It is important to be in optimal physical shape before any surgery. Healthy people heal faster and better than people who are unhealthy. When it comes to any invasive procedure, like surgery, complications can occur that can place you at risk. Being strong and healthy will reduce your risk of serious or minor complications during and after surgery. Cosmetic surgery is elective, meaning that you “want” it but don’t “need” it. This makes safety even more important. You will be completely evaluated by your primary medical doctor prior to your surgery. Being healthy for surgery includes:
- Having any chronic medical conditions controlled
- Not having any serious medical problems
- Not smoking cigarettes
- Having normal blood work results
- Being at a safe weight
Should My Weight Be Stable Prior to My Surgery?
We require that a person’s weight be stable and also within a relatively normal range. It is common for someone’s weight to fluctuate a few pounds up or down. Many people find that they put on about 7-10 pounds of “winter weight” and then slim down in the warm weather months. However, you should not have surgery if your weight is steadily going up or going down. It is important for your weight to be stable for about 6 months (give or take a few pounds). This allows your skin to adjust and tighten. If you are having trouble stabilizing your body weight, you should be evaluated by your medical doctor. While weight changes are due to diet and exercise, or lack of it, there are some medical problems that can account for weight changes. Diabetes and low thyroid can cause weight gain. Hormonal changes, commonly associated with menopause or birth control, can result in weight gain as well. Over-active thyroid can result in uncontrolled or unintended weight loss. There are dozens of medical conditions that can result in unintended weight changes, which is why a complete medical evaluation is necessary.
What Should My Weight Be Prior to Surgery?
So, your weight is relatively stable, but what should it be? Generally, we want your weight to be in a safe range, not too high, and not too low. This is why we use a guide called Body Mass Index, or BMI. BMI is number that is generated by using your height and your weight. The calculation is:
BMI = Weight (kg) / height (meters)2
But don’t worry! You can simply google “BMI calculator” and there are several calculators that will do the math for you.
Why Does BMI Matter?
Using a BMI calculator, you will be categorized based on your number:
- Underweight = <18.5
- Normal weight = 18.5–24.9
- Overweight = 25–29.9
- Obesity = BMI of 30 or greater
The reason why BMI matters is because the data shows that the risk of complications increases as BMI increases. These complications include complications that can occur during surgery as well as those that can occur after surgery. Elevated BMI can place you at increased risk for anesthesia-related complications with your heart and lungs. It can also increase your risk for delayed wound healing, poor wound healing, scarring, and infection after the surgery. Patients with an elevated BMI may also have a poorer cosmetic outcome. This is particularly true for procedures designed to shape the body such as tummy tucks, liposuction, and mommy makeovers. So, BMI, or Body Mass Index, is an important tool for assessing your risk of complications or poor cosmetic outcome.
What Should My BMI Be Before Surgery?
We prefer that your BMI be 30 or below before you undergo elective cosmetic surgery. This is because your risks increase as your BMI rises above 30. However, it is important to realize that BMI is not a precise predictor of complications or results. It is just a guide. For example, some people with an elevated BMI would not really be considered “obese”. Since the calculation is only using height and weight, it does not account for muscle mass or bone structure. Some people who are in amazing physical shape may actually be categorized as “obese” solely based on the BMI calculation. For example, think about someone like Serena Williams. She is an elite athlete and in amazing physical shape. However, using her height and her weight in a classic BMI calculation, she would be classified as “overweight”. Men have similar issues with the classic BMI calculations because of the increased muscle mass. Kevin Durant would similarly be classified as “overweight”, but no one would ever really consider him “overweight”. In fact, most would consider him “skinny” by any standard.
This shows some of the imperfections of the Body Mass Index calculations. Accordingly, plastic surgeons do allow some flexibility when using BMI. The BMI number must be combined with careful examination of each person. Sometimes people with a BMI of 25 is more overweight than someone with a BMI of 30. In my practice, I will allow a consultation for people with a BMI 32 or below. Depending on what I see during the examination, I may agree to operate on them at their current weight, or I may require weight loss prior to surgery.
Can My BMI Be Too Low for Surgery?
It seems obvious why a very high Body Mass Index would make someone a poor candidate for an elective cosmetic procedure. However, sometimes a BMI can be too low. Someone can be “too skinny” for a surgery. This may be related to the procedure they want done. For example, if someone is requesting liposuction, there needs to be some fat to be removed. If you don’t have much body fat, then there is nothing to removed. Attempting to remove fat in someone who has very little to begin with, will likely result in contour abnormalities that may be impossible to fix. Also, those who desire to have fat transfer to an area of their body, such as their butt and hips, require their own “donor fat”. This procedure, called a Brazilian Butt Lift, would not be suitable for people who lack adequate fat. So it is possible to be “too skinny” for a Brazilian Butt Lift, or BBL.
Other common procedures that are problematic in people with low BMIs would be tummy tucks and breast implants. In very thin people, the sutures used to tighten the underlying abdominal muscles during a tummy tuck, may be visible or palpable beneath the very thin abdominal skin. This can cause pain and unsightly appearance even after the most successful tummy tuck. Similarly, very thin women may not achieve the best cosmetic result with breast implants, because the implant may be less camouflaged. The result can be breast implants that are palpable and have visible rippling and wrinkles. Very visible and palpable breasts implants is a common reason why women request to have breast implants removed.
Know Your Body Mass Index Before Your Consultation
As you can see, BMI is an important tool that plastic surgeons use to help determine if you are an appropriate candidate for the procedure you are requesting. This means that you should know your BMI before you have your consultation. You should check your weight at home and put those numbers into one of the many BMI calculators available on the internet. You will then be aware of your actual BMI number and be able to have an informed and intelligent discussion with your Plastic Surgeon at your consultation. It will also help you understand why we sometimes tell patients that they should lose weight prior to surgery. The recommendation to lose weight is based on your plastic surgeon’s desire to give you optimal results in a safe manner. Since you are asking for an elective cosmetic procedure, our job is to avoid any complication whenever possible.
If you would like to learn more about the procedure you are interested in, and find out if you are an appropriate candidate, contact New York City, Board Certified Plastic Surgeon, Dr. Matthew Schulman.