Can I still have an SMAS facelift with well controlled HBP that unfortunately spikes greatly due to GAD?

Question

My BP spikes to around 138/98 or sometimes even higher . I have generalized anxiety disorder and [white coat synd.] In the plastic surgeons office it was 159/106, but after I left I went to have it taken and it was 117/ 72. My surgery is to be done under general anesthesia. It will be a smas facelift/neck lift so around 3 to 4 hours. I am worried about increased risk of hematoma due to my anxiety . What is the best way to combat anxiety ridden BP so that I can still have surgery?

Paul Lanfranchi, DO, FAOCOO · Answer

Thank you for sharing your thoughts and concerns.  Certainly having controlled BP both during and after the procedure is important in helping prevent hematomas and unnecessary swelling.  It is usual to have one's BP increase slightly after a lift simply from the mild/moderate discomfort that occurs normally.  Thus good pain control afterwards would be part of the solution.  Assuming there were no factors that contraindicated their use, for my patients I would prescribe 2-3 days of a mild sedative (ie xanax) to keep them relaxed and not anxious.  However, we perform our procedures under local anesthesia, and thus is it reasonable to prescribe these sedatives afterwards (since we don't need to worry about the after-effects of General Anesthesia).  Having the procedure under general anesthesia may require you to have a discussion with both your PS and anesthesiologist to see if this is indeed an option.

Alejandro J. Quiroz, MD · Answer

Thank you for your question. The most valuable peace of information I can give you is to have a complete physical by your internist and also normally prescribe a tranquilizer the day before surgery and give medication as soon as the patient arrived to the office of course a Board Certified anesthesiologist in keep you overnight for observation

Zoran Potparic, MD · Answer

We routinely give our patients 1 mg of Ativane night before surgery for good sleep and anxiety. Sometimes Xanax is given few days, possibly a week before surgery to help with anxiety. For HBP female patients are given 0.1 mg of Clonidine to take 2 h before surgery it their BP is over 130. When in preoperative area patients are reevaluated and additional BP and anxiety meds are given as needed. Twilight anesthesia may be a better option than general for face/neck lift in patient with elevated BP. Good luck.

William Portuese, MD · Answer

It is probably a good idea to check in with your primary care physician  to make sure your high blood pressure is under control, especially leading up to the surgery. Management of your medications would be a priority, to prevent a hematoma.  If you have significant anxiety, might be best to seek out professional help by a psychiatrist before the surgery. In addition, make sure you tell your operative surgeon about your all your issues to minimize complications and risks

Gaby D. Doumit, MD · Answer

Thank you for sharing your concerns
It is best to have your blood pressure controlled prior to surgery with anti hypertensive medication. 
your anesthesiologist will make sure that it is well controlled during surgery,
It is also essential to control it after surgery
Sincerely
Gaby Doumit MD

P. Craig Hobar, MD(retired) · Answer

One of the biggest risks after facial surgery is a hematoma, or blood collection under the skin. This risk is increased if the patient already has a history of high blood pressure. We want this to be adequately controlled prior to surgery in order to create the safest environment in the OR and during the recovery period. I require a medical clearance from your primary care physician and typically a record of your daily blood pressure several weeks prior to surgery. Your physician may up the dose of your medication around the time of surgery as well as suggest a short course of anti-anxiety medication. You are absolutely correct in trying to address this early, many patients with high blood pressure have successful outcomes as long as protocols are followed closely and pressure is controlled.

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.  Non smiling photos of your face from the front and side would help in the evaluation. You are correct to be concerned, especially if your BP is prone to that level of fluctuation....the situation doesn't matter, if the BP goes up that high after surgery your risk of hematoma would go up exponentially.  You should see your GP and get the pressure under better control and manage your GAD.  You may also consider a minimally, invasive SMAS facelift that has limited dissection and as such far less risk of hematoma.
 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
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. 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.  Conversely, men look chiseled and handsome with angularity created in the cheeks, chin and mandibular angles.
 If the chin is weak, this 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.
Hope this helps.

Can I still have an SMAS facelift with well controlled HBP that unfortunately spikes greatly due to GAD?

Answers (7)

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