An influencer died following plastic surgery. What you need to know about blood clots

There was a recent influencer death after plastic surgery.

I read this headline in US Magazine. This is tragic. I do not know the details, but it inspired me to write another blog. (To read their article, click HERE)

What is a blood clot?

When you hear about blood clots in surgery, we are not talking about normal clotting needed to stop bleeding. In fact, we plastic surgeons make you stop blood thinners before surgery to reduce bleeding risk. But when is a blood clot bad? dangerous?

What we worry about is a DVT or PE.  DVT = Deep Vein Thrombosis.  PE = Pulmonary Embolus. This is when the deep veins form a blood clot. We don’t actually care about a clot in your leg- it may cause pain or swelling, or it may be silent. What we care about is when that clot dislodges it can go up and land in your lung. That is a pulmonary embolus. If the blood vessels in your lung are blocked, air exchange cannot occur. If you can’t get rid of carbon dioxide and get new oxygen, if that embolus is big enough, you can die.

If you hear of someone dropping dead, particularly about a week after surgery or in a young healthy person, this is the number one concern.

Who is at increased risk?

There are many reasons for blood clots to occur.

• Genetics. Do blood clots run in your family? Are you a carrier for Factor V Leiden? Prothrombin ? Elevated serum homocysteine? Positive lupus anticoagulant? Elevated anticardiolipin antibody?
• BMI. Higher BMI has higher risk
• Longer surgery. It is broken into less than 1 hour, 1-3 hours, or longer than 3 hours.
• Hormone use. On birth control? IUD with progesterone? Hormone replacement?
• Age. Your risk goes up with age, starting after age 40.
• History of prior blood clot
• Immobility. Long travel/flights, fractures, casts, recovery from surgery or trauma, or movement restriction.
• Pregnancy
• Cancer. Many cancers make you hypercoagulable. In English, this means it increases your clot risk.
• Type of Surgery In COVID-19, cancer, trauma, vascular, general, head and neck, and thoracic surgery patients with ≥9 and ≥11 to 12 scores the VTE incidence was extremely high (ranging from 13% to 47%).

Caprini score

This was a score developed by, you guessed it, Dr. Joseph Caprini, a researcher at U of Chicago in 1991. They used 20 factors to stratify surgical risk for blood clots in patients. It has been validated and updated multiple times. You can find many variations of the score, which assess point scales slightly differently.

At my center we do the Caprini Score on all surgical patients. If you score above a 7 on our scale (and note: there are many versions of the Caprini Score now, which all have different numerical scales for when you need to anticoagulate), we will use Lovenox anticoagulation around the time of surgery to lower the risk of blood clots. Below that score, the risk of a DVT is lower than the risk of bleeding from use of anticoagulation. Even with a score of 7, the risk is still low for most patients.

On all of our patients we institute procedures to avoid blood clots, regardless of Caprini score. It is just good medicine.

What can you do to lower your risk?

• Sequential Compression Devices. SCDs. We use these leg massagers in all cases to keep blood from pooling in the legs. Moving blood= less risk of clot
• Pillow behind the knees. This helps blood flow to keep moving.
• Pain control. If you are in pain, you do not move. Not moving = increased risk of clot
• GET OUT OF BED. This varies depending upon what surgery you have, but you need to move. You can do leg flexes in the bed, but the best thing is to get up. This is NOT doing laps around the neighborhood.  This is going to the bathroom. Going to the living room.
• Lovenox. If you are at higher risk, do the blood thinner following your surgery. We can treat bleeding more easily than blood clots. Blood clots can kill you.
• Break the surgery into smaller surgeries. Your risk goes up with length of time of surgery. If high risk, consider doing two shorter surgeries than one long one.
• Stop hormones before surgery. Hormone therapy only tends to give 1 point, but it is something patients stop to lower risk.
• Avoid long plane flights, travel, or other surgeries right before this surgery. Not moving = increased risk. Don’t go into surgery at increased risk.
• Lose weight prior. Statistically DVT risk goes up with BMI. Ideally you want your BMI below 25.

Dr. Greenberg’s thoughts on DVT and PE

When doing elective cosmetic surgery safety is everything. Period. You can see my blogs on DVT risk going back to when I started blogging over a decade ago. DVT blogs

This is something to be taken seriously. If you or a family member has a history of blood clots, DVT, or pulmonary embolus you need to alert your surgeon. Times you may hear of blood clotting issues are after a long plane flight, during pregnancy, after starting birth control, or with a prior surgery or fracture.

Medical Citations

Systematic review of venous thromboembolism risk categories derived from Caprini score, Journal of Vascular and Surgical Venous Lymphatic Disorders, Nov 2022

The Thresholds of Caprini Score Associated With Increased Risk of Venous Thromboembolism Across Different Specialties: A Systematic Review, Annals of Surgery June 2023

The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.

This blog has been authored by Dr. Lauren Greenberg

Dr. Lauren Greenberg is a Stanford-trained, board-certified plastic surgeon who brings over two decades of experience and a strong commitment to natural-looking results. She is known for combining advanced techniques with an honest, thoughtful approach to help patients feel confident and empowered.

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