Immunocompromised patients - potential risks with endoscopic brow lift, eyelid surgery and deep plane facelift?

Question

I am 70 y.o. and on methotrexate (an immunosuppressant drug) to manage my psoriasis and arthritis. I understand that bleeding, wound healing and infection are the potential risks I face if I undergo surgery. As I am considering an endoscopic browlift, eyelid surgery and a deep plane facelift, I would like to know if complications are inevitable and if the results could be compromised as a consequence. Is it best to avoid the surgery altogether?

Ronald J. Edelson, MD · Answer

I have performed surgery on patients in methotrexate without any problems. However you may wish to ask your doctor when is the best time for surgery relative to your methotrexate

Lucian Ion, FRCS · Answer

Thank you for your question. New paragraph. I would like to qualify the answer and break it down into several elements.

In principle, an intervention that involves endoscopic brow lift, deep plane facelift, eyelid surgery is relatively long, and in itself it could be a consideration. For you, I would recommend separating this into two interventions.

The endoscopic brow lift and deep plane facelift go together very well, and to some degree the deep plane facelift would allow you to have also changes in the contour of the lower eyelid.

Methotrexate has not been shown to have severe impact on healing from surgery, and therefore would not write it off altogether.

I would actually say that if you want to have the eyelid surgery, it would be preferable to do this separately, potentially under local aesthetic or local aesthetic and intravenous sedation.

The general anaesthetic intervention would be associated with an increased risk of deep vein thrombosis, which in the presence of psoriasis is potentially higher. Facelift and endoscopic brow lift can also be carried out under local anaesthetic and deep sedation This may be the better solution for you.

Stephen Prendiville, MD · Answer

Although you should discuss these issue with both the prescribing Physician and your Surgeon, the actual risk of infection during properly performed facial rejuvenation procedures is very low.  Many Surgeons prescribe antibiotics during and after surgery as a preventative measure, but there's no data to show that they are beneficial.  In SW Florida, I perform many procedures on patients 70 plus and on Methotrexate without any significant difference in complication rates. There is always risk when having procedures performed, but the risk in aesthetic procedures by responsible Surgeons in accredited facilities is small. The concerns that lead to you to consider having facial rejuvenation will not go away spontaneously, a factor that you should consider in your decision making process.

Berat Cigdem, MD - Account Suspended · Answer

Surgery in your case is high-risk due to your immunosuppressant medication. There’s a higher chance of infection, poor healing, and complications. I strongly recommend consulting a plastic surgeon in Ireland and having surgery in a fully equipped hospital where your condition can be properly managed. Surgery abroad is not a safe option for you.

Immunocompromised patients - potential risks with endoscopic brow lift, eyelid surgery and deep plane facelift?

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