What Types of Medication Are Routinely Given for Swelling and Pain After a Brow Lift and Full Eye,face and Neck Lift?

  NSAIDS may not be a great idea around the time of a facelift due to the increased bleeding risk.   Kenneth Hughes, MD Los Angeles, CA

In my practice in New York, I don’t routinely give my patients anti-inflammatory medications after browlift, eyelid surgery or facelifts. Occasionally I do give a medication like Decadron during surgery. As far as your question about HRT and bioidentical hormones is concerned, I don’t ask my patients to stop these medications. Your surgeon may have specific preferences based on the surgical technique and the type of anesthesia you will be having.

I usually keep most people with this combination overnight with a pain pump IV. I then switch them to a nonnarcotic, non-NSAID containing oral medication. This usually is all they need. As far as NSAID’s are concerned, because they increase the risk of bleeding and blood collections under the skin, I get all my patients to stop them at least two weeks before surgery and like them not to start back for a week. I also like all my patients to stop all hormones for at a month before and after surgery to reduce the risk of blood clots in the legs which can break off and go to the lungs (a possibly deadly complication). We use various medications and techniques during surgery to reduce swelling, but do not use any postoperative meds to do so. I also leave a drain for about 24 hours, as it seems to markedly reduce swelling.

After facial cosmetic surgery it is important to rest, elevate the head, and use ice compresses for the first few days to reduce swelling and bruising.  NSAIDs are off limits, as these can result in excess bruising and/or bleeding.  Pain is not usually a significant issue with facelifts or browlifts, however, I prescribe Nucynta for my patients. This is a newer narcotic with reduced incidence of side effects such as nausea.  I also prescribe Zofran for my patients, as this medication also reduces any risk of nausea and vomiting, which could result in excess bruising and swelling. 

Occasionally, a surgeon may have the anesthetist administer an intravenous dose of steroid during a facelift procedure which can help reduce postoperative swelling and edema.  It also may be helpful to increase postoperative intake of foods containing bromelain (pineapple, papaya,etc.), once the patient is able to resume a normal diet.  

Hormone Replacement Therapy usually does not need to be discontinued prior to or following surgery. It is a good idea to have a general checkup prior to surgery to assure that problems with blood pressure or bleeding issues do not result in excess bruising or swelling as well.

NSAID's should be avoided as they can cause bleeding and excessive bruising, not to mention other common problems such as gastritis, etc. Most of my patients only require pain meds for a few days - typically a narcotic/acetominophen combination and/or Celebrex (the only NSAID that doen't usually cause the problems mentioned above. I also recommend Arnica Montanum and Bromelain, and Clonidine patch (the last two also decreases pain and nausea to a degree).

Re: HRT-

After going through the informed consent process (see below), my experience is that most of my patients continue to take Hormone Replacement Therapy (HRT) during their surgery . I do recommend that high risk patients (see below) stop HRT prior to surgery.  Knowing your risk vs benefit information is the key to making the right decision.  Like all medical decisions an informed consent is needed with your surgeon and/or other physicians most knowledgeable about Hormone Replacement Therapy and long surgical procedures (e.g. hematologist or gynecologist with special interest in HRT). Ask them to provide you with data from studies to support their recommendations.
Here is some helpful information for you and others out there with similar concerns. First of all what is HRT.  HRT is a generic term  encompassing either  unopposed estrogen therapy, or a combinations of estrogen and progesterone. Unopposed estrogen is generally used in women after a hysterectomy. Cyclical use of progesterone has the  disadvantage for non-hysterectomy women of cyclical withdrawal bleeding. This can be avoided by continuous use of the drug. HRT may be taken as a transderm patch, orally, or as a subcutaneous implant. Each different type of therapy and dosage has a different risk profile.

Estrogen and Progesterone used for HRT are chemically different from  those used in the oral contraceptive pill (OCP), and are of significantly lower potency.  The doses used in HRT are most  often at the lower end of the normal pre‐menopausal range whereas the OCP  is designed to suppress the natural ovulatory cycle.
Several large studies have consistently demonstrated an increased risk of venous thromboembolism occurence (g.g. Deep Venous Thromosis (DVT) and/or Pulmonary Embolus (PE)) in women using HRT. However, HRT risk appears to be restricted to the first year of HRT use, and is estimated at 2–3 times that of non‐HRT users. It is important to appreciate that although a 2‐ to 3‐fold increase in risk appears high,and yes, a PE could prove to be a fatal complication; but in reality, it has been estimated that this only represents one or two additional cases of venous thromboembolism per 10, 000 women per year. In addition, studies differ in their conclusions about the relative importance of the different HRT regimens in current use. Further, it is a general maxim that the longer the surgery (especially after 2 hrs) the greater the risk with or without HRT. IF these statistics seem like undue risk then you should either stop HRT prior to surgery or seek council from an expert.
Here is what I recommend to my patients based on my understanding of the literature:  I suggest that my patients seek the council of their prescribing doctor and if they feel more comfortable a hematologist for patients taking HRT. My practice is that I recommend that  patients I consider at high risk to  stop HRT if possible a month prior to surgery. High risk include but are not limited to  the following reasons:  if started within a year of the proposed surgery, or if they have co-morbid conditions making them  hypercoaguable such as in all smokers, obesity,  past medical history of blood clots (especially DVT, or PE), genetic tendency for hypecoagulation,   vericose veins, COPD, heart disease, sedentary life style or if their is chronic lower extremity edema. Perhaps most important is that I use DVT preventative measures such as intermittent calf/foot compression devices for all of my patients with IV sedation or under general anesthesia, and antiembolism stockings, "TED's" for all of my patients and have them worn for at least 10 days or until they are walking normal daily amounts.

Bottom Line -Make your decision wisely based on available information and the advise of your experts.

In general, after the first day there is usually very little pain with facelift or brow lift. Often Extra strenght Tylenol is sufficient but Vicoden is OK. Steroids either, by injection once at time of surgery or orally for few days may help swelling.

I cannot speak for other surgeons but I prescribe Medrol Dose Pak for swelling and Vicodin or Percoset for pain.Bioidentical hormones can be taken at surgery and post-op.

Face lifts should cause little pain. I prescribe small amounts of relaxants and pain killers. Most of my patients need little or no medication after 48 hours.

Here's what you need to know about swelling, HRT, NSAIDs and face lifts.

• NSAIDs can cause swelling, bloating, bleeding and ulcers.
• Swelling after surgery is temporary and part of normal healing.
• Swelling is less if you keep your head up and the surgery area cool. 
• NSAID or even steroid help severe swelling but it may return when meds are stopped.
• HRT risk varies - if your surgery is 4 hours or less and you have no other risk factors, e.g. smoking, they are probably ok . I ask my patients to stop all HRT for 2 weeks before/after surgery if they can. Hope this helps!

Everyone responds differently to medications. We customize a treatment plan for each patient dependent on their needs. There are very few choices these days at pain relievers that do not cause nausea, etc. We will use NSAIDs only for severe swelling, which is usually not the case with these procedures. There is always an associated risk with these medications for causing stomach problems such as bleeding.

  Wow, I'd bet the answers will vary significantly based upon the particular patient.  Typically for a Brow Lift we'd prescribe something for sleep, anxiety, pain medication of varying strengths based upon the patient history of previous pain medications and antibiotics.  For bruisiing and swelling, we recommend Arnica 12 C post-op.  Hope this helps.