title: Venous thromboembolism after facelift surgery under local anesthesia: results of a multicenter survey.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a serious complication of cosmetic surgery, and studies have suggested that the incidence is not insignificant in facelift surgery. Use of local anesthesia over general anesthesia and shorter operative times are probable contributing factors to lower VTE incidence. Because there have been no large-scale assessments of VTE in facelifts as such, we investigated VTE incidence and relevant factors in facelift surgeries performed under local anesthesia only.
  
  
  METHODS
  We conducted a retrospective multicenter survey of facelift surgeons who utilize the American Society of Anesthesiologists level 1 oral anxiolysis and local diluted lidocaine anesthesia technique. Anonymous online surveys were sent to surgeons with questions regarding facelifts performed and VTE incidence over the previous 19 months.
  
  
  RESULTS
  Seventy-seven surgeons (93 % response rate) completed the survey, with 74 eligible surgeons reporting at least one facelift. Respondents reported five VTE events, for an overall VTE incidence of 1 event in 5,844 surgeries. Surgeons who reported performing facelifts at high volumes (>500 facelifts in 19 months) had a significantly lower VTE incidence than lower-volume surgeons (p = 0.011). High-volume surgeons also reported a significantly lower average operative time (p = 0.016), but for surgeries that did or did not result in VTE, there was no significant difference between surgeon-reported average operative times.
  
  
  CONCLUSIONS
  The low VTE incidence in this facelift series supports prior understanding that there is a low risk of VTE in surgery performed under local anesthesia and in surgery with shorter operative times. Limiting ancillary procedures to the face likely reduces operative time and likely also contributes to a lower VTE rate. The data further suggest that physicians performing facelifts more frequently tend to have shorter average operative times and overall lower VTE incidence.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Lifestyle Lift, 11040 Main Street, Suite 102, Bellevue, WA, 98004, USA. facialbeautymd@yahoo.com.
authors.forename: David Q
authors.initials: DQ
authors.lastname: Santos
authors.affiliation: Lifestyle Lift, 11040 Main Street, Suite 102, Bellevue, WA, 98004, USA.
authors.forename: Mimi
authors.initials: M
authors.lastname: Tan
authors.affiliation: Lifestyle Lift, St. Louis, MO, USA.
authors.forename: Carlos L
authors.initials: CL
authors.lastname: Farias
authors.affiliation: Lifestyle Lift, Tampa, FL, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Swerdloff
authors.affiliation: Lifestyle Lift, Santa Ana, CA, USA.|Aesthetic and Plastic Surgery Institute, University of California, Irvine, Irvine, CA, USA.
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Paul
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects* / Q000592:standards; D013518:Surgery, Plastic; D011795:Surveys and Questionnaires; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology*