Is it normal to be prescribed a blood thinner injection for the day before facial procedures (rhino & under eye bags)?

Question

I am 40.5 yo, on oral birth control, thin, and no history of any med problems. My doctor advised me to come to the hospital the day before surgery for a blood thinner injection. He said he's more worried about a blood clot from the 5 hour surgery than trouble with bleeding, calling the injection a cautious approach. I am having rhinoplasty, under eye blepharoplasty w skin pinch, and lipo-filling under eyes. Is this injection common pre-surgery? Will my bruising and recovery be a lot worse?

William Portuese, MD · Answer

In our practice, we do not recommend blood thinners for elective cosmetic surgery. In our practice, lower eyelids and a rhinoplasty would take between  an hour and a half -2 hours, so blood thinners are not required. We also place sequential compression devices on the legs to prevent a blood clot or DVT. For many examples of rhinoplasty  and eyelid surgery, please see the link below

Algird R. Mameniskis, MD · Answer

Hello, thank you for your question. Blood thinners {heparin, lovanox} are sometimes administered pre-operatively to prevent deep veins from clotting during a surgical procedure. These are most frequently administered to patients who have increased risk of clotting compared to most patients or sometimes for a procedure which is anticipated to be lengthy and will utilize general anesthesia. In my practice I do not use blood thinning medications unless there is a known history of abnormal blood clotting. I use pneumatic calf pumps in all procedures which involve general anesthesia and are anticipated to be longer than one hour duration.I don't perform procedures which would be anticipated to last longer than four hours at one time. All additional blood thinning medications have some increased risk of bleeding and bruising at least to some small extent. My best recommendation would involve having a detailed discussion with your surgeon regarding the rationale for the blood thinner so you can feel confident moving forward.

Darryl J. Blinski, MD · Answer

Based upon the limited information posted I have concerns if this pre operative approach is in your best interests. Maybe you need a more detail explanation than given?

Peter E. Johnson, MD · Answer

The need for a blood thinner is determined by a risk assessment for a blood clot, also called a DVT. Most patients for cosmetic procedures are of a low risk and medications are not indicated though there must be something in your medical history and risk measure which makes the DVT prophylaxis with medication necessary.

Dennis Barek, MD (retired) · Answer

If your high risk is only from birth control pills, I would stop them in advance of surgery.I don't think elective plastic facial surgery should be done with someone on anticoagulation therapy. I would not operate under those circumstances.I think the standard of care would be to not operate,  rather than give anticoagulants,  if the patient is at such high risk for long surgery, under general anesthesia.

Harrison C. Putman III, MD (retired) · Answer

Without further details, I would say that this form of preoperative treatment is unusual, and may predispose to more bleeding and bruising post operatively. You might seek a pre op consultation with a hematologist before proceeding, and discuss this idea with your surgeon.

Is it normal to be prescribed a blood thinner injection for the day before facial procedures (rhino & under eye bags)?

Answers (6)

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