TL;DR: The most common complication of a facelift is a haematoma — a collection of blood under the lifted skin — and in the largest published series (1,078 consecutive facelifts) its independent risk factors were aspirin or anti-inflammatory use, smoking and raised blood pressure: three things the patient controls in the weeks before surgery. This guide sets out, with the anaesthesia and surgical literature behind each line, which medicines and supplements to stop and roughly when, which to keep taking, the fasting rules on the morning of surgery, the questions to put to the anaesthetist before you fly, and what to pack. Medical Korea Service (Registered Facilitator for International Patients — Seoul Metropolitan Government, Reg. No. A-2014-01-01-1414, registered 23 July 2014) sends every Singapore, Indonesian and US facelift patient a written pre-operative list before the surgery date is fixed. This article is that list, with the reasons attached. It does not replace the clinic's own written instructions, which govern.
Why the pre-operative list matters more for a facelift than for most operations
A facelift is a large operation on a small blood supply. The surgeon lifts skin and the deeper layer beneath it across the cheek, jaw and neck, and every one of those raised flaps has to survive on the vessels left attached to it. Anything that makes bleeding more likely, or healing slower, shows up in a facelift sooner and more visibly than in most procedures.
The clearest evidence is a British series of 1,078 consecutive facelifts published in 2001. Haematoma — blood collecting under the skin after the operation — occurred in 4.2 per cent of patients, and on multivariate analysis five factors were independently associated with it: an anterior neck tightening (platysmaplasty), higher systolic blood pressure, male sex, aspirin or non-steroidal anti-inflammatory intake, and smoking (Grover, Jones and Waterhouse, Br J Plast Surg 2001). Two of the five are about the operation and the patient's sex; the other three are about what the patient takes, breathes and how well their pressure is controlled in the weeks before.
That is why the pre-operative list is not paperwork. In our own ledger, across the 31 facelift plans we coordinated for Singapore, Indonesian and US patients between 2019 and 2026, the median age at surgery was 57 and four in five patients were 50 or older — the age at which a daily aspirin, a blood-pressure tablet, a statin or a hormone prescription is ordinary rather than exceptional (we set the age data out in Facelift in Korea by age). The list below is written for that patient.
Medicines and supplements: what to stop, what to keep, and who decides
One rule sits above every line in the table: a medicine prescribed for your heart, your blood or your brain is stopped only by the doctor who prescribed it, in coordination with the anaesthetist — never by the patient on the strength of a blog post, including this one. What the patient can do alone is stop the things nobody prescribed: over-the-counter painkillers, supplements and herbal preparations.
| Category | Common examples | Typical instruction (the clinic's written instruction governs) | Why — and the source |
|---|---|---|---|
| Over-the-counter aspirin and NSAIDs | Aspirin, ibuprofen, naproxen, diclofenac, high-dose combination cold remedies | Stop for the period the clinic specifies — commonly one to two weeks before surgery. Paracetamol (acetaminophen) is usually the permitted alternative | Independent haematoma risk factor in 1,078 facelifts (Grover 2001) |
| Prescribed aspirin or anticoagulants | Low-dose aspirin after a stent or stroke, clopidogrel, warfarin, apixaban, rivaroxaban | Do not stop on your own. The prescribing cardiologist or physician decides whether, when and with what bridging, in writing, and the anaesthetist receives that letter | Stopping an antiplatelet after a stent or an anticoagulant for a clot can be more dangerous than the haematoma it prevents; this is a physician-to-physician decision |
| Herbal and dietary supplements | Garlic, ginkgo, ginseng, fish oil, vitamin E, and Asian preparations that contain them (jamu, TCM decoctions) | Stop, commonly one to two weeks before; declare them even if stopped | Garlic, ginkgo and ginseng increase bleeding; kava and valerian potentiate anaesthetic sedation; St John's wort accelerates the breakdown of many peri-operative drugs (Ang-Lee, Moss and Yuan, JAMA 2001) |
| GLP-1 weight-loss and diabetes injections | Semaglutide, liraglutide, tirzepatide | Tell the anaesthetist the drug, dose and date of the last injection. Depending on dose and symptoms you may be asked to hold a dose or to take clear liquids only for 24 hours before surgery | These drugs slow stomach emptying, which matters for anaesthesia; multi-society guidance issued in 2024 (Kindel et al., Clin Gastroenterol Hepatol 2024) |
| Oestrogen: the pill and hormone replacement | Combined oral contraceptives, HRT tablets and patches | Declare them. Whether to pause is decided case by case by the surgeon and anaesthetist against your overall clot-risk score | Oestrogen is a recognised factor in the Caprini venous-thromboembolism score, which has been validated in plastic-surgery patients (Pannucci et al., J Am Coll Surg 2011) |
| Blood-pressure medicines | Amlodipine, losartan, bisoprolol and similar | Usually continue, including on the morning of surgery with a sip of water, unless the anaesthetist says otherwise | Higher systolic pressure was an independent haematoma factor (Grover 2001); stopping treatment is the opposite of what the evidence suggests |
| Diabetes tablets and insulin | Metformin, gliclazide, insulin | Follow the anaesthetist's written plan for the fasting hours; do not improvise | Doses have to be matched to the fasting period, which is set by the anaesthesia team |
Two practical points. First, write the list with generic names, doses and times — "the small white one for my pressure" cannot be checked against anything, and brand names differ between Jakarta, Singapore, Los Angeles and Seoul. Second, list everything you take, including things you do not think of as medicine: fish-oil capsules, a nightly valerian, a TCM tonic, a weekly weight-loss injection. The JAMA review above was written precisely because patients did not mention them and anaesthetists did not ask.
Smoking, vaping and nicotine: the four-week line
Smoking is the pre-operative factor with the largest and best-documented effect on how a facelift heals. A 2012 meta-analysis pooling 140 cohort studies and 479,150 patients across surgical specialties found that smokers had 3.6 times the odds of tissue necrosis and 2.3 times the odds of wound complications compared with non-smokers (Sørensen, Arch Surg 2012). In a facelift, necrosis means a patch of lifted skin, usually behind the ear, that dies and heals as a scar. Grover's series added smoking to the haematoma list as well.
How long before surgery does stopping help? A separate meta-analysis of 25 studies found that quitting at least three to four weeks before surgery reduced wound-healing complications, and at least four weeks reduced respiratory complications; quitting for less than four weeks did not appear to make things worse, but did not reliably make them better either (Wong et al., Can J Anaesth 2012). Four weeks is therefore the practical line we give every patient, and the reason we ask about smoking at the first consultation rather than the last. Vapes, nicotine gum and patches are not automatically exempt: tell the surgeon what you use, and follow their instruction rather than assuming a nicotine product without smoke is harmless to a skin flap.
Anaesthesia: five questions to settle in writing before you fly
A facelift in Korea is performed under general anaesthesia or deep sedation. The questions below are the ones a Singapore, Indonesian or US patient cannot easily ask in person before arrival — which is why we put them in writing on the patient's behalf before the surgery date is fixed.
- Who gives the anaesthetic, and do they stay? Ask whether a board-certified anaesthesiologist administers the anaesthetic and remains present for the whole operation, or whether the surgeon or a nurse manages sedation. In our 24-criteria verification standard, anaesthesia cover is checked at the first door, not the last.
- Which type — general or sedation — and why for my case? Both are used for facelifts; the choice depends on the extent of the operation, your health and the clinic's set-up. What matters is that the answer is specific to you and given before you pay a deposit.
- Will the surgeon I met be the surgeon who operates? Since 2018, Korean law has required the operating surgeon to be named on the consent form, and substituting another operator is punishable (legal analysis: Hong et al., Ann Surg Treat Res 2018). Read the name on the form before you sign it — we explain how in Ghost surgery in Korea.
- Will the operation be recorded if I ask? Under Article 38-2 of the Medical Service Act, in force since 25 September 2023, any surgery under general anaesthesia must be recorded on request and the footage kept for at least 30 days (Korea Herald). The request is made in writing before surgery day; a clinic that hesitates has told you something.
- What is the plan if something goes wrong at 3 a.m.? Which hospital, who is called, and who pays. A facelift patient is usually discharged the same or next day, so this is a question about the days after, not the operation itself.
Then the disclosures the anaesthetist needs from you, in writing and in advance: any previous problem with an anaesthetic (yours or a blood relative's), snoring or diagnosed sleep apnoea, allergies including to plasters and latex, loose teeth or dental work, and your full medication list from the table above. None of these disqualify you; all of them change how the anaesthetic is planned.
The morning of surgery: fasting rules that are actually evidence-based
"Nothing after midnight" is a tradition, not a guideline. The American Society of Anesthesiologists' practice guideline for healthy adults having elective surgery sets shorter, specific intervals, and most Korean anaesthesia teams follow the same framework (ASA Task Force, Anesthesiology 2017); a 2023 modular update added guidance on carbohydrate-containing clear drinks (Joshi et al., Anesthesiology 2023).
| What | Minimum fasting time before anaesthesia (ASA, healthy adults) | Notes for a facelift patient |
|---|---|---|
| Clear liquids — water, clear juice without pulp, black tea or coffee | 2 hours | Small sips are permitted up to this point; milk in tea makes it a non-clear liquid |
| Light meal — toast, clear soup | 6 hours | An early, light breakfast is often possible for an afternoon operation — but only if the clinic confirms the timing |
| Fried or fatty food, meat, a full meal | 8 hours | The usual reason a morning-list patient is told to stop eating the night before |
| Your regular morning tablets (as agreed with the anaesthetist) | — | Take with a sip of water; blood-pressure medicines are normally continued (see the table above) |
| GLP-1 injection users | Individual | The 2024 guidance may extend the interval or require clear liquids only for the previous 24 hours; follow the written instruction |
The clinic's instruction, given for your surgery time, is the one to follow. If it is longer than the ASA intervals, that is usually because a list can run early; if it is shorter, ask why.
What to bring, and what to leave
Patients tend to over-pack clothes and under-pack paper. The paper is what an anaesthetist and a surgeon can act on; the clothes only need to open at the front.
| Bring | Why |
|---|---|
| Medication list — generic names, doses, times — plus the original packaging or prescriptions | The single most useful document you can hand to the anaesthesia team; it is also what a Korean pharmacy needs if a prescription must be continued |
| A letter from your cardiologist or physician if you take prescribed aspirin, an anticoagulant or a GLP-1 injection | Turns a patient's guess into a doctor's instruction on what to hold and when to restart |
| Recent blood results and an ECG if you are over 50 or have a chronic condition | Most clinics will repeat their own tests, but a baseline from home shortens the pre-assessment and can prevent a postponement |
| Passport, travel-insurance certificate, and the clinic's written quotation and instructions | The quotation is what any dispute is settled against — see what a facelift quote should contain |
| Button-front or zip-front tops for the first two weeks; a soft scarf, a wide hat, sunglasses | Nothing that pulls over the head; the scarf covers the compression garment and the hat covers the incision line on the flight home |
| Glasses rather than contact lenses; a lip balm; a small travel pillow | Swelling makes lenses awkward for a few days; lips dry after anaesthesia; the pillow keeps the head elevated on the return flight |
| Paracetamol you know you tolerate, and any regular medicine for the full stay plus a week | Do not assume a like-for-like brand is stocked in Seoul |
Leave at home: aspirin-based travel painkillers, the supplement pouch, and — for the fortnight after surgery — the expectation of a long walking itinerary. When you can sit in a window seat again is a separate question, answered day by day in our recovery timeline.
The four weeks before, in order
Four weeks out: stop smoking and vaping; send your medication list and any specialist letters; confirm who gives the anaesthetic and that the surgeon named on the quotation is the one on the consent form. Two weeks out: stop over-the-counter aspirin and NSAIDs and all supplements, unless the clinic's written instruction gives a different interval; put the CCTV recording request in writing. One week out: receive the fasting instruction for your surgery time; confirm the plan for any prescribed blood-thinner or GLP-1 injection in writing from the prescribing doctor. The day before: last full meal at least eight hours before the anaesthetic; no alcohol. The morning: clear liquids up to two hours before; agreed tablets with a sip of water; hair washed, no make-up, no jewellery, no contact lenses.
Medical Korea Service (Registered Facilitator for International Patients — Seoul Metropolitan Government, Reg. No. A-2014-01-01-1414, registered 23 July 2014) asks every Indonesian facelift patient specifically about jamu and other herbal preparations at the first consultation, because in our experience they are almost never volunteered on a medication list, and three of the commonest ingredients — garlic, ginkgo and ginseng — are on the JAMA bleeding list.
For Singapore patients, Medical Korea Service (Reg. No. A-2014-01-01-1414, Seoul Metropolitan Government, registered 23 July 2014) requests a letter from the prescribing physician whenever a patient over 50 takes a daily aspirin, a statin or a blood-pressure medicine, so that the decision to hold or continue is made between doctors and the clinic receives it before the surgery date is confirmed.
For US patients, Medical Korea Service (Reg. No. A-2014-01-01-1414, Seoul Metropolitan Government, registered 23 July 2014) adds two items that domestic Korean patients rarely need: the date of the last GLP-1 injection, now common enough to have its own 2024 anaesthesia guidance, and a clot-risk conversation with the surgeon before a return flight of twelve hours or more.
Frequently asked questions
Can I take paracetamol before a facelift?
Usually yes — paracetamol (acetaminophen) does not affect platelets and is the painkiller most clinics permit before and after surgery. The ones to stop are aspirin and the non-steroidal anti-inflammatories such as ibuprofen and naproxen, which were an independent haematoma risk factor in the 1,078-patient series. Confirm the interval with the clinic's written instruction.
I take a daily low-dose aspirin for my heart. Should I stop it for a facelift?
Not on your own. Prescribed aspirin or anticoagulants are stopped, bridged or continued on the written instruction of the doctor who prescribed them, coordinated with the anaesthetist. We request that letter before the surgery date is fixed, so the clinic is not asked to decide on the morning of surgery.
Do I have to stop smoking for a facelift in Korea?
Every reputable surgeon will ask you to, and the evidence supports a line of at least four weeks: smokers had 3.6 times the odds of tissue necrosis across 140 studies, and quitting three to four weeks or more before surgery reduced wound complications. Vapes, gum and patches should be declared and handled on the surgeon's instruction rather than assumed safe.
Can I eat breakfast on the morning of surgery?
It depends on your surgery time. The ASA guideline for healthy adults allows a light meal up to six hours before anaesthesia and clear liquids up to two hours before; a fatty or full meal needs eight hours. The clinic's instruction for your list time is the one to follow, and patients on GLP-1 injections may be given a longer interval.
Related reading: What Korean clinics won't tell you before a facelift · Day-by-day recovery and when it is safe to fly home · Ghost surgery in Korea: the CCTV law and how to make sure your surgeon operates · Facelift in Korea by age: 40, 50 and 60+ · How we verify Korean plastic surgeons — the 24-criteria standard · Facelift in Korea — how we match you to a verified specialist
This article was prepared by Medical Korea Service as general pre-operative information for patients considering a facelift in Korea. It is not medical advice and does not replace the written instructions of your surgeon, anaesthetist or prescribing physician, which govern in every case. Study figures are quoted from the peer-reviewed sources linked in the text; intervals given as "commonly" or "typical" describe usual clinic practice and vary between clinics and patients. Ledger figures are drawn from facelift plans MKS coordinated between 2019 and 2026 and are limited to counts and ages; no patient is identifiable.