Physiotherapy Treatment of Subcutaneous Facial Hematomas Larger than 2 cm in Diameter: Case Report

Abstract

This case presents a rare example of successful non-surgical management of large facial hematomas in an elderly patient. While midfacial trauma is well documented, particularly in younger male populations, its conservative treatment in geriatric patients is scarcely reported. This case contributes to the literature by demonstrating the potential of kinesiological therapy as an alternative to surgical drainage, especially when aesthetic and functional preservation is a priority. An 80-year-old female patient with a history of Parkinson’s disease experienced a ground-level fall resulting in two subcutaneous hematomas: one in the supraciliary region (34 mm × 20 mm) and another in the right zygomatic-maxillary area (47 mm × 39 mm). She presented five days post-trauma with significant facial swelling, but no bone injuries were identified through imaging. Despite recommendations for surgical drainage due to lesion size and skin tension, the patient opted for a non-invasive approach. Kinesiological therapy-including manual lymphatic drainage, massage, ultrasound, and radiofrequency-was initiated one week after trauma. After 20 sessions over two months, the zygomatic hematoma reduced by 85% and the supraciliary hematoma by 95%, avoiding surgery and its associated risks. This case highlights that in selected patients, even large facial hematomas may be effectively managed through conservative kinesiotherapy. The main takeaway is that interdisciplinary collaboration and patient-centered decision-making can yield successful outcomes, particularly when surgical risks or cosmetic concerns are relevant.