Purpose

Hypertension is a common chronic medical condition. In the facelift patient, uncontrolled hypertension is a difficult acute condition, which can lead to significant complications in the perioperative period. The treatment of hypertension in the ambulatory medical setting has been standardized, though its treatment in the cosmetic surgery setting has been relatively ambiguous. The purpose of this study was to evaluate the current national trends in face lift practice and perioperative hypertension management.

 Methods

Members of the American Society of Aesthetic Plastic Surgery (ASAPS) were surveyed regarding the management of hypertension in the perioperative period. Geographic location, surgeon volume, facelift method, and hematoma rate were evaluated.

 Results

A response rate of 35.4 % (CI 95%) was attained with a total of 1776 surveys mailed and 629 surveys completed. Respondents were evenly distributed across the southern United States and, east and west coasts. West coast respondents reported a significantly higher annual number of face lifts as compared to the rest of the country. SMAS plication under general anesthesia performed as an outpatient procedure was the most common practice nationally for facelifts.  The perioperative management of blood pressure was consistent with all respondents. Beta-blockers were commonly utilized throughout the perioperative course, though alpha agonists were reported more frequently by higher volume and more senior plastic surgeons (p<0.0001). Hematoma rate did not vary with medication type. Medical treatment at an intra-operative systolic blood pressure (SBP) threshold below 100 (p<0.04) and a post-operative SBP threshold above 140 (p<0.05) did significantly affect surgeon reported hematoma rate.

Conclusion

The most common practice trend currently in the United States for facelift surgery is SMAS plication under physician administered general anesthesia in an outpatient setting. Alpha agonists are more commonly utilized by experienced plastic surgeons in face lift surgery; however treatment threshold for systolic blood pressure significantly affects hematoma rate, not medication type.