What Should My Blood Count Be Before My Plastic Surgery?

A proper blood count is required to be a candidate for elective cosmetic surgery. In otherwise healthy individuals, a low blood count is the most common reason for surgical cancellation or postponement. Let’s talk in more detail about:

  • what a low blood count means
  • what causes a low blood count?
  • what can be done to treat a low blood count?

What Testing is Required Before My Plastic Surgery?

It is necessary for you to be in optimal physical shape to be eligible for cosmetic surgery. Unlike other procedures that may be considered necessary, like gall bladder removal, appendectomy, heart surgery, gynecological surgeries, etc., cosmetic surgery is entirely elective. It is something you want, but not something you need. Accordingly, your Board Certified Plastic Surgeon should never place you at unnecessary risk to have a procedure that makes you look better. If your surgery was to save your life, then certain risks are necessary, but this is never the case with elective cosmetic surgery. Before your surgery, you will undergo a full medical evaluation to make sure you are healthy and that your surgery can be done safely. You will have a physical examination to evaluate your heart and lungs. You will likely undergo and EKG to make sure your heart is functioning correctly. Your surgeon may require specialized testing for any pre-existing medical problems. You will also have blood tests to further evaluate your health. One of these blood tests will measure your blood cells and specifically, your hemoglobin level.

What is Hemoglobin?

Hemoglobin is the protein component of your red blood cells, found in the center of every single red blood cell. It is the part that specifically binds oxygen so that the blood cell can carry oxygen and deliver it throughout your body. The normal hemoglobin level will depend on your age and gender:

  • Women: 12 or higher
  • Men: 13 or higher

What Are the Symptoms of Anemia (Low Hemoglobin Levels)?

A proper oxygen level in your blood is necessary for the normal function of your body. If someone has a low hemoglobin level, they will have a lower level of oxygen in their blood. This can starve the cells of the body of vital oxygen. This is called anemia. A proper oxygen level in your blood is necessary for the normal function of your body. The symptoms associated with anemia is determined by the severity of the anemia. Mild anemia can make you feel tired and fatigue. You may feel low energy and even cold. Moderate anemia is more concerning and can cause a rapid heart-rate, dizziness, and shortness of breath. This is because your body is low on oxygen and your heart automatically tries to work harder and pump faster, and your lungs try to get more oxygen from the air. Severe anemia can lead to heart attacks, arrhythmias, stroke, and even death. Adequate blood oxygen levels are also necessary to help you heal after injury or surgery. This means that even moderate anemia can increase your risk of having wound healing problems after your plastic surgery.

Your hemoglobin level is determined with a simple blood test called a complete blood count, or CBC. This is one of the standard blood tests obtained in preparation for surgery. There are also some rapid testing devices, called Hemacue, that will measure the hemoglobin level in a few minutes from a simple finger stick.

What Are the Causes for Anemia?

There are a variety of reasons for low hemoglobin. First, your hemoglobin level may be low because you are bleeding or have lost blood. This will happen after surgery, after trauma, or most commonly, if you have very heavy menstrual periods. Women with uterine fibroids and heavy periods, commonly have a low hemoglobin level from blood loss. Other causes of blood loss may be bleeding hemorrhoids, bleeding ulcers, or even colon cancers.

However, one of the most common reasons for low hemoglobin levels is iron deficiency. Iron is necessary in the production of blood cells and hemoglobin. Anything that causes decreased iron in the body can lead to deceased blood counts. This iron-deficiency may be because of a lack of dietary iron that is commonly found in meats like beef and liver. Vegetarians often have some degree of iron deficiency and are encouraged to increase their consumption of non-meat foods that are high in iron, like beans. People with iron-deficiency anemia require daily iron supplementation with iron pills. This is usually very successful in raising the hemoglobin level but can take several weeks to show improvement.

People who have had prior surgeries like stomach resections (because of cancer or ulcer disease) or bariatric (weight loss) surgery, are also prone to anemia. This is because they are lacking a critical part of the stomach necessary for absorption of vitamins and minerals necessary for red blood cell production.

Other less common causes of anemia include:

  • Genetic diseases like sickle cell or thalassemia
  • Bone marrow diseases like leukemia
  • Older age
  • Pregnancy
  • Kidney disease
  • B12 or Folate deficiency

How Can I Treat My Anemia?

A combination of history and laboratory tests can help determine the cause of your anemia. The treatment will depend on the cause of your anemia. If your anemia is from blood lost like heavy periods, you will need to see your gynecologist to evaluate you. Sometimes birth control pills can regulate your menstrual cycle, or uterine fibroids may need to be treated with medication or surgery. People with iron-deficiency anemia will require daily iron supplementation with pills. This is usually very successful in raising the hemoglobin level but can take several weeks to show improvement. In extreme cases of iron deficiency, intravenous iron infusions are sometimes necessary. In some cases, such as occurs from genetic diseases, it may be impossible to raise the hemoglobin level. Treatment of your anemia may require the involvement of a hematologist, or a doctor who specializes in diseases of the blood.

What Hemoglobin Level is Required for Surgery?

Usually, I require that my patients have a hemoglobin level of at least 12 to be cleared for surgery. This will of course vary depending on the planned procedure, since some procedures normally lose more blood than others. A breast augmentation results in virtually no blood loss, while a Mommy Makeover will come with more blood loss. Since all surgery causes some normal blood loss, some degree of drop in hemoglobin level is expected after your surgery. If you are starting at a low level before surgery, then the level may be a more significantly lower level after the surgery. This can set you up for the potential complications after surgery, even if you have never had previous signs of anemia.

Avoiding serious complications during surgery and making your recovery better, is the reason why you need to have an appropriate hemoglobin level prior to surgery. If you are unclear of your hemoglobin levels, you can have this tested very easily. You may be surprised. If you have always been a little fatigued, or felt a bit more tired or look a little paler than your friends, you may be suffering from anemia. Since this is so common, especially in women, I think all women should be taking a daily iron pill. You may be shocked at how much better you feel after a few weeks.

Contact Dr. Matthew Schulman today to learn more about your options for safe plastic surgery.

Lost A Lot Of Weight? Plastic Surgery Can Improve Your Final Look

Lost A Lot Of Weight? Plastic Surgery Can Improve Your Final Look


Losing weight is a serious accomplishment, particularly if you’ve managed to lose a lot of weight and keep it off for good. It takes a lot of self-discipline, working against your body and society, and you should be proud of yourself. But what can you do if you lose all that weight only to find that you’re not happy with the results? This happens all the time because people lose weight and are left with a lot of loose skin.

Post-weight loss, loose skin is often concentrated around the waist, upper arms, and chest, and this excess skin can make otherwise remarkable weight loss results less than thrilling, but there is a solution: plastic surgery. Through the proper application of several different procedures, a surgeon can help you complete your body’s transformation, highlighting your hard work



What Procedures Address Excess Skin?

There are several different procedures that address the problem of excess skin, depending on where on the body it’s located. Among the most common are tummy tucks, arm lifts, and breast lifts. If you’ve lost a very large amount of weight, you may also need skin removal surgery; this is more common in those who have lost weight very quickly, since the skin doesn’t have a chance to contract back. Older patients are also more likely to need skin removal surgery because their skin is less elastic, due to reduced collagen production. Skin removal surgery targeting the area around the lower abdomen is known as a panniculectomy.

Most patients with excess skin require some combination of procedures to get the optimal results, but the procedures are not without risk. In addition to the usual risks associated with surgery, more extreme procedures like panniculectomy can leave significant scarring. For those who are concerned about scarring, a different selection of procedures may be more appropriate.

Why Remove Excess Skin?

In addition to issues of appearance, many people seek plastic surgery after losing a lot of weight because having hanging skin can actually present serious health risks. Specifically, loose skin can lead to infections, because the weight of hanging skin causes tears and the folds breed bacteria. That’s why many doctors will actually recommend that patients undergo these procedures once they’ve reached a stable weight. This isn’t just about how you look, but about your long-term health.

Body Lift Or Tummy Tuck?

Though the distinction may seem confusing at first, lower body lifts and tummy tucks – both common procedures among those who have loose skin – are radically different procedures, with the body lift being far more extreme. In body lift surgery, the surgeon actual performs a skin removal while also drawing up and tightening the skin around the entire lower body; there is also an upper body equivalent that addresses loose skin around the arms and back. As part of a lower body lift, you may also undergo liposuction for additional shaping, a buttock lift, and also buttock augmentation to adjust for the loss of shape, since the buttocks are prone to flattening.

Thought a tummy tuck is similar to a body lift, it targets a much narrower area of the body. Rather than addressing the thighs, waist, stomach, and arms all at once, a tummy tuck generally involved a panniculectomy coupled with tightening of the underlying musculature. Depending on the patient’s need, some patients also undergo additional liposuction.

Often, for patients with extreme weight loss, Dr. Schulman recommends an additional midline abdominal incision, known as a fleur-de-lis incision. Though this leaves an additional scar, it also allows for better contouring and the scars do fade over time, and the fleur-de-lis incision is widely considered to be safer.



Is A Breast Lift Enough?

Breast lifts are another common procedure among those who have lost a lot of weight, but it’s important to recognize that a breast lift may not be enough to address the results of such enormous physical changes. That’s because, while a breast lift repositions the breasts, it doesn’t change the amount of breast tissue or fat in the area. As such, depending on a woman’s final body shape, some may require an additional breast reduction or breast augmentation.

Some women have too much breast issue relative to their new body size, which can lead to back pain, which is why a breast reduction coupled with a breast lift may be appropriate. Others experience something more akin to the buttock flattening mentioned above. For these women, a combination breast augmentation and breast lift may be more appropriate, to create the desired proportions.

Male Breast Reduction – A Common Concern

While breast reduction and augmentation surgeries are commonly discussed, many men who have experienced substantial weight loss are left with “man boobs” – extra flesh around the chest from past fat stores. Unfortunately, this is much harder for men to talk about than for women seeking a breast lift. Many are ashamed to discuss the issue. However, men can also have breast reduction surgery, often combined with chest contouring procedures, which will resolve the problem, creating a more masculine, flat chest.

Arm Lifts And Other Procedures

One of the problems with loose skin following weight loss is that it can exist just about anywhere on the body, from the stomach and arms to the neck and back. Additional procedures like arm lifts, neck skin tightening, and other interventions can address loose skin elsewhere on the body. Every individual has different needs and different areas that they’re concerned about – your doctor will discuss your concerns with you and help you make the best decisions for your body.

Preparing For Post-Weight Loss Plastic Surgery


If you’re considering plastic surgery in New York City  of any kind after losing a lot of weight, it’s important to take your time. Dr. Schulman generally require post-weight loss patients to maintain a stable body weight for at least six months before these procedures, so you’ll need to demonstrate that you can remain at this new weight. Additionally, many formerly overweight patients have lingering health issues, ranging from Type 2 diabetes to high blood pressure, which can complicate the surgeries. Maintaining a stable, lower weight for at least a year can sometimes reverse these health issues and make surgery much safer.

Ready to get rid of excess skin after extreme weight loss? Then you need the best on your side. Contact Dr. Matthew Schulman today to learn more about your options for body shaping and contouring. You worked hard to change your life and lose weight – the right surgical procedures just reveal what’s hiding underneath.




When Is The Right Time For A Breast Lift? 5 Indicators

As women age, their breasts naturally begin to sag. Skin stretches and becomes less elastic, often sped along by childbirth or weight fluctuations. Though a completely normal process, many women find themselves dissatisfied with their changed appearance, leading some to consider having a breast lift.

Breast lifts are a common cosmetic procedure, often performed alongside other surgeries, such as breast augmentation or reduction and body contouring, but the surgery doesn’t just involve lifting the breast tissue. There are also several other factors that can make a woman a good candidate for a breast lift, with common reasons for pursuing the procedure ranging widely from correcting age-related breast shape changes to reducing areolar size. If you’re concerned about one of these 5 issues, a breast lift might be right for you.

You’ve Always Had Sagging Breasts

Breast lifts are largely associated with older women, or at least those who have already had children, but some women have a naturally droopy breast shape. This can make younger women feel self-conscious and can also make wearing a bra uncomfortable because the skin can bunch and fold. For young women who have always had a lower, more pendulous breast profile, getting a breast lift can provide the desired, perky shape typically associated with the youthful form.

Whatever your age, you can judge whether your breasts sag excessively at least in part by looking at where your nipples fall relative to your breast creases. Many doctors consider a breast lift to be advisable when the nipples point downward or fall below your breast creases. This is a good indicator that your breasts have lost their ideal form.

You’re Post-Pregnancy

Pregnancy can have a significant impact on the size and shape of a woman’s breasts. Many find that their breasts grow with the hormonal changes associated with pregnancy, stay large when their milk comes in and while breastfeeding, and then shrink and sag once their children are weaned. Even women who don’t breastfeed, though, may find that their breasts are significantly changed after childbirth, which is why many women pursue breast lifts after having children.

Often, women who seek a breast lift after having children do so as part of a multi-part “mommy makeover” procedure. A mommy makeover can include a variety of procedures, including breast augmentation or reduction, tummy tuck, and liposuction. The mommy makeover is one of the fastest growing surgery procedures and can reduce recovery time for patients and is widely considered safer because it involves just a single round of anesthesia. Many celebrities have undergone mommy makeovers to get their pre-baby looks back, and that has also contributed to the procedure’s increased popularity.

You’ve Lost A Lot Of Weight

Besides aging and pregnancy, weight loss is one of the most common reasons that women pursue breast lift surgery. Though each woman gains and loses weight in different parts of the body, substantial weight loss almost always leaves behind sagging skin – often around the stomach, breasts, and arms. A breast lift will remove some of that excess skin and shift the breasts back into their pre-weight change position.

Many women who undergo breast lifts after weight loss also choose to have a breast augmentation or reduction. That’s because breast lifts don’t change the amount of breast tissue or fat present in the area – the procedure just adjusts where the breasts fall on the body and their general shape, reversing sagging. To attain a more natural body shape and one that best fits the frame, then, many women have these procedures performed together.

You Have Very Large Areolas

This may seem like an unusual reason to have a breast lift, but in fact, Dr. Schulman regularly performs breast lifts to address this problem. That’s because a woman’s areolas often stretch with the rest of the breast tissue due to weight gain or tissue sagging, and many consider it unsightly. But what does a breast lift do to change areola size? During the procedure, Dr. Schulman not only removes excess skin and repositions the breasts, but also resizes and repositions the areolas. That includes cutting away excess skin, leaving a more visually pleasing and appropriately sized areola relative to overall breast size.

Your Breasts Are Different Sizes Or Sit Unevenly

Unequal breast size or position can have many different causes. Some women’s breasts naturally develop that way, while others find that their breasts are uneven just as the result of time or weight fluctuations. Regardless of the cause, a breast lift allows your doctor to reposition your breasts and adjust them to appear more even. An implant or reduction can also be performed at the same time to even out unequally sized breasts and attain a more balanced profile.

Other Considerations

There is no standard or best age to have a breast lift, but there are a few factors to consider. First, young women are more likely to experience re-stretching of the skin around the breasts, as well as weight fluctuations that could significantly impact the outcomes of a breast lift. This is why the procedure is mostly done on older women – their breasts have already undergone most expected stretching from gravity, whereas younger women have yet to experience the bulk of elasticity loss.

Another concern for younger women is that having a breast lift can, in some cases, impact the ability to breastfeed. Though most women won’t have a problem breastfeeding after the procedure, those who have their areolas resized and positioned may have difficult producing enough milk. Future pregnancies can also undo the results of a breast lift by re-stretching the skin, potentially necessitating a revision surgery.

Find Your Ideal Shape With Dr. Matthew Schulman

If your breasts are sagging due to the effects of age, pregnancy, or breastfeeding, you may be a good candidate for a breast lift, but you don’t have to make the decision alone. To learn more about the breast lift process and to discuss you needs, contact Dr. Matthew Schulman today to schedule a consultation. Everyone deserves to feel confident in their body and Dr. Schulman can help you attain your ideal shape.