow-up. Turning that into the sentence "it heals without a scar" both changes the outcome measured and converts an observation into a promise. The interval has to be read together with the type of mark.

What do publications outside face lifting show?

There are also publications on the hemostatic net in breast surgery and in skin grafts, that is skin taken from elsewhere and transplanted. The preliminary report by Goddard and colleagues on breast surgery is a small series covering 24 women. The intended redraping of the skin, that is the skin conforming to its new shape, was not achieved in 1 person.⁸ That study is not a comparative investigation of haematoma prevention; it shows the net being examined for a different purpose.

In the 2026 publication by Fonseca-Sada and colleagues, 2 wound areas on the same patient were compared in 15 people. However, whether the graft was meshed and the method of fixation both changed together.⁹ That design does not show the effect of the net independently of the other changes.

A technique being investigated in other areas does not mean the same benefit has been shown in all of them. The redraping of skin in the breast series and the integration of tissue in the graft study do not stand in place of the question about haematoma in face lifting. These publications should be read separately, with their scope and their limitations.

What follows from these data?

My view: In reading the publications on the hemostatic net I find the low rates valuable; but I do not find them sufficient for turning a technique into an obligatory measure of quality. For me the real question is not whether a method is named, but which comparison the claim attached to it rests on. Neither belittling a favourable finding nor making uncertainty invisible makes for good information. If a piece says "rarely seen", I want to know in which group it was seen; if it says "less", I want to know what it was compared with. With the sentence "it never happened", I expect it to be stated where the observation ends. I find it more meaningful to assess what new reviews contribute by the answers they give to these questions. As stronger comparisons arrive, and outcomes that better describe what patients experience, this assessment will need to be revisited. Reading today's data is not the same as closing off future uncertainty or giving an individual a guarantee of outcome.

References

1. Ribeiro LF, De Freitas LR, Udoma-Udofa OC, et al. Efficacy and safety of hemostatic net in facelift and rejuvenation surgeries (browlift and necklift): a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2026;116:118-130. doi:10.1016/j.bjps.2026.03.029 ↩ ↩² ↩³ ↩⁴ ↩⁵

2. Auersvald A, Auersvald LA, Biondo-Simões MLP. Rede hemostática: uma alternativa para a prevenção de hematoma em ritidoplastia. Rev Bras Cir Plást. 2012;27(1):22-30. doi:10.1590/S1983-51752012000100006 ↩ ↩²

3. Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthetic Plast Surg. 2014;38(1):1-9. doi:10.1007/s00266-013-0202-5 ↩ ↩²

4. Ismail M, Ghoraba S. Hemostatic net versus surgical drain after deep plane facelift surgery: a prospective randomized controlled trial. Aesthetic Plast Surg. 2025;49(16):4572-4578. doi:10.1007/s00266-025-04745-8 ↩ ↩²

5. Janssen TJ, Maheshwari K, Sivadasan A, Waterhouse N. Hemostatic net in facelift surgery: a 5-year single-surgeon experience. Aesthet Surg J. 2023;43(10):1106-1111. doi:10.1093/asj/sjad097 ↩

6. Gonçalves FG, Silva LDD, Sampaio ECDF, et al. Hemostatic net in cervical and facial surgeries: evidence from a systematic review and meta-analysis. Acta Cir Bras. 2026;41:e412326. doi:10.1590/acb412326 ↩

7. Wongkietkachorn A, Wongkietkachorn N. The use of the hemostatic net in Asian population: hyperpigmentation and the duration required for hemostatic net marking to disappear. Aesthetic Plast Surg. 2025;49(3):627-634. doi:10.1007/s00266-024-04561-6 ↩

8. Goddard NV, Pacifico MD, Campiglio G, Waterhouse N. A novel application of the hemostatic net in aesthetic breast surgery: a preliminary report. Aesthet Surg J. 2022;42(11):NP632-NP644. doi:10.1093/asj/sjac058 ↩

9. Fonseca-Sada JI, Méndez-Pérez AA, Salas-Treviño D, et al. Hemostatic net in non-meshed split-thickness grafts enhances graft integration and healing. J Burn Care Res. 2026;47(1):52-56. doi:10.1093/jbcr/iraf124 ↩