Q: Dr. Eppley, I’ve been diagnosed with lupus and ITP. However, my platelet count was always low (lowest was 12) back in 2013 when I went for my blood work to have a rhinoplasty. I was prescribed steroids to take to increase the count and undergo surgery. So I think I had lupus back then and it affected my platelet count. Every time I wanted to have surgery, I would just take the steroids for about a week prior to surgery. I’ve had 2 rhinoplasty, breast augmentation, upper and lower eyelid surgery, and mid-face lift. But now I am now taking plaquenil and prednisone (50mg) for the past 6 months. I am interested in revision rhinoplasty, zygoma reduction, and jawbone reduction. I am little afraid since this time I am taking medications for my lupus. If my platelet count is above 100. Is it safe for me to have those surgeries?
A: I think you have to recognize that at least two of these surgeries (zygoma and jawbone reduction) are major bone surgeries that can cause a lot of bleeding and require better healing potential that any of your prior aesthetic procedures. Since they are elective I would be very cautious about undergoing them. Plaquenil and prednisone are major anti-inflammatory drugs that can have negative impacts on healing, particularly at the doses you are taking.
If your platelet count is acceptable, I would only undergo a revision rhinoplasty first to see how the surgery goes. That would he a good test before ever proceeding with the more major facial bone surgeries.
Dr. Barry Eppley