What is a Good BMI for 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 cosmetic surgery, like plastic 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 in NYC 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 healthy weight

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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. Weight loss and weight gain are common over the course of one’s life. 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 plastic 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). For people who have undergone gastric bypass surgery, it is also important that their weight is stable leading up to surgery. Whether you have reached your goal weight through exercise or a weight loss surgery, maintaining a stable weight before surgery is important. 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 loss or weight gain.

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 significant weight loss or weight gain, which is why a complete medical evaluation is necessary.

What Should My Weight Be Prior to Plastic 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

We calculate your body fat based on your height against your weight. This results in your BMI. The reason why a healthy BMI matters is because the data shows that the risk of complications increases as BMI increases. If you don’t have a healthy BMI there are 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 cosmetic surgery designed to shape the body such as a tummy tuck, 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 Is A Good BMI For Plastic Surgery?

We prefer that your BMI be 30 or below before you undergo elective cosmetic surgery. We consider this a healthy BMI for the sake of surgery. If it is not, weight loss work may be needed on the part of the patient. We may ask that you lose weight before surgery 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” and certainly within a healthy weight range, by any standard. It would seem strange to suggest that he should lose weight before surgery.

This shows some of the imperfections of the Body Mass Index calculations. Accordingly, plastic surgeons do allow some flexibility when using BMI. The body mass index 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 body mass index BMI number 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 cosmetic surgery.

Can My BMI Be Too Low for Plastic 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 plastic surgery. This may be related to the cosmetic surgery 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 body 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 cosmetic surgery procedure, called a Brazilian Butt Lift, would not be suitable for people who lack adequate body fat. So it is possible to be “too skinny” for a Brazilian Butt Lift, or BBL.

Other common cosmetic surgery procedures that are problematic in people with low BMIs would be a tummy tuck 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. When it comes to a tummy tuck, 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 plastic surgery procedure you are requesting. No matter what surgery you are considering, if you are wondering about the ideal BMI for BBL or considering a tummy tuck surgery, liposuction or something else, your BMI factors into your eligibility for surgery. 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 work on weight loss prior to plastic 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.