Lower eye bleph wanted, but was dismissed b/c on Warfin for clotting disorder: Am I inoperable? Aged 52. (photo)

As you know, warfarin impedes blood clotting, which can cause prolonged bleeding after surgery. Bleeding after a blepharoplasty can result in blindness, so the pay off is not good to risk it without precautions.The best advice is to talk to your hematologist and see if you can stop the warfarin around the time of surgery. If so, your hematologist will have to be intimately involved in your postoperative care.Before seeking a consult with a new plastic surgeon, have a meeting with your hematologist to see if you can proceed with surgery.Looking at your photos, you are a candidate for excision of the excess fat in the lower lids. If an external approach is used, you might want to consider using local anesthesia and sedation to avoid an increased risk of a pulmonary embolism with general anesthesia.Good Luck.

while it is more risky to have surgery while on Lovenox it is not a total contraindication. Your surgeon will have to be meticulous in obtaining bleeding control and hopefully opt for a less invasive approach. All are doable in experiences hands.Best

Its not a good idea to undergo elective cosmetic surgery  when on blood thinners because of the  severe bleeding complications that can occur with that type of surgery.  It is important to be off of blood thinners for a few weeks before and after the surgery itself.  If you have already had a pulmonary embolism in the past, you are significantly at risk for another one  if you off your blood thinners.

I have undertaken eyelid surgery on a number of patients who used a Lovenox (low molecular weight heparin) bridge. I believe you intended to write Lovenox where you wrote levothyroxine. Levothyroxine is thyroid hormone. As long as you understand and accept the small but always existent and modestly increased risk for bleeding behind the eye that can cause blindness, I think its reasonable to proceed.

I would certainly hesitate to say that you are "inoperable".  Obviously you are in a slightly more complicated position when dealing with elective cosmetic surgery than others; however, with a bit more information it may be safe to proceed with your surgery.  I can understand that a surgeon would refuse to perform an elective cosmetic blepharoplasty on a patient taking coumadin, I would as well.  Bleeding around the eyes after this surgery can result in the catastrophic complication of blindness.  You may have answered this already, but can you stop taking the coumadin for a few days before and after surgery?  You mentioned levothyroxine -- I think you meant to say that you bridge your surgeries with lovenox?  If you can stop the anticoagulants for a short window and have the surgery, then most surgeons would probably feel comfortable performing your procedure.  I would want to discuss your case with your hematologist.  If he or she can come up with a safe yet reduced blood thinner protocol for the perioperative period then surgery may be feasible.  I would require you to have the procedure done in a hospital or surgery center under anesthesia where I could spend the extra time needed to ensure hemostasis (stopping the bleeding), control your blood pressure, and have you monitored by nurses for a few hours after surgery.