Lupus Can Increase the Risk of Complications during and After Plastic Surgery
Lupus is an autoimmune disease that causes inflammation in different healthy tissue and organs in the body. This chronic disease can increase the risk of certain complications during and after plastic surgery. These include delayed wound healing, excessive bruising, increased bleeding, and increased risk of infections.
Proper communication between the plastic surgeon and lupus doctors can help lupus patients undergo the safest possible cosmetic procedures.
Learn more about lupus disease, how it can affect cosmetic procedures, and how to prepare for plastic surgery if you have lupus.
What Is Lupus?
Lupus is a chronic autoimmune disease where your body’s immune system attacks your healthy tissues and organs. This disease can affect different body parts, including the skin, joints, kidneys, heart, lungs, blood cells, and brain.
Usually, the body’s immune system causes inflammation in response to an injury or an infection caused by germs. Alternatively, in patients with lupus, the immune system causes inflammation in healthy tissue.
Lupus can cause different symptoms depending on the body part it affects, which may be present in other diseases such as diabetes or arthritis. That makes this autoimmune disease hard to diagnose. However, the most common signs and symptoms of lupus include the following:
- A butterfly-shaped facial rash across the nose and both cheeks
- Fingers and toes turn white or blue in response to cold or stress (Raynaud’s syndrome)
- Extreme fatigue
- Hair loss
- Low fevers
- Pain, swelling, and stiffness in the joints
- Chest pain when taking deep breaths
Other symptoms that are common in lupus patients include:
- Dry eyes and dry mouth (Sjögren’s syndrome)
- Swelling around the eyes, in the hands, or feet
- Mouth sores/ Nose sores
- Skin lesions that start to show or get worse when exposed to the sun
Each patient experiences different lupus symptoms depending on which body system the disease attacks. Most people with lupus experience symptoms that come and go, known as lupus flares.
There are three major forms of lupus in adults:
- Systemic lupus erythematosus (SLE): SLE is the most common form of lupus, and it affects several organs and systems, including the skin, kidneys, and joints
- Cutaneous lupus: there are three main types of cutaneous lupus (lupus of the skin), which are acute cutaneous lupus, chronic cutaneous lupus erythematosus or discoid lupus erythematosus, and subacute cutaneous lupus erythematosus
- Drug-induced lupus: this form of lupus develops because of certain prescription drugs and leads to inflammation in the joints and around the lungs
How Does Lupus Affect Plastic Surgery?
The effect of lupus disease on your plastic surgery depends on which form of lupus you have and the type of cosmetic surgery you wish to get.
Without proper management, systemic lupus erythematosus (SLE) specifically and its treatments can lead to risks following plastic surgeries such as a tummy tuck, breast lift, liposuction, or a facelift.
Patients with lupus may experience the following postoperative complications after their plastic surgery:
- Poor wound healing: certain autoimmune diseases, such as lupus, can cause inflammation in the blood vessel walls (vasculitis), which delays wound healing. As a result, lupus, especially SLE, can cause poor wound healing at the incision sites following plastic surgery
- Increased risk of infection: people with lupus are often prescribed immunosuppressive medications, steroids, or both. These medications tune down the immune system to improve lupus symptoms. Because the immune system becomes weakened, people with lupus who are on immunosuppressants have a higher risk of infection after plastic surgery
- Increased bruising: another possible side effect of long-term steroid treatments is thinned skin that bruises easily. Therefore, lupus patients treated with steroids are more likely to have excessive bruising following cosmetic surgery
- Increased risk of bleeding: anti-inflammatory drugs prescribed to lupus patients act as blood thinners. Hence, patients on anti-inflammatory medications for lupus have a higher risk of bleeding during and after plastic surgery
- Hyper pigmented scars: Lupus is associated with complications such as skin scarring and hyperpigmentation. The surgical incision made in the skin of a person with lupus could trigger post-inflammatory hyperpigmentation of the skin (the skin around the incision becomes darker than the skin surrounding it). Hence, a person with lupus may have hyper pigmented scars that are aesthetically unpleasant after cosmetic surgery
- Acute kidney injury: Lupus patients are at a higher risk of developing postoperative acute kidney injury (PO-AKI) after plastic surgery. Systemic lupus erythematosus (SLE) can cause lupus nephritis, a type of kidney disease. Lupus-induced kidney disease increases the risk of acute kidney injury after cosmetic surgery
- Postoperative autoimmune flare: cosmetic surgery can cause lupus flare-ups after the procedure. Although the exact reason why that happens is still unknown, doctors believe that injury to the skin (surgical incision) or surgery itself can trigger lupus autoimmune flares in people who already have the disease
Although cosmetic surgery may be challenging for people with lupus, it’s not impossible. Elective procedures, such as plastic surgery interventions, may be performed on lupus patients when the disease is not active or under control.
Can You Get Plastic Surgery If You Have Lupus?
There is no direct answer to whether lupus patients can get liposuction or whether someone with lupus can undergo tummy tuck surgery.
People with SLE and other forms of lupus can get plastic surgery if:
- They’ve been off immunosuppressants and steroid medications for a while
- They don’t have any active lupus flare-ups, especially in the area you want to get work done on
- Their platelet count is within the normal range
- They don’t have any active infections or blood clotting problems
- They don’t have organ damage that may prevent them from going under general anaesthesia for some time
Before determining whether you can have cosmetic surgery with lupus, your plastic surgeon needs to consult with the healthcare provider treating your lupus to discuss the status of your disease.
Getting Ready For Plastic Surgery When You Have Lupus
Several things can help you prepare for your plastic surgery and ensure the safest possible outcomes if you have lupus and want to get liposuction, abdominoplasty, and breast lift or even a facelift.
Getting in touch with your rheumatologist
The good thing about plastic surgery is that it’s elective. That means you can schedule it after you’ve had time to plan for it.
Before scheduling a tummy tuck or a breast lift, inform your rheumatologist about your plans to get cosmetic surgery. Depending on the status of your lupus, your doctor will advise you if and when you can get plastic surgery.
If you have active lupus flares, vasculitis, or a weakened immune system because of lupus medication, your doctor might suggest putting the surgery off until those become resolved.
Getting your plastic surgeon in touch with your lupus doctors
The best case scenario is that your plastic surgeon gets in touch with the doctor managing your lupus disease. Your rheumatologist can provide your plastic surgeon with all the necessary information regarding your health and medications.
If you have lupus-associated organ damage, you should also involve any specialists overseeing your medical case.
Accordingly, your plastic surgeon can make the appropriate preparations to give you the safest cosmetic procedure possible despite your lupus condition.
Before your plastic surgery consultation, make appointments with your rheumatologist, primary healthcare provider, and other lupus specialists to confirm you’re ready to undergo plastic surgery.
Getting your medication adjusted
You’ll probably need to stop taking some of your lupus medications for a while before undergoing a breast augmentation or another cosmetic surgery.
Your rheumatologist and other lupus specialists will recommend when you should stop and restart your lupus treatment.
Some of the lupus medications that may need adjustments before cosmetic surgery include:
- Anti-inflammatory drugs: your doctor can recommend when to stop taking your anti-inflammatory medications before your plastic surgery because they increase the risk of bleeding
- Herbal supplements: you will also need to inform your surgeon about any herbal supplements you’re on. Certain herbal supplements can increase bleeding, and others can interfere with anaesthesia. Both of which can lead to dangerous complications during cosmetic surgery
- Immunosuppressants: these drugs increase the risk of post-surgical infections. Your doctor may adjust your immunosuppressants before cosmetic surgery
- Steroids: your doctor may recommend you stop taking your steroids days before your plastic surgery since steroids can increase the risk of excessive bruising and the risk of infection. On the other hand, your doctor might recommend increasing the dose of your steroid medications instead of stopping the treatment before your cosmetic surgery. That’s because of a condition called adrenal insufficiency that happens when someone is on steroid treatment for a long time. The adrenal glands of patients with adrenal insufficiency can’t produce enough natural steroid hormones. In such cases, the stress of surgery can trigger an adrenal crisis. Consequently, lupus patients with adrenal insufficiency might receive a higher dose of steroids instead of lower doses before plastic surgery to prevent serious illness
- Cholinergic agonists: up to 33% of lupus patients also have Sjögren’s syndrome, which manifests as dryness in the eyes and mouth. For that reason, people with lupus may be prescribed cholinergic agonists such as Cevimeline (Evoxac®) and Pilocarpine (Salagen®) to treat the dryness in the mouth and eyes from Sjögren’s syndrome. You may need to stop these lupus meds before your plastic surgery to prevent breathing problems during the procedure.
Moreover, you should inform your plastic surgeon and nurses if you have any lupus-associated complications, such as Sjögren’s or Raynaud’s syndrome.
Your surgical team can provide adequate lubrication and moisture before your plastic surgery if you have excessive dryness from Sjögren’s syndrome.
They may also be able to adjust the temperature of the operating room or provide you with additional blankets and covers to prevent Raynaud’s syndrome flare-ups before, during, or after your plastic surgery.
Be careful not to adjust your medications unless your lupus doctor advises you to do so. Follow your doctor’s recommendations to the letter to avoid any complications or the worsening of your condition.
Can Surgery Cause Lupus?
Although the exact cause of Lupus is still unknown, scientists believe that genetics, hormones, and environmental factors all play a role.
The surgery itself does not cause lupus. However, doctors believe that stress from surgery, including plastic surgery, can trigger lupus flare-ups in patients who already have the disease.
Thus, although plastic surgery does not cause lupus, it can worsen some of its symptoms if not properly managed.
Taking the appropriate steps to prepare for plastic surgery in patients with lupus can help people with this disease go through safe and cosmetically rewarding procedures without any additional complications.
Medical References about Lupus and Plastic Surgery
- Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with lupus erythematosus
- Systemic Lupus Erythematosus – StatPearls – NCBI Bookshelf
- Vasculitic Diseases and the Prothrombotic States Contributing to Delayed Healing In Chronic Wounds – PMC
- Orthopedic surgery and its complication in systemic lupus erythematosus – PMC