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Patients with hypothyroidism at risk for prolonged edema after face-lift surgery

A small subset of patients with hypothyroidism were prone to prolonged edema following face-lift surgery despite being treated with thyroid replacement therapy, according to study results recently published in JAMA Facial Plastic Surgery.

Researchers conducted a retrospective review of 198 who underwent a face-lift between Jan. 1, 2014, and May 31, 2015. They identified four women (mean age, 63 years) with documented hypothyroidism and prolonged postoperative edema.

The four women were white, had the same surgeon and anesthesiologist and had edema lasting for a mean of 3.75 months. They also underwent additional procedures at the time of the face-lift, with a mean length of surgery of 236 minutes.

Levothyroxine sodium was used to treat the patients’ hypothyroidism. One patient had an elevated thyrotropin level, while three patients experienced both thyroglobulin antibodies and thyroid peroxidase antibodies.

The four women had no history of surgical complications, and experienced substantial greater length of facial edema compared with typical patients, who experience a 75% reduction by 2 weeks after the procedure and 85% resolution by 2 months.

All patients experienced residual postoperative edema at 2-week follow-up, and deviated from normal recovery length at 1 month. The women were treated with a 10-day tapering regimen of oral hydrocortisone acetate, with all patients eventually achieving edema resolution.

“Face-lift is a major procedure that alters the dynamics of the facial soft tissue owing to alteration of lymphatic drainage of the skin toward the medial portion of the face,” the researchers wrote. “Concurrent midface procedures, such as blepharoplasty and rhinoplasty, can further alter drainage, thus increasing the edema.”

“Antithyroglobulin and antithyroid peroxidase antibodies, although not typically indicative of thyroid disease, are representative of an autoimmune state that may indirectly affect wound healing via inadequate thyroid hormone activity,” the researchers concluded. – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.