<< Back to the abstract archive
Enhanced Recovery After Surgery (ERAS) Protocol in Facelift Surgery
Abigail Meyers, BS; Demetrius M Coombs, MD; James E Zins, MD, FACS
Cleveland Clinic Department of Plastic Surgery
2022-02-01
Presenter: Abigail Meyers
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. A majority of the study design and entirety of data collection, analysis, and writing in preparation of the abstract was carried out by the first author.
Director Name: James E Zins
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Aesthetics
Purpose
An ERAS protocol for facelift surgery is presented to standardize care, optimize outcomes, and minimize morbidity.
Methods
A protocol was developed based upon review of available evidence from the current plastic surgery literature and contains the following standard ERAS elements: patient counseling, medical optimization, perioperative nutrition, anesthetic practices, antimicrobial prophylaxis, prevention of other complications, and postoperative management.
Results
Preoperative
Medical optimization includes standard screening with emphasis on strict blood pressure control, smoking cessation, and anticoagulant discontinuation.
Perioperative
Perioperative measures include 0.1mg clonidine patch the night prior, or oral the morning of surgery. Urine or serum cotinine test is required for all former or recent smokers. Since the facelift operation is usually >2 hours and many patients are ≥70, high Caprini scores mandate intermittent compression stockings. First-generation cephalosporin is given 30 minutes prior to incision, followed by one additional dose.
Intraoperative
Tranexamic acid is given either mixed with local anesthesia, topically, or intravenously. A second look technique is used at closure to minimize epinephrine rebound bleeding. Flap closure is performed only after both sides of the facelift and anterior neck work are completed. Blood pressure is raised to preoperative levels prior to closure. Hemostatic net is an optional adjunct to minimize bleeding.
Postoperative
Systolic blood pressure control below 140 is mandatory. Labetalol and hydralazine are initiated if necessary. All patients are seen and discharged the following day with an emergency physician contact.
Conclusions
Use of ERAS protocols in surgery have reduced morbidity. Evidence-based protocols may also enhance facelift surgery outcomes.
