APS Aesthetic Plastic Surgery · 2012

Management of patients undergoing rhinoplasty while receiving anticoagulant therapy

Bracaglia R, Tambasco D, D'ettorre M, Gentileschi S.

What this paper says

A 36-year-old man with two inherited clotting mutations had cosmetic rhinoseptoplasty while on low-molecular-weight heparin, and the authors describe balancing clot prevention against the bleeding that would make surgery unsafe.

Overview

Rhinoplasty needs a dry field and normal clotting. Some patients carry inherited clotting disorders that require blood thinners around surgery, and the literature gave no guidance on how to manage them for nasal surgery. The authors report one such case and the decisions involved.

Sections of note

Single case report; level of evidence IV.
Patient: 36-year-old man with a heterozygous prothrombin G20210A mutation and a homozygous methylenetetrahydrofolate reductase C677T mutation.
Indication for anticoagulation: high thromboembolic risk from congenital thrombophilia, managed with low-molecular-weight heparin.
Procedure: aesthetic rhinoseptoplasty.
The abstract states no bleeding volume, complication or outcome figures and does not give the dosing schedule.
The authors note the literature contained no specific management guidance for rhinoseptoplasty on anticoagulants.

What it means for a patient

Having an inherited clotting tendency does not automatically rule out cosmetic nasal surgery, but the blood thinner plan must be set with the surgeon and a hematologist.
Too little anticoagulation risks a clot; too much makes the operation bloody and hazardous.
This is one patient's experience; it cannot give rates of bleeding or clotting for others.

Why this paper matters

Anticoagulated patients are usually excluded from elective aesthetic surgery. This report shows a managed pathway exists. A protocol with dosing and timing, and data from more than one patient, remain absent.

Terms

Rhinoseptoplasty: rhinoplasty combined with straightening of the septum.
Anticoagulant: a medicine that slows blood clotting.
Low-molecular-weight heparin: an injectable blood thinner used to prevent clots around surgery.
Thrombophilia: an inherited or acquired tendency to form blood clots.
Prothrombin G20210A: a gene variant that raises clotting risk.
MTHFR C677T: a gene variant in the methylenetetrahydrofolate reductase enzyme that has been linked to clotting risk.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“A proper bloodless field and coagulation profile represent essential elements for performing a safe, effective, and fast rhinoplasty. However, some particular conditions among patients with a high thromboembolic risk for congenital thrombophilia require antithrombotic prophylaxis using low-molecular-weight heparin. To…”

Excerpt; the full abstract is on PubMed.