Deep Venous Thrombosis and Pulmonary Embolus after Face Lift: A Study of Incidence and Prophylaxis

Abstract

Deep venous thrombosis and pulmonary embolus are known risks of surgery. However, the incidence of these conditions in face lift is unknown. In this study, the incidence of deep venous thrombosis/pulmonary embolus after face lift is studied and factors associated with thromboembolic complications are evaluated. One-third of the active members of the American Society for Aesthetic Plastic Surgery were randomly selected. Participating surgeons completed a one-page survey providing information on face-lift procedures during a 12-month study period. A response rate of 80 percent was achieved, with 273 of the 342 surgeons responding to the survey. A total of 9937 face-lift procedures were reported in the 1-year study period. There were 35 patients with deep venous thrombosis (0.35 percent), 14 patients with pulmonary embolus (0.14 percent), and 1 patient death in the series. Although 43.5 percent of patients underwent face lift under general anesthesia, 83.7 percent of deep venous thrombosis/pulmonary embolus events occurred with general anesthesia. For prophylaxis for deep venous thrombosis/pulmonary embolus, 19.7 percent of the surgeons used intermittent compression devices, 19.6 percent used thromboembolic disease hose or Ace wraps, and 60.7 percent used no prophylaxis. Of patients developing deep venous thrombosis/pulmonary embolus, 4.1 percent were treated prophylactically with intermittent compression devices, 36.7 percent with thromboembolic disease hose/Ace wraps, and 59.2 percent with no prophylaxis. It was found that deep venous thrombosis/pulmonary embolus after face lift is a measurable complication experienced by one of nine surgeons surveyed. Deep venous thrombosis/pulmonary embolus is more likely to occur when the procedure is performed under general anesthesia. The majority of plastic surgeons surveyed used no prophylaxis for deep venous thrombosis when performing face-lift procedures. Intermittent compression devices were associated with significantly fewer thromboembolic complications, whereas Ace wrap/thromboembolic disease hose afforded no protection against deep venous thrombosis/pulmonary embolus when used alone. In conclusion, aesthetic surgeons should consider adopting intermittent compression devices when performing face lift under general anesthesia.

Analysis of Outpatient Surgery Center Safety Using an Internet-Based Quality Improvement and Peer Review Program

“…7). This represents 0.01 percent of procedures performed, consistent with the report by Reinish et al 13 As with the study by Morello et al, the Reinish group's study was conducted through a voluntary survey. The correlation of statistics with the mandatory AAAASF quality improvement and peer review Internet-based reporting system is significant.…”

“…14 Fatal pulmonary emboli occur in 0.1 to 0.8 percent of general surgery patients, 2 to 3 percent of patients undergoing elective hip replacement, and 4 to 7 percent of patients undergoing operative reduction of hip fracture. 14 In a study of patients undergoing face lift surgery, Reinisch et al 13 reported an incidence of thrombosis of 0.1 percent based on a survey of selected surgeons from the American Society of Plastic and Reconstructive Surgeons. In that study, 37 of 9493 face lift patients developed deep vein thrombosis (0.39 percent) and 15 patients developed pulmonary embolism (0.16 percent).…”

Mechanical mechanisms of thrombosis in intact bent microvessels of rat mesentery

“…When the micro-thrombi are brought by the blood flow to a major vein, deep vein thrombi would form and may induce death if they completely occlude the major pulmonary circulation (Grabowski, 1995;Hume et al, 1970). Another case is that deep venous thrombosis and pulmonary embolus happened in 1 of 200 cases after face-lift plastic surgery (Reinisch et al, 2001;Most et al, 2005). This may be also due to the bending and stretching in the microvessels during the operation.…”

Prevention of Venous Thromboembolism in the Plastic Surgery Patient

“…This same study demonstrated that 83.7 percent of the face lift patients who developed venous thromboembolism had received general anesthesia, whereas only 16.3 percent of the venous thromboembolism cases occurred with local anesthesia and sedation. 5 Grazer and Goldwyn 6 reported a deep venous thrombosis incidence of 1.1 percent and pulmonary embolism incidence of 0.8 percent in abdominoplasty patients. Applying these percentages to the 2001 national plastic surgery statistics for abdominoplasty indicates 644 cases of deep venous thrombosis and 468 cases of pulmonary embolism for that year.…”