Introduction: Facelift is the seventh most common aesthetic surgical procedure in Italy, according to statistics released by the Italian Association of Aesthetic Plastic Surgery in 20141 . This procedure is gaining in interest and certainly represents a large portion of plastic surgery practice with more than 11.000 procedures. Materials and Methods: We performed a retrospective analysis of all facelifts cases performed over a 6-year period from January 2010 to April 2016 by multiple surgeons in the practice. In the 6-year period, there were 305facelifts performed by three attending surgeons. Over the course of the next three years, the overwhelming majority of the facelifts being performed in the practice were utilizing the BAT technique. In the final study a total of 303 patients were included. Overall, there were 201 patients with BAT and 102 with traditional facelift (TF). Results: Ten main end points were examined in the BAT vs TF groups. These included rate of hematoma, bruising, long lasting edema, infection, seroma, nerve injury, hypertrophic scar, skin necrosis, need for revision surgery, and pulmonary embolism/deep venous thrombosis. Three of the most interesting findings were a significantly decreased rate of hematoma, bruising and long lasting edema (more than 14 days) in the BAT group, with0% vs 9, 1% for hematoma, 9.9% vs 31% for bruising and 3,48% vs 17,64% for long lasting edema. Other sensitive elements were the decrease rate of seroma and nerve injury with 0% in the BAT patients and 3,92% in the TF group for the first and 0% in the BAT and 2,94% in the TF, although the lesions were always non permanent (lasting interval from 7 days to 90). Discussion: Hematoma may be linked to several factors in facelift5-18-19. All kind of trauma, bleeding and blood soaking into tissues, causing pain, swelling and inflammation could increase this risk and that of bruising and long term edema. Implementing itemized surgical methods and instrumentations, as realized in BAT, allow to reach a prospective hemostasis, it means the surgeon has the possibility to create the flap for different facelift procedures while preventing bleeding before it ever occurs (No Blood Technique); and allow dramatic reduction of mechanical and thermal lesion to tissues (No Touch Technique). Conclusions: The use of Bloodless Atraumatic Technique significantly decreased the hematoma rate in our practice and offers objective improvements in recovery, complications, reoperation rates, and the overall patient experience, but do not happenin a predictable manner without substantial commitment of the surgical staff and effort primarily of the surgeon.
