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I Had A Pulmonary Embolism 28 Years Ago. I Am Considering Having a Face Lift. Is There Still a Big Risk?

28 years ago I had a pulmonary embolism. At that time I was a heavy smoker and had traveled a long plane flight while feeling under the weather. I was hospitalized for about 2 weeks and took blood thinners for approx.6 months. I have had no other episodes or complications from this event and I quit smoking at that time. I am now 67 years old and am considering a 4-5 hour elective surgery for a face lift. Am I still at risk for complications because of the previous pulmonary embolism event?

Doctor Answers (22)

Pulmonary Embolism 28 Years Ago - Considering Face Lift

+1

A PE is much more likely to result from a long general anesthesia as opposed to IV sedation.  You should also have SCDs on your legs, massaging the leg during surgery.

For most face lifts we use IV sedation anesthesia, which is a very safe and effective method of anesthesia for facial plastic surgery and rhinoplasty. IV sedation anesthesia is extremely safe compared to the standard general anesthesia techniques used today. The main advantages of IV sedation anesthesia are: (i) it does not require putting a breathing tube in the throat, (ii) it does not require a breathing machine, (iii) the recovery is much faster, (iv) there is much less "hang-over" from anesthesia, (v) and there is much less nausea. All these elements translate into greater comfort and safety. We have used this technique of anesthesia in several thousand plastic surgery procedures without any anesthetic complications.

During IV sedation anesthesia a small flexible IV (intravenous) needle is placed into one of the veins of the back of the hand. Through this IV line, relaxing medication is given to make you fall sleep. The amount of medication given is adjusted to the specific needs of each person. After you are sleeping, some numbing medicine is also placed in the skin to numb the area that is being operated on. The beauty of IV sedation anesthesia is that during the procedure you are unaware of anything going on and cannot hear anything, yet you are still breathing on your own.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 141 reviews

Facelift - I Had A Pulmonary Embolism 28 Years Ago. I Am Considering Having a Face Lift. Is There Still a Big Risk?

+1

Probably not, but it will take a few assessments to get a more specific answer than that.  And, of course, no one knows what the word "big" means in this case.  My general sense is that you've undergone such a dramatic transformation since that time, and that pulmonary emboli are well known in the specific situation you were in (overweight, a long plane ride) so you can reasonably start with the assumption that this is an entirely different situation.  That being said, you should start with a complete medical assessment, including a stress test, and also have a consultation with a hematologist.  If those assessments show that you're in good shape, I think you can proceed with this procedure, though you may want to consider having it under sedation rather than general anesthesia (less vascular dilatation and stasis), be sure that SCDs are used (Sequential Compression Devices, which are placed on the lower legs to stimulate the legs at a time they would otherwise remain motionless - which is what happens on a long plane ride) and consider a medication that prevents blood clots.  That, however, has to be coordinated with your plastic surgeon, and may be a contraindication to the surgery (less clotting means more bleeding!).  The bottom line:  I think it's reasonable to consider.  Now you need to be cleared medically and, if that goes in your favor, you can discuss the procedure more specifically with your PS.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 151 reviews

Blood clots associated with facelifts

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I would see a hematologis before sugery.  consider iv sedation which has lower rates of DVT.  compared with general,   wear ted hose,,  use seq compression in surgery..  consider. perioperative SQ.  thinners by injection

consider shorter procedure such as the LiteLift  which can be done in 1-2 hours under local

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 20 reviews

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Facelift after previous pulmonary embolus.

+1

A full medical workup with Medical Clearance by your Internist will answer this question for us.  There may be a slightly higher risk for you, but this can be managed adequately and should not  prevent you from having a lift.  Always ask your Plastic Surgeon about this and I am sure the best opinion will be offered to you.

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Can I have a facelift after a Pulmonary Embolism?

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I would strongly recommend you get preoperative clearance from your primary doctor.  Your history of having a PE in the past places you at a higher risk clearly for another event.  You may consider a mini-facelift in an office setting under local anesthesia to  reduce your risks.  You may also see if your physician is open to using Arixtra after your surgery to reduce your risks. This is a blood thinner used often in abdominoplasty patients with great success in reducing post op PE risks. Good Luck.

Christian Prada, MD, FACS
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Pulmonary embolus-lung clot and plastic,cosmetic surgery

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Fortunately, pulmonary embolus is a rare occurence but one that I make my patients aware of because I really have very little control over. I take appropriate precautions. During the surgery, the patient has alternating pressure stockings on which pump and circulate the blood in your legs. This are on until you leave the facility. Also, I encourage my patients to ambulate early and move their legs around at least every half hour while awake.   

If you have had a pulmonary embolus in the past, your risk is increased and I would defer to the recommendation of your specialist as to other precautions to take like blood thinning medications during or after the surgery. This does not prevent you from having any type of surgery, including a facelift but more aware of what needs to be done to prevent or minimize it happening again!

Edward J. Domanskis, MD
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Face Lift after a pulmonary embolism

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 If you are properly  medically prepared for the surgery, your chances of a repeat pulmonary embolism are quite remote.  My recommendation would be to perform your procedure under twilight sleep. In my practice most patients successfully undergo face lifts, lid and brow surgeries in this fashion.  Another factor to consider, is how long does it take for the surgeon to perform the procedure. Lower face-neck lift can usually be performed in under 3 hours.

Boris M. Ackerman, MD
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Yes of course you are at increased risk.

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That does not mean you can't have a face lift which considered a low risk surgery.  The important thing is to have an appropriate work up by your internist.  What that work up will include very much depends on your current and past medical history and a number of factors.  At your age, that work up might include a detailed assessment of your cardiac status.  It is likely that your past embolism was related to smoking and travel at the time.  Many surgeons employ strategies to reduce embolism risks in all patients.  These are important considerations in evaluating your health status but they are unlike to keep you from having a facelift.

Kenneth D. Steinsapir, MD
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Risk of Pulmonary embolus with facelift

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You need a complete medical clearance prior to your procedure to rule out underlying clotting issues.  Post op measures such as early ambulation are also important.  The fact that you have stopped smoking also decreases the risk.  Donald R. Nunn MD   Atlanta Plastic Surgeon.

Donald Nunn, MD
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History of pulmonary embolus and facelift

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In answer to your question, whenever one has experienced a pulmonary embolus in the past, he or she is then at increased risk, statistically, of deep venous thrombosis and pulmonary embolus in the future.  With that said, the details in your history indicate prolonged immobility during a long plane flight contributed to your pulmonary embolus.  A four to five hour face lift, whether under local or general anesthesia, is prolonged immobility.  The use of sequential compression device stockings, used appropriately, should greatly decrease your chances of a repeated DVT or PE during this procedure.  I think with appropriate use of the SCD stockings, you would do quite well.

L. Dwight Baker, MD
Dothan Plastic Surgeon
5.0 out of 5 stars 13 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.