If You Are on Blood Thinner Can You Get Lift?

As a dermatologic surgeon, I do not perform facelifts or neck lifts, but I do perform a large number of reconstructive cases on my Mohs surgery patients. Those patients who are taking Coumadin are told not to stop their medication but we work with their internist or cardiologist to maintain their INR in a reasonable level. This type of surgery, for skin cancer, improves the benefit to risk ratio but elective cosmetic surgery does not have such a good ratio because the need for surgery does not exist. There are times for reconstruction that the Coumadin can be stopped under supervision by the cardiologist and a replacement, short term blood thinner Lovenox, can be used to keep the blood thin while the coumadin's effect lowers. The surgery can then be done and the coumadin then is resumed. The problem with neck lifts is that their can be significant bleeding after the coumadin is resumed and a hematoma, blood collection, can cause very serious risks. If there is delayed bleeding, and the coumadin has been resumed, it's effect can't quickly be eliminated even after it's stopped because Coumadin's effect lasts long. In summary, NO, it's not worth the complication of having a STROKE by stopping coumadin for an elective cosmetic procedure. This decision should be ultimately up to you and your internist or cardiologist and/or cardiothoracic surgeon.

hello the king To go over some simple, general rules: smokers will need to stop smoking well before their surgery, you may be asked to stop certain medications that may contribute to bleeding. #blood #pre-op

I would not recommend a face and neck lift if you are on a blood thinners such as coumadin or warfarin.  There are instances that under appropriate cardiology care, one can come Off these thinners and have plastic surgery. I would discuss with your cardiologist first.

It is possible to rejuvenate the neck while on blood thinners.  First and foremost, your cardiologist needs to determine if it is possible for you to discontinue use of blood thinners such as Coumadin or Warfarin for an elective cosmetic procedure such as a neck lift.  If so, you would have to decide if you are willing to assume the risks associated with discontinuing such medication.  If you cannot or do not feel comfortable discontinuing such medication, procedures to rejuvenate the neck are still possible.  However, there are increased risks associated with performing a neck lift while on blood thinners such as developing a collection of blood under the skin called a hematoma.  I recommend that you consult with a plastic surgeon who specializes in performing face-neck lifts to learn more about the options which are available to address your aesthetic concerns while minimizing the risks of developing any complications.

Many patients who are on blood thinners are advised to obtain the approval of their anticoagulating physicians before going off the anticoagulants.  I know of one case (not my patient), resulting in a stroke after elective cosmetic surgery from stopping their anticoagulation before their facelift.  There is always risk involved in surgery, and more so if other medical conditions are present.  My job is to recommend the safest path to your rejuvenation, and in some cases, this means not offering surgery.

This depends on the type of neck lift you need.  Traditional undermining and flap development probably not advisable on Warfarin/Coumadin.  If you are male with a "turkey gobbler," consider a submental T-Z excision under local anesthesia, popularized by Drs. Tom Biggs (Houston) and Gilbert Gradinger (Northern California).  If your skin elasticity is good and fat is the primary problem, tumescent syringe liposuction with half percent lidocaine and epinephrine (local anesthesia) with immediate post surgical neck compression may give you a good result, and should be safe provided your INR (protime) is not too high.  In any case, you should be evaluated by a plastic surgeon in your area, and the plastic surgeon will likely want to communcate with the cardiologist prior to any intervention.

Generally speaking, the risk of forming a clot on your valve which causes a possible stroke outsweighs the benefits of a neck lift. Your cardiologist would likely advise you similarly but if they felt comfortable with cessation of the warfarin peri-operatively, it could be a consideration.

You will have to stop these medications (as well as any heparin-like medications) under the supervision of your cardiologist prior to the face and neck lift. Because of the unacceptable high risk for hematomas, your blood clotting ability need to be normal or near-normal.

I would definitely proceed with caution.  Your plastic surgeon will have to coordinate well with your cardiologist to see if you could be safely converted to a short acting blood thinner like Lovenox.  However, it's unlikely your cardiologist would agree to this for a cosmetic procedure.   In the end, your heart and your health should be a priority to any elective cosmetic surgery.  You could also consider less invasive techniques like lasers to see if that help give you a satisfactory result.

Dr. Cat Begovic M.D.

Generaly, valve replacement patients are maintained at high INR's - 2.0-3.0. I, for one, would be terrified of hematoma (or worse) as a complication of a necklift in a patient with this degree of anticoagulation.

While you might be able to stop your blood thinners and have surgery, you likely do so at increased risk of stroke.