This isn’t so deep, but when you have a facelift you don’t want bleeding after. That can lead to delayed healing and other complications. Men in particular tend to have issues with higher blood pressure and are a greater risk for bleeding. This was a study of 500 facelift patients where they made a concerted effort to lower blood pressure on patients after surgery.
Aesthetic Surgery Journal December 2023, “Systolic Blood Pressure Less Than 120 mmHg is a Safe and Effective Method to Minimize Bleeding After Facelift Surgery: a Review of 502 Consecutive Cases.” They postulate that treating 140mmHg has been standard, but that 120 mmHg is better. They discuss how hematomas can cause skin loss, fluid collections, irregular contours, and unfavorable aesthetic results. Hematomas have been reported in 0.5% – 8% of patients. Again, men, those with prior high blood pressure, and those on supplements and medications which cause bleeding are at higher risk.
Study:
- Patients before 2013 , 319 patients. After 2013 183 patients.
- Before they instituted the 120mm limit, they had 12 hematomas (bleeds). After they had one.
- Their protocol:
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- All Facelift patients get 0.1mg of clonidine orally upon arrival. Holding it if the systolic blood pressure is less than 100mmHg
- All patients were kept overnight
- Blood pressure was monitored every 2 hours
- It was treated with clonidine 0.1mg if above 120mmHG. If they couldn’t tolerate oral medications, 10mg labetalol or 10mg hydralazine was given
- In all men and “type A females” .25mg Xanax was also given
- Patients were given prescription 0.1mg clonidine to take at home.
- Those with a history of high blood pressure were told to use their at home cuff and treat as needed.
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My thoughts?
Facelifts are not unique to issues of bleeding. Our understanding of high blood pressure has evolved. It used to be “high blood pressure” was a systolic of over 140 and diastolic of over 90/95. Those numbers have lowered. Anything over 120/80 is high.
I catch younger, normal weight patients with high blood pressure that they didn’t know they have ALL. THE. TIME. Menopause, weight, genetics, inactivity- there are many causes. But you need to treat it. If you were told you have “white coat hypertension” (ie it is high in the doctors office), then you likely already have high blood pressure. Buy a cuff. Check your pressures every 3 hours (and don’t zen out to take it- take it regardless of what you are doing so you get accurate numbers).
The issue is for patients who are used to high blood pressure, would keeping them lower hurt them? They in their discussion state “no adverse events related to hypotension” were seen. If you have too low of blood pressure that would be fainting, dizziness, feeling light headed with standing, low blood pressure, and light headedness.
Interesting study and just highlights the importance of controlled blood pressure. Plastic surgery is painful and stressful- that doesn’t lower your blood pressure. Avoiding complications like bleeds (or just the amount of bruising which tends to correlate with pain and recovery) is important.