What Should My Weight Before My Plastic Surgery?

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.

A Tummy Tuck Explained

One of the most popular procedures performed by Board Certified Plastic Surgeons is a Tummy Tuck, or abdominoplasty.  There are almost 200,000 tummy tucks performed each year in the United States.  This is a procedure performed by 93% of all Board Certified Plastic Surgeons. The reason for it’s popularity is how powerful it is at transforming the body and erase years off someone’s appearance. 

 

What is a Tummy Tuck?

A tummy tuck is a procedure that addresses the abdomen and mid-section.  It simultaneously addresses skin, fat, and muscles in a one operation.  The result is a firmer, flatter, and smoother abdomen, Specifically, a tummy tuck includes:

 

  • Removal of excess abdominal skin
  • Tightening of lax or stretched abdominal muscles
  • Removal of excess fat with liposuction
  • Rejuvenation of the belly button

 

Who is a Good Candidate for a Tummy Tuck?

Because a tummy tuck addresses many aspects of the abdomen and mid-section, it is an operation appropriate for a variety of people.  If you have skin that has been stretched out from weight fluctuations, aging, or pregnancy, a tummy tuck may be right for you.  If you have a lot of stretch marks on your abdominal skin, a tummy tuck will help.  If pregnancy has left you with separation of your abdominal muscles, called rectus diastasis, a tummy tuck will tighten those muscles with the use of carefully placed internal sutures.  Because of the wide variety of things that this operation addresses, it can be appropriate for both women and men, young and old.

 

If any of the following applies to you, you may want to consider exploring a tummy tuck:

  • Your abdomen sticks out despite diet and exercise
  • Your belly has the appearance of you being pregnant
  • There is loose of hanging skin from your belly
  • Your skin has significant stretch marks

 

 

Preparation for Your Tummy Tuck

The first step is an evaluation by a Board Certified Plastic Surgeon, experienced in a tummy tuck procedure. During your evaluation, your surgeon will take your medical history and perform a physical examination. He or she will specifically examine your abdomen, looking carefully at the amount of excess skin, the quality of that skin, underlying muscle separation, and the presence of excess fat.  Your surgeon will also examine you for any underlying hernias, or holes in the abdominal wall.

 

If you are an appropriate candidate for the procedure, your surgeon will discuss specific details about the anesthesia, recovery, and scars.  He or she will also discuss the risks associated with this tummy tuck procedure. You will also be sent for medical clearance with your primary medical doctor. This will include a physical examination, bloodwork, and an EKG, along with any other tests required to make sure you are healthy enough to undergo the surgery.

 

Where is the Procedure Performed?

A tummy tuck is a surgical procedure that needs to be performed in an accredited ambulatory surgery center or hospital. These are regulated facilities with the appropriate safety standards and appropriately trained staff.  The procedure is usually performed on an out-patient basis, meaning, you are able to go home the same day. In situations where other procedures are being done at the same time, you may be required to stay overnight for monitoring.

 

See Also Clearing up the confusion versus Liposuction and Tummy Tucks

 

The Surgery

  • The Anesthesia

The procedure is performed under intravenous sedation or general anesthesia. This anesthesia is administered by a Board Certified Anesthesiologist and you will be monitored the entire time. You breathing and heart rate will be monitored, as well as your oxygen level. 

 

  • The Incision

A tummy tuck is performed using a low incision the curves beneath your underwear of bikini line. This incision is used to lift up the skin and expose the muscles of the abdominal wall.  The incision also allows removal of the excess skin.  A lot of effort is made to keep this incision well hidden beneath clothes, since the incision is what creates the scar. During your pre-operative visit, your Plastic Surgeon may ask you to bring in underwear and bikini bottoms. This helps to determine the best placement of the incision, since modifications of the incision can be made depending the type of clothes you prefer to wear. 

 

The length of the incision, and ultimate scar, will depend on the amount and distribution of excess skin. If your excess skin is mostly in the front of your abdomen, you may require a shorter incision than if you had extra skin more on the sides by your flanks. Of course, everyone prefers a short scar, but the shorter the incision, the less skin that can be removed.  There is a balance. Your surgeon will draw the planned incision on you so you can visualize where the scar will be located and how long it will be.

 

  • Repairing the Muscles

After the incision is made, the skin of the abdominal wall is lifted. This exposes the underlying muscles. Very commonly after pregnancy, aging, and weight fluctuations, the abdominal muscles separate in the midline. This is called a rectus muscle diastasis and can make the abdomen appear to bulge outward. The muscles are normally responsible for keeping a flat, tight abdomen, but when they are separated, they cannot hold back the internal organs. This can give the appearance of being bloated and pregnant.

 

Carefully placed sutures are placed in the abdominal muscles, bring the muscles back to the midline.  This is the most powerful part of a tummy tuck and serves as an internal corset, flattening the belly and narrowing the waistline. This muscle tightening, or plication, is done all the way form the breast bone to the pubic bone.

 

  • Removing the Skin

After the muscles are tightening, the skin of the abdominal wall will be pulled downward. The excess skin will be marked and then cut off. Usually all the skin between the initial incision and the top of the belly is removed.  Any stretch marks on this skin is also removed. Multiple layers of sutures will be placed connecting the remaining skin back together, resulting in a low, smooth scar.

 

  • The Belly Button

Up to this point, the belly button was left attached to the abdominal wall.  The next step is to bring your old belly button out through a new opening.  The location of your belly button is marked and a small opening is made. The belly button is then brought through this opening and secured in place with meticulous sutures. The creation of the belly button is a critical step in your tummy tuck, since it is essentially the only scar anyone will see. Overly large or overly round belly buttons tend to appear “surgical” and are a tell-tale sign of a tummy tuck.  The ideal belly button tends to be a vertically-oriented oval belly button that is not too large.

 

  • Liposuction

In a well-crafted tummy tuck, liposuction is the icing on the cake. It allows the surgeon to perform the final contours. Specifically, any residual fat can be removed. Usually, liposuction is done on the flanks, bra rolls, and upper abdomen.  Careful grooves can be made in the midline, creating highlights that accentuate the natural contours of the underlying muscles.

 

Recovery

After a few hours in the recovery room, you will be allowed to go home with your escort. You will have pain medication and antibiotics. The first few days is usually the worst, since you will be “hunched over” and in pain, but it will be manageable.  After about a week, most people feel better, but not great. You should plan on having help at home for a few weeks. You are encouraged to walk throughout this process to promote good circulation. While everyone is different, most patients will require about 3 weeks off from work and 6 weeks off from heavy exercise.

 

Scar management

Scars never go away, but they will fade. Special care is taken during your surgery to promote good healing and the best possible scar. However, everyone’s skin is different and creates different scars. Some scars are thin and flat, while others are raised and dark. Your Board Certified Plastic Surgeon should be able to assess your skin before surgery in order to determine the types of scar you are likely to produce. In general, the darker the skin, the higher the possibility of thick and dark scars.  If you have a history of making “bad” scars, be sure to let your surgeon know about that so proper precautions can be made.  There are some things that can be done after the surgery to help your body create better scars These include the early use of silicone scar gels or tapes, and laser treatments.  Your scar will continue to evolve over the next 9-12 months. During this time, you should limit the exposure to the sun since UV rays can make the scar appear more red and irritated.

 

Combining a Tummy Tuck with Other Procedures

It is very common to combine a tummy tuck with other procedures. Most commonly, tummy tucks are combined with breast implants, breast lifts, or breast reductions. This is because breasts, like the abdomen, are very susceptible to changes associated with aging, weight fluctuations and pregnancies.  Breast and tummy procedures combine well together and can be performed in a single operation, assuming you are healthy.  Combining multiple procedures together is commonly called a Mommy Makeover.  Other procedures commonly combined with a tummy tuck include a Brazilian Butt Lift, where your own fat is used to increase the size and improve the shape of your butt and hips.

 

If you would like to learn more about slimming your abdomen and gaining back the confidence, contact Board Certified Plastic Surgeon, Dr. Matthew Schulman. During your consultation, you can find out if a tummy tuck is right for you.

Do You Need to Change Your Breast Implants Every 10 Years?

Breast augmentation with implants is among the most popular cosmetic surgery procedure performed worldwide. Women want to know if they need to change their breast implants every 10 years. This is a very common question asked by women who have breast implants, or women who are thinking about getting breast implants.  The quick answer is “No.”  Implants are not car tires that have an “expiration date”. They are carefully studied medical devices that you can technically live with forever. They don’t “stop working” or “fall apart” 10 years after they are placed.

 

What Type of Issues Can I have with My Breast Implants?

Like with anything, issues can occur. There is a small chance that your breast implant can rupture or leak.  The shell of the implant may develop a small hole or tear over time.  Also, some abnormal thickened scar tissue may develop around the implant, making the implant feel hard. This is called capsular contracture and can vary from very mild to more severe.  Mild capsular contracture can result in an implant that feels slightly “harder”.  As the severity increases, the scar tissue can distort the shape of the implant, making is appear more oval than round.  Severe capsular contracture can cause painful breasts.

 

Other issues with breast implants can occur, such as implant malposition or “shifting”.  The implant may appear to shift upwards or even into sideways into the armpits.  The may also be visible folding or rippling of the implant, or bottoming out where the implant seems to drop below the breast fold.  These would be reasons to change, or remove, your breast implants.  So, as you can see, there are certainly reasons why you may need to have another surgery on your breasts after breast augmentation surgery.

 

 

Where Did The 10-Year Recommendation Originate?

Where did the “ten-year” thing come from and why does everyone focus on this time frame?  “Ten-years” exists for a variety of reasons.  The FDA studies that were done on breast implants were incredibly detailed and carefully followed women for 10 years. The studies found that although the rate of all complications was relatively low, the risk increases the further out you get from the date of surgery. So that means that you are more likely to experience an implant-related complication at 10 years after your surgery then you would only 3 years after your surgery. This does not mean that you WILL experience a complication at 10 years. It just means that the longer you have your breast implants, the higher the likelihood. The vast majority of women, however, do not experience any problems at 10 years after surgery. I have met some women, including some of my own patients, who have had breast implants for 20 years and have absolutely no adverse issues.

 

What Do I Tell My Patients?

So what does this mean and what recommendations do I give to my patients who are thinking about getting breast augmentation with breast implants? I tell all my patients that breast implants are not considered a “lifetime” device. In fact, the FDA specifically says that breast implants should not be considered a lifetime device. If you have breast implants placed when you are young, there is a very high likelihood that you will have another surgery (or surgeries) on your breasts in your lifetime. However, it will usually be because you “want” another surgery, not because you “need” another surgery.

 

Why Would You Want Another Breast Surgery?

There are several reasons why you may choose to have another breast implant surgery, even if you are not having any complications like rupture, rippling, malposition, or capsular contracture. Perhaps you decide that you want a different size. Maybe you want them to be made a little larger or a little smaller. This would require that you schedule a surgery to exchange the implants.  Maybe your body changes as you age, or after childbirth, and your breasts change in size or shape. It would not be uncommon to require a breast lift, or breast reduction, after aging, weight fluctuations, or pregnancies.  This would require and additional breast surgery.  You may also just want to “upgrade” your breast implants.  Technology is always changing and improving, and breast implants improve.  The implants we have today are significantly better than the implants we offered just a few years ago.  It is also true that the implants we will offer in the future will be even better in terms of safety, comfort, and appearance. In this case, you may want to “upgrade” in the future to an improved implant.

 

Why Would I Want to Upgrade My Implants in the Future?

There are many women coming in today to have their older implants changed to current implants that are more advanced.  For example, 10 years ago, most women were getting breast augmentation surgery with saline, or salt water, filled implants. These implants are satisfactory and have been placed in millions of women. However, they have a higher rate of visible rippling and also tend to look and feel a little more “fake” than silicone alternatives.  The data also shows that these implants have a higher rate of rupture, or leaking, than current silicone implants.  Many women who have saline implants, are electively asking to change to silicone implants now.  Also, even women who received silicone implants years ago, are requesting that their implants are changed. This is because the silicone implants of the past are very different than the silicone implants of today. Older silicone was a liquid consistency. Today’s silicone is a cohesive gel, or a “gummy bear” consistency.  The more cohesive silicone tends to look and feel more natural as compared to older, liquid silicone.  New, cohesive silicone implants have a lower incidence of leaking, rupture, and capsular contracture.

 

 

What if I Am Not Willing to Have Another Surgery in The Future?

It is indisputable that if you are considering breast implant surgery, you should accept that at some point you may have more surgery. If you are 100% opposed to any future surgeries, then breast augmentation with implants is not the procedure for you, since additional procedures are likely. It is possible that additional surgery will be needed because of an implant-related complication, but more likely it will because you desire a change or an upgrade.  The 10-year mark is a fabricated number, but it is a reasonable guide for you to be aware of.  It serves as a good mental reminder that you may want to consider a change or upgrade. But, if you are happy with your size, and you are not experiencing any implant-related issues, you do not have to schedule a routine procedure after 10 years.  So, while you may find that you want to change your breast implants after 10 years, you are not required to.

 

Learn More About Breast Augmentation

You can learn answers to more Frequently Asked Questions about breast augmentation here.

 

When you’re ready to discuss your plastic surgery goals with Dr. Schulman and specifically discuss breast augmentation, feel free to give our New York City office a call at (212) 289-1851. We’d be pleased to help you schedule an appointment and get you in for your initial consultation with Dr. Schulman.