MRSA Risk After a Facelift: How to Protect Yourself

By Denise Mann; reviewed by Scott R. Miller, MD, FACS

It may be slight, but there is a risk of developing methicillin-resistant Staphylococcus aureus (MRSA) infections following a facelift, according to research reported in the March/April 2008 issue of Archives of Facial Plastic Surgery.

About one-half percent of 780 people who got facelifts at a New York outpatient surgical center between 2001 and 2007 developed surgical site infections that tested positive for MRSA.

But choosing the right surgeon and the right facility, along with asking the right questions before your facelift, can help bring your risk for MRSA closer to zero.

What Is MRSA?

MRSA is a type of bacteria that is resistant to certain antibiotics, including methicillin, oxacillin, penicillin and amoxicillin, according to the federal Centers for Disease Control and Prevention. More virulent than other forms of staph infection, MRSA spreads through the tissue more rapidly, is difficult to control and causes infections that can be fatal.

Staph infections, including MRSA, tend to occur most frequently among people in hospitals and healthcare facilities who have weakened immune systems. This is known as healthcare-associated MRSA (or HA-MRSA).

In contrast, MRSA infections that occur in otherwise healthy people who have not been recently hospitalized or had a medical procedure within the last year are known as community-associated MRSA (or CA-MRSA).

Risk Factors for HA-MRSA Infections

  • Current or recent hospitalization
  • Residence in a long-term care facility
  • Presence of invasive devices such as feeding tubes or catheters
  • Recent antibiotic use

How to Reduce Your MRSA Risk

Make sure your plastic surgeon asks the right questions during your preoperative evaluation. A full medical history should include information on possible prior contacts with people at high risk for carrying MRSA. He or she should ask if you have recently taken antibiotics, been hospitalized, visited sick relatives or friends in the hospital, been in contact with health care workers or had previous MRSA infections.

If you have been hospitalized during the last month or visited a sick relative in the hospital recently, your surgeon may treat you with mupirocin nasal ointment (a brand name is Bactroban). This is the treatment of choice for people who may be MRSA carriers. If you have staph on your skin or in your nose but aren't sick, you are "colonized" but not infected with MRSA. Healthy people can be colonized with MRSA and pass the germ to others.

When deciding where to have your facelift, it is wise to seek out an accredited ambulatory surgical center. These facilities are often safer than a hospital, because such centers typically do only cosmetic surgery on healthy individuals, and no ill patients are there to pass along infectious agents. For the same reasons, consider cosmetic surgery retreats for aftercare, unless staying in a hospital is deemed necessary. Taking precautions such as this can lead to a shorter facelift recovery period as well as minimize any facelift risks. Be sure to ask your surgeon where he or she performs surgery and where they recommend you should recuperate following surgery.

Ask your doctor if you are a candidate for antibiotic-coated sutures, designed to kill infection-causing bugs at the site of the wound. At this juncture, there is no hard evidence that they decrease infection, but they do decrease bacterial colonization, so it's reasonable to think they may reduce susceptibility to infection.

Inquire about your surgeon's policy on preventive (prophylactic) antibiotics. While many surgeons will give an initial dose of antibiotics to people undergoing facelifts, there is no evidence that this is helpful past 24 hours. In fact, additional antibiotics after this time can actually increase the risk of MRSA and other antibiotic-resistant infections, which developed due to the over-use of antibiotics. Antibiotics may be required for longer periods of time for other procedures, particularly those involving implants.

Always choose a plastic surgeon certified by the American Board of Plastic Surgery. This ensures that the surgeon has specific and rigorous surgical education and training and is up to date on the latest advances in surgery as well as infection control.

Finally, use common sense. If the place looks dirty and the staff looks unkempt, choose another surgeon and/or facility.

Sources:
Centers for Disease Control and Prevention. "Healthcare-Associated Methicillin Resistant Staphylococcus Aureus (HA-MRSA)," CDC website
Zoumalan RA, Rosenberg DB. Methicillin-Resistant Staphylococcus Aureus-Positive Surgical Site Infections in Face-lift Surgery. Archives of Facial Plastic Surgery, 2008;10:116-123