Can a Blepharoplasty be done while on 81mg ASA daily? I can't come off.

Question

I have 2 drug eluding stents in the LAD for anterior MI 4 years ago. I also have a prophylactic AICD because of an EF 30% ( never had an arrhythmia or single ectopic beat). I am looking for a surgeon around upstate NY Rochester to Albany who would do the above surgery. I have a very kind Plastic Surgeon in Rochester, Dr Vito Quatella who has done procedures for me in past, but says the risk of ocular hematoma is too great. I respect his opinion, but am looking for options.

Andrew Campbell, MD · Answer

Aspirin will increase the risk of bruising, and the risk of complications with blepharoplasty, but precautions can be performed to limit or even eliminate the risk of blindness. Blindness from blepharoplasty occurs when bleeding goes back to the optic nerve and puts pressure on it. This can only happen when blood goes behind the orbital septum. An upper lid blepharoplasty can be performed to remove the skin, but by leaving the muscle, orbital septum, and any orbital fat alone, there would be no risk to the optic nerve. A similar technique could be used on the lower lids where the orbital septum can be exposed, but only cauterized with the bipolar cautery to tighten it. No fat would be removed. This could give you a nice improvement, and though you may have more bruising than average, you wouldn't be at risk of blindness.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Mark L. Mazow, MD, FACS · Answer

Thank you for your question. The Aspirin will cause increased risk of bleeding during surgery as well as afterwards. The surgery can still be done, but with some modifications to reduce the risk of hemorrhage behind the eye. Your AICD will limit the kind of cautery the can be used. I am never as worried about intra-operative blessing while on 81mgAsprin as I am about post operative bleeding. I advise all of my patients who can't come off Asprin to be extra careful about lifting straining, eye rubbing and sleeping with their head elevated postoperatively. I do think the surgery can be done, but you will need to have some realistic expectations about the limitations your cardiac condition will place on the results.

John R. Burroughs, MD · Answer

Yes, but Dr. Vito Quatella, whom I respect, is correct that the risk of hematoma is much greater.  A retrobulbar (bleed) behind the eye could cause blindness.  Also because of your AICD you should not have bovie used, which can interfere with it.  Laser could be used and bipolar cautery can also be used and these reduce bleeding risks.  Your expectations need to be reduced as an upper blepharoplasty on you would be safest with just skin removal and no opening of the septum.  This limits bleeding to occur mostly to the outside of the skin and not go deep in the eye socket.  An upper or lower blepharoplasty that involves fat removal is much riskier and carries higher risk for bleeding into the orbit already.  For some of my blood-thinner patients that need an upper blepharoplasty I will do one side followed by the other a few weeks later.  This reduces risk by only operating on one side at a time.  There are agents that can be used intraoperatively, to include topical thrombin, that can reduce bleeding both during surgery and after.  Your blood pressure needs to be well controlled as well.  Dr. Dale Meyer is a very qualified and outstanding oculofacial plastic surgeon in Albany.  Best regards.

Can a Blepharoplasty be done while on 81mg ASA daily? I can't come off.

Answers (3)

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