Accutane and Facial Plastic Surgery
Q: Dr. Eppley, My questions on facial plastic surgery:
1. I plan to go on a course of Accutane but I understand this impairs wound healing. As a result, it is advised not to have elective surgery for 12 yo 18 months after one finishes the medication. I cannot wait that long. Also I have the fistula under my neck (a large hole) it needs to heal first before I can start Accutane…as Accutane negatively affects wound healing.
Does Accutane only affect the epidermis or does it also affect the gums / intraoral incisions to place cheek and jaw implants? I understand that as part of placing the total jaw implant, you make a submental incision – would Accutane affect this healing if the surgery is carried out around 6 months before or after a course of Accutane?
2. Would having a hair transplant cause any problems for facial implants currently in place? For example, could it potentially trigger inflammation or an infection?
3. I need to have revision rhinoplasty – could I do this after having cheek and jaw implants or should I do it before inserting new implants? I’m thinking I might wait 12 months after the Accutane treatment to do this.
4. I was also thinking that perhaps I could have the revision rhinoplasty at the same time as cheek implant replacement and then have the jaw implant done later – is this feasible? After the damage caused by the previous jaw implant infection, I’m very weary and apprehensive about triggering infections. I lived with the previous implant for around 2 years. The remaining jaw implant is Goretex (screwed in) but I believe my current cheek implants are silicone/silastic and not screwed in.
The surgeon who removed my infected implant, only inserts silicone implants due to their ease of placement and removal. His comments concerned me so I want the ‘healthy’ remaining jaw implant removed as soon as possible (but I’ve read it’s best to have the replacement done at the time it’s removed but for me, that cannot be done until I heal fully from the infection.)
A: In answer to your questions:
1) Accutane primarily affects epithelial and dermal healing of which is most relevant to facial laser skin resurfacing. Its negative effects on deeper tissue healing is less certain. But that being said, it is still best to not undergo elective surgery for six months after it has been stopped.
2) Hair transplants have no known association with causing facial implant infections.
3) The timing of a revision rhinoplasty is one of convenience. It can be done in conjunction with other facial implant surgeries or done in isolation. This is not a medical decision.
4) The revision rhinoplasty, as indicated in answer #3, can be paired with any other aesthetic facial procedure. There would be no reason to have the remaining good jaw angle implant removed first before placing another one.
Dr. Barry Eppley