Why stop taking phentermine before a lower face lift procedure?

Question

i was reading lower face lift preparations on this web site and i understand that your weight before a lower face lift procedure should remain consistent. On reply from a doctor on this forum said to stop taking phentermine? he didn't state why?

Stephen Prendiville, MD · Answer

Thank you for asking a great question. The answer is twofold because phentermine is a stimulant that can raise blood pressure. However, the most important reason is that use of such medications can lead to a depletion of catecholamine reserves, which would would blunt your body's ability to respond to a drop in blood pressure.  Although such situations are rare, they can be catastrophic and discontinuation of the medication for at least 4 weeks is recommended prior to anesthesia.  It is critical to know that phentermine is not a benign medication, and its real benefit for patients is in the first 6-12 weeks due to a mechanism known as tachyphylaxis.  A definite must in terms of disclosure to your Surgeon.

Richard Balikian, MD · Answer

Because phentermine raises blood pressure, there may be more bleeding during the facelift procedure. Not only will this slow down the surgery and lead to more anesthesia than is needed, but will also increase swelling and delaying a rapid healing process. Increased risks of hematoma (a blood collection) are also a potential problem with taking phentermine around the time of surgery.

Brian K. Machida, MD, FACS · Answer

Phentermine as a side effect can raise the blood pressure.  Increased blood pressure can lead to an increased risk of bleeding.  So its best to optimize the surgical outcome by decreasing the risk of bleeding.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Phentermine, like other weight suppressants, can have adverse interactions with anesthetic agents.  A quick internet search can provide further details.  
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.

Michael Elam, MD (retired) · Answer

Dear Vera, You should stop taking phentermine prior to facelift surgery as it can interfere with the anesthesia. One of many side effects of Phentermine is that it elevates your blood pressure which increases the risk of bleeding. You should not be using phentermine as a way to keep your weight consistent. This should be done with a healthy diet and exercise program. Speak with your consulting surgeons so that they can discuss your options prior to surgery. See examples of before and afters in the link and video below. Best regards, Michael V. Elam, M.D.

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