Psychiatric Comorbidities Requiring Antidepressant Therapy and Their Impact on Wound Healing and Postoperative Complications in Facial Plastic Surgery: A Propensity-Score Matched Analysis

BACKGROUND: Antidepressant medications are widely prescribed, yet their perioperative effects in facial plastic surgery remain poorly defined. Certain antidepressant classes have been associated with altered platelet function and potential changes in wound healing. This study evaluated the association between preoperative antidepressant exposure and postoperative complications following aesthetic facial plastic surgery procedures. METHODS: A retrospective cohort analysis was conducted using the TriNetX Research Network. Patients undergoing rhinoplasty, blepharoplasty, or rhytidectomy were identified using procedural codes. Antidepressant exposure, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, and atypical antidepressants, was defined as documented use within 6 months before surgery. Propensity score matching (1:1) adjusted for demographic and clinical covariates. Postoperative complications were assessed at 30 days, 90 days, 6 months, and 1-year. Risk ratios (RR) with 95% CIs were calculated. RESULTS: After matching, 18,064 patients were included in each cohort. At 1-year, antidepressant exposure was associated with higher rates of any surgical site complication (3.40% versus 2.30%; RR 1.48, 95% CI: 1.30-1.69; P<0.0001), infection (3.19% versus 2.21%; RR 1.44, 95% CI: 1.26-1.65; P<0.0001), wound-related complications (1.22% versus 0.91%; RR 1.34; P=0.0047), seroma or hematoma (0.28% versus 0.16%; RR 1.73; P=0.0175), and unplanned readmission (3.85% versus 3.27%; RR 1.18; P=0.0114). Infection was the most consistent signal across all follow-up intervals. CONCLUSIONS: Preoperative antidepressant exposure was associated with increased postoperative morbidity following aesthetic facial plastic surgery. These findings highlight the importance of incorporating antidepressant use into perioperative risk assessment and patient counseling.