I have to take anticoagulants. Can I still have a facelift?

Question

I have been diagnosed with atrial fibrillation and have to take anti coagulants and beta blockers. Would I still be able to have a facelift or lower eye bag removal?

Daniel Butz, MD · Answer

The risk of hematoma is too high if you have to stay on anticoagulants. I would check with your cardiologist and see if you could tolerate a short break.

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question.  Due to your medical history, you would need a letter of clearance saying that you are eligible for an elective procedure.  Your plastic surgeon will likely want you to discontinue the anticoagulants for some time before and after your procedure.  Best of luck.

Luis Villar, MD, FACS · Answer

You cannot safely undergo blepharoplasty or a facelift while you are on anticoagulants.  So the question becomes, "Can I safely go off the anticoagulants to have the surgery".  Atrial fibrillation increases the risk of stroke by releasing clots from the heart valves.  If you stop the anticoagulation, you may very well be lucky and not have any problems.  Or you may stroke out.  30 years ago I reviewed a case in which a patient with atrial fibrillation was going to get married and wanted a facelift.  Her plastic surgeon said it was too risky.  She pleaded it be done.  She was sent to her cardiologist who said it would be risky, a gamble.  She told them both that she was willing to take the risk and would sign any waivers to protect them from liability.  She begged, pleaded , and insisted.The surgeon finally gave in.  She signed the waivers, stopped the anticoagulation, and had an uncomplicated facelift on a Friday.  Monday she stroked out.I determined there was no malpractice since the patient was adequately informed of the risk, demanded the procedure, and signed waivers.But as a young surgeon, I learned a valuable lesson.  It is my responsibility as the treating physician to protect patients from their own ignorance.  Patients may wish to gamble, but I have an ethical (though not legal) obligation not to take the bet.Cosmetic surgery is not worth a big gamble with your health.

Vaishali B. Doolabh, MD, FACS · Answer

Hi.  As you know, blood thinners increases your risk of blood collecting below the skin (hematoma)--requires removal and can compromise the final result.  If your prescribing cardiologist can not alter your regimen, you may wish to consider other less or noninvasive options for rejuvenation--such as chemical peels, topical retin A use, and some times of resurfacing (laser, Renuvion technology).  Good luck, Dr. Doolabh

Michael I. Echavez, MD · Answer

A facelift or lower eyelid surgery could not be done while taking anticoagulants.  You could speak with your cardiologist to see if it is possible for you to go off of your anticoagulants for a period of time surrounding any possible cosmetic surgery.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Unfortunately, you would not be a good candidate for a facelift because of your need for anticoagulation.  The appropriate function of your heart overshadows the desire and or perceived benefit of a facelift.

Elbert T. Cheng, MD · Answer

Hello and thank you for your question. No elective surgery is worth risking your health. Therefore, your cardiologist must clear you for your prospective facelift surgery before you can have this procedure.  He or she must approve discontinuation of your anticoagulants for a period of time before and after a facelift procedure. This decision must be made by your cardiologist and not by the board-certified facial plastic surgeon who would be performing your surgery, as these are different specialties. Once you get a letter of approval, you can then schedule a consultation with your board-certified facial plastic surgeon and proceed. Good luck! - Elbert T. Cheng, MD

Nicholas S. Karter, MD · Answer

It is definitely very risky to perform a facelift on a patient who is anticoagulated and most surgeons would not even consider it. The good news is that anticoagulation taken for atrial fibrillation can often be held for small periods of time with very little risk, however this decision has to be made by your cardiologist. Your cardiologist will know your specific history and your specific risk and determine if it is safe to hold your anticoagulation. As nice as it is to be able to able to get a facelift, it is not worth putting your life or health in serious risk. Hope this helped, good luck!!

Jonathan Zelken, MD · Answer

Hi Kimmy,
This is a great question and one I've battled for some time. Why? You are taking blood thinners to save your life. Facial anti-aging services are elective. Doesn't it seem ill-advised to compromise your health by holding the blood thinners for the sake of moving forward with surgery? 
I think so. Even if a cardiologist clears my patient, I am uncomfortable asking her to stop blood thinners for the sake of moving forward with surgery. However, I do appreciate the psychic importance of feeling young and looking your best. 
In this special group of patients, I tend to continue blood thinners but modify my surgical plan, accordingly. For example, I may offer a direct necklift (with meticulous control of bleeding) where the extra skin is cut out directly rather than tunneled, a direct browlift, where skin above the eyebrow is trimmed, and pinch-blepharoplasties. These alternatives achieve respectable results in anticoagulated patients without the unneccessary risk of stopping potentially life-saving anticoagulants.
I hope this helps! I know my view on this topic may be unique, but I am a physician first, and a plastic surgeon second.

Farhad Ardesh, MD · Answer

You will need to discuss this with your surgeon as well as your  cardiologist. The cardiologist may feel that it is safe for you to stop the  atrial fibrillation medications or change the medications for a short period of time around your surgery. This risk is something for them to determine. If they are not able to change your medications then you are at increased risk of bleeding with the procedure. Your Surgeon will then have to determine if it can be perform safely. I hope this helps and wish you the best, Dr. Ardeshirpour

I have to take anticoagulants. Can I still have a facelift?

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