What do you do when you've been instructed to use aspirin or other prescription blood thinners for medical reasons (for instance, to prevent clots, strokes, or heart attacks) but learn that such medications are off-limits before and after blepharoplasty and your general physician advises against discontinuation for even a period of two or three weeks?
The results of a recent study in JAMA Facial Plastic Surgery on over 600 patients suggests that aspirin and other anticoagulants may be continued immediately before and after facial plastic surgery without increasing the risk of serious complications. Its authors have suggested that such findings may lead to a "change in clinical practice" instructions now used almost universally by plastic surgeons before surgery.
The authors studied complication rates in two matched groups of patients undergoing facial plastic surgery: one group used anti-platelet and/or anticoagulation therapy (aspirin, Coumadin, and/or clopidogrel) and a second matched control group refrained from using any such drugs in the peri-operative period.
Complication rates and severity after surgery in the two groups were nearly identical with aspirin/no aspirin use and only slightly increased with Coumadin. The findings were consistent with other studies that have shown no increase in serious complication rates in patients who undergo various "cutaneous surgical procedures" while using the most common blood thinners.
So, what should you do when your surgeon or your general doctor refuses to alter standard routines before a proposed blepharoplasty you so badly desire? First and foremost, remember this: Do only what your own doctors tell you to do, not what you may read here or in some third-party medical article.
That said, here are a few comments more pertinent to blepharoplasty specifically rather than "facial plastic surgery" in general:
• The eyelids are richly supplied with a wide network of blood vessels in the skin and muscle layers and deeper. When those vessels do bleed unexpectedly, they can bleed very fast. Oozing skin bleeding is one thing, while a severed small artery deep to the incision is quite another.
• If your orbital septum (the layer just beneath the muscle) is opened to remove fat, any brisk bleeding can quickly make its way into the deeper orbit surrounding the eye and optic nerve.
• Removing a suspicious mole from the cheek is very different from performing a blepharoplasty, where anything more than slight bleeding can increase the chances of infection, scarring, wound separation, delayed recovery, and, in the extreme, vision loss.
• One advantage of laser-assisted blepharoplasty is that laser energy can instantly seal most superficial blood vessels as it cuts. While not infallible, it may offer some advantage over standard stainless steel incisions and instruments.
• If your general medical condition is so fragile that your main doctor says no to stopping a blood thinner, you really should think twice before undergoing cosmetic surgery that is entirely elective. If, on the other hand, you have a real eyelid problem such as skin cancer, ptosis, or ectropion, your doctors may decide to continue with blood thinners before and after surgery, aware that the chances of serious complications are not as high as previously thought.
• For everyone else with no compelling medical reason to be using aspirin, ibuprofen, or other known blood thinners, it remains easy and prudent to stop for a few weeks before surgery and not resume again until a few days into recovery. Simply cutting down on your aspirin dose or skipping it every other day makes no difference in its effect on blood coagulation.