How do surgeons manage immuno-compromised patients? 70 y/o concerned about risks while taking immune suppressing medication.

Question

I am 70 y.o woman looking to have a full facelift, eyelid surgery and rhinoplasty. I am concerned about the inherent risks as I am on methotrexate (an immune suppressing drug ). I understand that bleeding and delayed poor wound healing are some of the problems that can arise post surgery. May I ask the Doctors how these problems are managed and if there have been any patients who's results were seriously compromised by the condition? Is surgery best avoided altogether?

George Bitar, MD · Answer

Taking methotrexate does not necessarily make it impossible to have surgery.  You are correct that methotrexate can possibly increase the risks of surgery, specifically wound healing and infection.  It would have to be a discussion between you, your surgeon, and the doctor managing your methotrexate.  The things to consider are: (1) whether the methotrexate can be stopped for short period or reduced or (2) splitting up the surgeries, so you are not left with multiple wounds if the healing is delayed.  I would recommend consulting with your doctor and surgeon to discuss our concerns and how to best manage your medication.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question regarding managing immunocompromised patients.

I would recommend that you see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.

In my practice, patients meeting certain requirements are required to undergo pre admissions testing and may require a surgery clearance letter from the physician managing his/her care.

Hope this helps!

Ronald J. Edelson, MD · Answer

Methotrexate is not necessarily a deal breaker for your facelift. Ask your surgeon to look into it and discuss with your other doctor. It should be possible to have done.

Nancy de Kleer, MD, FRCSC (Plast) · Answer

As you mention, methotrexate can cause problems after surgery.  This does not mean a person who takes methotrexate cannot have surgery.

What is important is that you are fully assessed and receive recommendations from the physician who prescribes the medication, as well as from your surgeon, before deciding to proceed.  The underlying reason you are on the medication needs to be evaluated, as this itself may cause risks, and whatever disease condition it is needs to be optimized.

I have safely operated on many patients on methotrexate.   A consultation with a surgeon is the best place for you to start, so that your full health history can be reviewed, and specific recommendations be made.

All the best to you,
Dr. Nancy de Kleer

How do surgeons manage immuno-compromised patients? 70 y/o concerned about risks while taking immune suppressing medication.

Answers (4)

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