Why aren't broad spectrum antibiotics prescribed after facelifts?

Question

Why don't doctors prophylactically prescribe a broad spectrum antibiotic like Keflex to all facelift patients to prevent infection in the incision areas? I've been reading reviews here and a common theme seems to be swollen, throbbing ears where the stitches are, as well as pus in those areas, even if the incision areas are cleaned daily.

Scott K. Thompson, MD · Answer

Hello and thank you for your question. I do agree with the previous comments made by other physicians in regards to the over-use of antibiotics in general and the unlikelihood of infection when the procedure is performed in a sterile environment. That being said, I do prescribe all facelift patients a 5-day course of Keflex to prevent any risk of infection, though it is small.

Manish C. Champaneria, MD · Answer

Thank you for your questions.As many have already stated, prophylactic antibiotics have not shown to be beneficial in preventing infections. So, we have stopped giving them to patients unless there is an infection. Hope this helps! Best of luck to you...

Stephen Prendiville, MD · Answer

For starters, Keflex isn't a broad spectrum antibiotic, but a limited spectrum gram positive range antibiotic that has been heavily overused.  In circumstances where I use antibiotics in this day and age of resistance, it is more likely to be an older antibiotic like Doxycycline or Bactrim.  Use of a full course of antibiotics (7-10 days) in sterile facial surgery is not proven to add significant benefit.

Stephen Bresnick, MD · Answer

Facial surgical procedures, especially those of the skin, are quite resistant to infection because of the rich blood supply of facial skin.  You are more likely to develop a complication from the antibiotics themselves!   For example, stomach upset, diarrhea, rash, etc. may follow from a broad-spectrum antibiotic.    I do use antibiotics for a few days for most patients, and will use a full-course of antibiotics for patients who have had a history of MRSA infection or are known to be colonized with this bacteria.  Hope this helps!  Dr. Bresnick

Jeffrey M. Darrow, MD · Answer

Infections in facelifts are rare so most surgeons will give a dose of antibiotics prior to the surgery.  Whether additional doses are required during the recovery from a facelift is surgeons preference.  It has not been should that it decreases the infection rate and even medications like antibiotics may cause issues. so if they are not needed, it's best to avoid them.  My personal preference is antibiotics before surgery starts and 3 days after surgery.

Anil R. Shah, MD · Answer

Antibiotics are given preoperatively (before the procedure day of surgery) to help with infection as this has been shown in several studies.  Postoperative antibiotics (antibiotics after the procedure) are at the surgeon's discretion.  Infections can happen after a facelift but is a rare occurrence.

Michael I. Echavez, MD · Answer

Using antibiotics in relation to a facelift, or any facial cosmetic procedure, is really up to the surgeon.  A facelift is a sterile procedure, so technically, antibiotics should not be necessary.  Some surgeons may choose to use a dose of IV antibiotics just prior to the procedure or give oral antibiotics starting before and continuing after the surgery.  This is given as prophylaxis, meaning to prevent any potential infection rather than treat an existing one.  Most patients do not develop infections after a facelift, whether they receive antibiotics or not.

R. Scott Yarish, MD · Answer

I typically give a dose of antibiotics an hour prior to surgery when it has been proven to be of value.  Pus around the sutures is a rare event and isn't typically amenable to antibiotics.  Generally that is due to absorbable sutures that did not dissolve, although ingrown hairs can cause the same problem.

Camille Cash, MD · Answer

The use of antibiotics varies from surgeon to surgeon.  Antibiotics are generally given in the operating room, and some surgeons prescribe them orally after too.  The use of topical antibiotic ointment is also recommended by some physicians on the incisions as well.  It is a physician preference.

Julio Clavijo-Alvarez, MD, MPH, FACS · Answer

Thanks for sharing your question. I can appreciate your concern.

There are not standardized management of antibiotics for facelift. In theory, it is a clean surgery, in an area with great blood flow in which antibiotics are not mandated to be given. I usually give it to patients for my peace of mind.Wishing you the best in your journey

Why aren't broad spectrum antibiotics prescribed after facelifts?

Answers (17)

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