Do you recommend your patients to take Emend anti-nausea medication on the morning of facelift surgery?

I have usually been prescribed Zofran for after surgery nausea but some members of the facelift forum advise taking Emend tablet on the morning of surgery? It is VERY expensive at $150 for one pill and is not covered by my insurance. Surely the anti nausea meds in the IV during surgery, and the aftercare meds like Zofran will be enough? I did not feel nauseous after a previous bleph and rhinoplasty 10 years ago. Thanks in advance!

Doctor Answers 17

Is Emend Anti-Nausea Necessary?

Emend is a very effective anti-nausea medication and it is also very expensive. Most patients usually don't need it. Your surgeon is probably prescribing it because nausea and vomiting after surgery is unpleasant, and it increases your risk for a bleeding complication after facelift surgery. If you have done well in the past with Zofran then you are someone who would likely do fine without Emend as long as your anesthesiologist is careful with medications and anesthetic agents. 

Another very effective option is a Scopalomine patch which is placed before the surgery starts and is very effective in preventing nausea and vomiting. Still there is small sub-population of patients who are extremely sensitive and they are the ones who benefit from  a medication like Emend, despite it's cost. There are also a number of medications that can be given during surgery which reduce the risks of N&V. In our practice we tailor the medication regimen to each person's circumstances and are able to avoid the problems of post-operative N&V in almost all patients. 

Nausea medication. Facelift and Zofran

It`s definitely not necessary to use or take this medicine before a facelift surgery. In my experience  the use of Zofran is absolutely enough to control nausea. It`s very important that you consult with your plastic surgeon whether you should or should not take this medicine before the surgery. I hope this was helpful.


Nausea is a troublesome problem after facial plastic surgery due to its affect on raise blood pressure and bleeding.  All plastic surgeons give anti-nausea medications such as Zofran or Reglan.  In my practice we reserve the use of Emend for patients that say that they always get nauseated and have tremendous problems with vomiting after surgery no matter what Emend was developed to deal with severe nausea after chemo therapy. It is an excellent drug but we only reserve it  for people that have severe problems. The vast majority of people do very well with the usual medications 

Andrew Kaczynski, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 106 reviews

Emend for nausea

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

Emend is a latest generation of antiemetic. It is very effective and costly. If you have had success with zofran in the past, I do not see why to change now.

Finally, make sure that you have a consultation with a board certified plastic surgeon.

Wishing you the best in your journey

Emend for nausea

Stick with what has worked for you and the recommendations of your surgeon and anesthesiologist. Newer more expensive meds are not necessarily worth the money. If Zoran has worked for you ask for it again. The anesthesiologist is your friend.

Best of Luck,

Dr. J

A. Dean Jabs M.D. Ph.D. FACS
Board Certified Plastic Surgeon
6430 Rockledge Drive
Bethesda MD 20817

Emend for nausea after surgery

Emend is a wonderful option that is unknown to many doctors.  You should know that it works in a completely different way than the medications we typically use to treat nausea. 

I have used it with very good success.  However, it is costly.  For most patients the standard medications such as IV Zoran at the time of surgery are adequate.  I find that promethazine (Phenergan) is a more potent option as an oral pill to take after surgery (if needed) when compared to oral Zofran.

Emend is an option that I use for patients who have a strong history of problems with nausea and vomiting after surgery.  There are patients out there who are particularly sensitive to prolonged post-operative nausea and vomiting.  For these people I find that Emend in addition to other medications is worth the relatively small additional cost.

David W. Rodwell III, MD
Charleston Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Nausea After Facelift Surgery

Nausea is very uncommon after facelift surgery. There is a lower incidence of nausea when having a facelift under IV sedation rather then general anesthesia. However, even pain medication can give you nausea. Nausea is good to avoid because vomiting after surgery can potentially increase swelling and/or the chances for a hematoma. 

Most surgeons will give you zofran to take just in case you experience nausea after surgery. We give our patients a dose during surgery in order to help prevent this. We rarely have anyone complain of nausea after surgery.

Jacob D. Steiger, MD
Boca Raton Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Emend and Facelift Surgery

Emend is a great drug for those patients who have a known history of refractory nausea and vomiting from prior surgery that did not respond well to traditional drug treatments. Your prior surgeries does not show this to have been a problem in the past.

Facelift surgery and nausea

Facelift surgery and nausea

here are some of our recc.   Emend is given to patients with severe hx of nausea who do not do well with other meds  ..  See the cross activity on medications

1 day before surgery
Scopolomine patch (nausea) Place on upper arm the day of surgery.
Day of Surgery
 Antibiotic – only three pills required (preventative only)
If you are having your surgery in the office please eat a light breakfast and take your first
pill with breakfast the day of surgery. Proceed to take the next pill the evening of your
surgery and the last one the following morning.
If you are having your surgery at a surgery center (Talbert or HSC) please begin taking
the antibiotic after surgery with food at dinner time. You will then take the second pill the
following morning and the last one the following evening.
 Aprepitant (EMEND) (nausea) Take with a sip of water 1-3 hours prior to surgery. If taking birth
control pills, also use additional contraception for 28 days. Note: This medication costs
approximately $60 but worth it.
 Celebrex (Pain/Swelling) Take 2 pill (200mgs) with a sip of water upon awakening on the day of
 Zofran Take 1 pill by disolving on the tongue the morning of surgery.
 Ativan (oral sedative) Please bring the prescription of Ativan with you on the day of surgery. It will be
administered to you by the staff.
After Surgery
 Norco (pain medication) You can begin taking your pain medication once home from your surgery
and may continue to take one pill every 6-8 hours as needed for pain relief.
 Zofran (nausea) Take one pill every 8-12 hours as needed for nausea (this medication melts under
 Periactin (nausea) Take one pill 3 times per day while taking pain medication or if nausea persists.
 Flexeril (muscle relaxant) Take one pill 3 times per day for 5 days beginning the day after surgery
when you start eating.
 Celebrex (pain/swelling) Take one pill every 12 hours. Do Not take with other anti-inflammatory
 Sclopolomine patch Remove after 3 days, then wash hands immediately after removal.
 Clonodine patch Remove 7 days after application

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Do you recommend your patients to take Emend anti-nausea medication on the morning of facelift surgery?

In my Beverly Hills facility we only offer Emend to patients who have a history of severe postoperative nausea and vomiting despite the use of Zofran.  This is pretty rare but the drug has been effective in about 75% of those cases.  I would not recommend spending the money to use it if you do not have such a history.  Zofran combined with proper selection of anesthetics by your anesthetist should do the job nicely.  Good luck and enjoy the results of your facelift.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 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.