Can I have a facelift if I'm on blood thinners (Xarelto)?

Question

I'm on a therapeutic dose of Xarelto. Is it possible to have a face lift?

Gianfranco Frojo, MD · Answer

I believe that being on anticoagulation is a direct contraindication for facelift/necklift surgery. The biggest problem that could happen is significant bleeding (hematoma) that could cause airway compression, skin necrosis, significant blood loss requiring fluids/transfusion/iron supplementation, and even possibly death. There are some select patients that can be operated on with the help of a hematologist/oncologist to ensure that the blood thinner can be held for surgery and properly resumed when deemed an adequate time frame (by both the plastic surgeon and heme/onc MD). In general, I would recommend avoiding any unnecessary risk, but as long as everyone is aware of the potential risks/complications/complications, it is a possibility.

Semih Yildiz, MD, FEPOBRAS · Answer

Therapeutic Xarelto is a major planning issue for a facelift because facelift surgery is particularly sensitive to bleeding and hematoma. It does not automatically make surgery impossible, but the decision should be made with your prescribing doctor or cardiologist, the surgeon, and the anesthesia team together.

The key questions are why you take Xarelto, your clotting risk if it is held, kidney function, and whether it can be stopped for a safe interval before and after surgery. Do not stop or adjust it on your own. If Xarelto cannot be interrupted safely, most surgeons would recommend postponing or avoiding an elective facelift. If medical clearance is obtained and there is a clear perioperative plan, surgery may be possible in an accredited setting with careful blood pressure and bleeding control.

Gary Motykie, MD · Answer

Being on blood thinners does increase the risk of bleeding complications, particularly a hematoma, after a facelift.

If you’re taking something like Xarelto, it’s important to coordinate with the prescribing physician to see if it can be safely paused around the time of surgery. Temporarily holding the medication can significantly reduce your risk, and in many cases, it can be restarted shortly after the procedure.

Stephen Prendiville, MD · Answer

Thank your for your question.  You cannot be taking Xarelto at the time of your facelift and would require medical clearance to stop this medication for 3-5 days prior and after the procedure.  This is not an uncommon question and the decision making algorithm will depend on the Physician who prescribed this medication.

Todd Christopher Hobgood, MD · Answer

It's not so much that facelift surgery would be impossible on blood thinners, so much as it would be much riskier if your medication plan cannot be adjusted. The main concern with taking blood thinners is that it makes it more difficult to control bleeding during surgery and puts you at a significantly higher risk of developing hematomas (pools of blood under the skin) during your recovery.

In some cases, patients can coordinate with their prescribing physician and surgeon to temporarily adjust or pause anticoagulation, but this has to be done very carefully and only if it’s safe for your underlying medical condition.

I encourage you to talk to your doctor first to see if you are medically a good candidate for elective surgery and whether you can develop a safe perioperative plan for your medication.

Bianca Knoll, MD · Answer

Xarelto is an especially potent blood thinner affecting the extrinsic and intrinsic clotting system. During surgery  severe bleeding would occur. Some patients are on Xarelto temporary for a "minor" medical problem. In that case, please wait until your treatment is finished. However, the medical reason you were prescribed Xarelto might be a risk factor in itself undergoing an aesthetic surgery, like a facelift in your case. Don't take this topic lightly, and discuss it with your different medical providers.

Warren Schutte, MD · Answer

You do need to be off of blood thinners to have safe surgery. Many surgeons will work with your Dr. who is prescribing the blood thinners to develop a plan. Sometimes, physicians are ok with you being off of them for a period of time, or they may switch you to a different blood thinner that gets out of your system quicker.

Jeffrey M. Darrow, MD · Answer

Having a facelift while you are on blood thinners certainly increases your risk of having a hematoma in your face after your surgery. You should check with the physician who put you on Xarelto and find out whether you could pause the medication for a short period of time around the time of your surgery so that your surgery is safer, it decreases your risk of having a hematoma, and you can resume it relatively shortly afterward.

Ronald J. Edelson, MD · Answer

You would need to discontinue your blood thinners for a period of time before and after surgery, typically you would need to get the okay from your primary care doctor or whoever put you on it begin with.

Zoran Potparic, MD · Answer

Yes, blood thinners should be stopped few days before surgery per your cardiologist or PCP recommendation and continues after surgery. Good luck.

Can I have a facelift if I'm on blood thinners (Xarelto)?

Answers (12)

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