title: Preoperative use of alpha tocopherol does not increase the risk of hematoma in the face lift patient: a preliminary report.
abstract: BACKGROUND
  Antiplatelet therapy and nutritional supplements are factors that may increase the risk of hematoma after routine face lift. This has led to the often-repeated instruction "do not take any vitamins, herbs, aspirin, and any medications that may increase bleeding for 10 days before your face lift operation." At odds and diametrically opposed to this goal is combating the increased risk of deep venous thrombosis and venous thromboembolism associated with surgery.
  
  
  METHODS
  On the basis of clinical observations, the author has incorporated the routine use of preoperative oral alpha tocopherol (vitamin E) into his preoperative instructions. The cohort included 146 patients scheduled for elective face lift enrolled in this study from February of 2007 to April of 2008. Aspirin and clopidogrel were stopped before surgery. Patients were instructed to take 400 IU of alpha tocopherol daily 3 weeks before surgery.
  
  
  RESULTS
  No hematoma developed in any of the 146 patients. The time for routine drainage was not prolonged. No clinically evident case of deep vein thrombosis or venous thromboembolism occurred. The clinical impression was that increased bruising was not observed.
  
  
  CONCLUSIONS
  A recent landmark article has documented the efficacy of alpha tocopherol in the prevention of venous thromboembolism in over 39,000 patients. The addition of this readily available, over-the-counter medication may have profound effects in the prevention of a potentially devastating complication in the elective cosmetic surgery patient. Future prospective studies may further elucidate the efficacy of alpha tocopherol in the prevention of venous thromboembolism.
authors.affiliation: San Francisco, Calif. From the California Pacific Medical Center.
authors.forename: Brunno
authors.initials: B
authors.lastname: Ristow
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D006406:Hematoma / Q000139:chemically induced*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014815:Vitamins / Q000008:administration & dosage / Q000627:therapeutic use*; D024502:alpha-Tocopherol / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D024502:alpha-Tocopherol