Can someone with an autoimmune condition have elective facial surgery?
⚠️ Contact your doctor or seek care urgently if:
After surgery you notice increasing redness, swelling, warmth, or discharge around your wound; develop a fever; or experience a sudden worsening of your autoimmune symptoms. These could signal infection or a disease flare that needs prompt medical attention.
Short answer
Having an autoimmune condition does not automatically rule out elective surgery, but it does require careful planning with your rheumatologist and surgeon. Key concerns include managing your medications around the time of surgery and making sure your disease is as well controlled as possible beforehand.
What the research shows
People with autoimmune conditions often take medications called disease-modifying antirheumatic drugs (DMARDs) or other immunosuppressants. Research on elective surgery in these patients shows that managing these medications around the time of surgery is critical. [6] Studies suggest that some conventional DMARDs (such as methotrexate and hydroxychloroquine) can generally be continued through surgery, while biologic DMARDs (injectable or infused drugs that target the immune system more specifically) should usually be paused for at least one dosing cycle before surgery and restarted only after the wound has fully healed, typically at least 14 days after the procedure. [6]
For conditions like systemic lupus erythematosus (SLE), the decision to pause immunosuppressants is especially complex because stopping them can trigger dangerous disease flares. [6] Patients on high-dose steroids (20 mg/day of prednisone or more) are generally advised to postpone elective procedures until their inflammation is controlled at a lower dose. [6]
A survey of spine surgeons found that most consult a rheumatologist before deciding whether to continue or pause DMARDs, and the majority withheld these drugs for an average of about two weeks before and nearly three weeks after elective surgery. [7] A systematic review noted that patients who continued DMARDs through surgery had higher rates of wound infections and healing problems compared to general surgical populations. [3]
What this means for you
The bottom line is that elective facial surgery can often still be possible with an autoimmune condition, but the timing, your disease activity level, and your current medications all matter greatly. Your surgeon and rheumatologist need to work together to create a plan that balances the risk of a disease flare against the risks of infection or poor wound healing that can come with immunosuppressive therapy. [6] A multidisciplinary approach involving your anesthesiologist, surgeon, and rheumatologist is considered the best strategy for a safe outcome. [6]
What to ask your surgeon and rheumatologist
- Is my autoimmune condition well enough controlled right now to safely proceed with elective surgery?
- Which of my current medications should be paused, and for how long before and after surgery?
- What is my personal risk of wound healing problems or infection given my specific condition and medication regimen?
- Are there any signs of disease flare I should watch for in the weeks around my surgery?
Note that most of the available research focuses on spinal and orthopedic surgery rather than facial cosmetic surgery specifically. [3][6][7] The general principles likely apply, but your care team can best judge how they translate to your specific procedure.