Risks of Facelift for Patient with Protein S Deficiency?

Question

I am wanting a Facelift surgery but I have a slight protein S deficiency, making me slightly higher risk for blood clots.I am 42 yrs old. My hematologist says I can have surgery and hold aspirin prior to, but should have DVT (Deep Vein Thrombosis) therapy afterwards by walking, wearing compression hose for 1 week after.I do not have any medical conditions, other than this irregular blood result, which is only milder borderline. Do you think it would be a problem for me to have surgery. I hope it won't concern the plastic surgeon.  I am otherwise extremely healthy and thin.

Larry S. Nichter, MD, MS, FACS · Answer

Protein S deficiency certainly makes you more prone to clotting problems such as deep venous thrombosis (clot in leg vein) and aspirin can case other problems like excessive brusing and bleeding. Your hematologist knows best, and most plastic surgeons have had experience with this and similar clotting prone patients.My specific recommendation is to use TED stockings worn as soon as you stop aspirin and until you are back on it and walking normal amounts, and having the procedure under oral sedation or IV sedation (twilight sleep) and local anesthesia rather than general anesthesia. If general anesthesia is still selected then use of pneumatic stockings is recommended.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Protein S (named after the city  Seattle) defiency is associated with thrombosis.  As long as you have been cleared by your hematologists should  to comfortable proceeding with facelift surgery.  it will  be important for your plastic surgeon to follow the guidelines suggested by the hematologist.

	Best wishes.

William Portuese, MD · Answer

A preoperative letter of clearance from your hematologist would be prudent to have prior to pursuing elective surgery. As you know aspirin products need to discontinue for two weeks before and at least two weeks after a facelift surgery. It is important to have sequential compression devices on your legs during the surgery and compression hose for at least a week after the surgery and stay active by ambulation during your postoperative recuperative phase. There probably is a small risk for a development of blood clot during this period and that is something you will have to weigh in your decision to undergo elective cosmetic surgery.

Christopher L. Hess, MD · Answer

Ten years ago a patient like yourself would have undergone a facelift and may or may not have developed a hematoma or other bleeding complications after surgery.  Fortunately,  minor bleeding conditions such as Protein S and Protein C deficiencies have been discovered.  
I don't have a problem operating on patients with these conditions as long as they stay over night at the hospital and I'm given instructions by the endocrinologist.  Extra care is taken to make sure there are no bleeders.  In addition I use Clonidine to slightly decrease the blood pressure, again to prevent bleeding.
All in all surgery can be performed if the surgeon if vigilant and careful and the patent's health if fully optimized.

Darryl J. Blinski, MD · Answer

Yes! It will concern your plastic surgeon. Blood clots can cause a pulmonary embolus leading to death, you know the big "D" word. BAD, very BAD. Discuss this issue in detail with the operating surgeon prior to getting the operation. Your safety is the most paramount issue here. Regards.

Risks of Facelift for Patient with Protein S Deficiency?

Answers (6)