From the Guidelines
Facial lift under general anesthesia is considered low to intermediate risk surgery for cardiovascular complications. The primary concerns for patients undergoing this procedure include blood pressure fluctuations, cardiac arrhythmias, myocardial ischemia, and thromboembolism 1. Preoperative assessment should include a thorough cardiac evaluation, especially for patients with existing cardiovascular disease, hypertension, or those over 50 years old.
Key Considerations
- Patients with untreated or uncontrolled hypertension are at increased risk of cardiovascular complications, with a 35% increase in risk associated with a preoperative diagnosis of hypertension 1.
- The presence of active clinical risk factors, such as prior angina, recent or past MI, decompensated HF, significant arrhythmias, and severe valvular disease, should be carefully evaluated 1.
- Beta-blockers, such as metoprolol, may be considered for patients with known IHD or myocardial ischemia to control heart rate and reduce the risk of cardiovascular complications 1.
- Local anesthetics with epinephrine should be used cautiously to minimize cardiac effects, and postoperative monitoring should include careful observation for signs of cardiovascular instability 1.
Management Strategies
- Preoperative evaluation: A thorough cardiac evaluation, including assessment of functional capacity and identification of clinical risk factors, is essential to determine the need for further testing or intervention 1.
- Intraoperative management: Blood pressure should be maintained within 20% of baseline values, with careful monitoring of heart rate and rhythm, and medications such as beta-blockers and vasopressors should be used as needed to control tachycardia and hypertension 1.
- Postoperative care: Patients should be monitored for at least 24 hours for signs of cardiovascular instability, and early mobilization, compression stockings, and prophylactic anticoagulants may be recommended to reduce the risk of thromboembolism 1.
From the Research
Cardiovascular Risks for Facial Lift Under General Anesthesia
- The risk of perioperative cardiovascular complications for noncardiac surgery, such as facial lift, is approximately 3% of hospitalizations in the US 2.
- Preoperative cardiovascular risk assessment is necessary to identify signs and symptoms of ischemic heart disease, heart failure, and severe valvular disease 2.
- The Revised Cardiac Risk Index can be used to identify individuals with low risk (<1%) and higher risk (≥1%) for perioperative major adverse cardiovascular events 2.
Precautions for Patients Undergoing Facial Lift Under General Anesthesia
- Patients with cardiovascular disease, respiratory disease, diabetes mellitus, low hemoglobin level, and longer duration of surgery are at higher risk of developing pressure injuries and other complications 3.
- Continuing beta-blockers and calcium channel blockers on the day of surgery is recommended, while angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers may increase the likelihood of intraoperative hypotension 4.
- Statins are associated with fewer postoperative cardiovascular complications and lower mortality, and should be considered preoperatively in patients with atherosclerotic cardiovascular disease 2.
Comparison of General Anesthesia and Local Anesthesia for Facial Lift
- High superficial musculoaponeurotic system (SMAS) lamellar facelift can be performed under local anesthesia without sedation, and may be considered as an alternative for patients who do not want to undergo general anesthesia or who are at risk of undergoing general anesthesia 5.
- However, the outcomes of local anesthesia may not entirely match the expectations from total face and neck lift performed under general anesthesia 5.