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Body Mass Index: BMI for Surgery

Body Mass Index BMI For Surgery

Body Mass Index, or BMI, is a number that is calculated based on your height and your weight. It is a measure of obesity. You can calculate your BMI by using a BMI calculator that you can easily find on the internet. When you plug in your height and your weight, you will get a number, and this number characterizes your degree of obesity:

  • Less than 18.5 = underweight
  • 5 – 24.9 = normal
  • 25 – 29.9 = overweight
  • 30 – 34.9 = obese
  • over 35 = extremely obese

Why Does Body Mass Index (BMI) Matter?

The importance of BMI is that it reflects your risk of diabetes, high blood pressure, heart disease, and obstructive sleep apnea among other obesity related health conditions. This is why using a BMI calculator is so important so that you can be acutely aware of your own Body Mass Index and modify your diet and activity level if needed. After using a calculator some decide to pursue weight loss surgery to get to a healthy weight before plastic surgery.

BMI is also very important in Plastic Surgery at Schulman Plastic Surgery NYC since it also reflects surgical risk. Whether a patient has undergone weight loss surgery to get to a healthy weight before pursuing plastic surgery or has not undergone weight loss surgery in the past, it is important to be knowledgeable about your BMI. It is extremely important when evaluating someone for an elective procedure like cosmetic surgery. This is because the level of obesity is related to the risk for complications during and after surgery, as well as predicting your body’s ability to heal from surgery. The data shows that people with a BMI above 30 are at increased risk for having a surgical complication. 

These complications may include a negative reaction to anesthesia, breathing problems, heart attack, stroke, and blood clots. High blood pressure is always a concern for any patient. These obesity related health conditions and complications can be serious and even fatal. Additionally, we know that people with a BMI over 30 are at increased risk for healing problems. This means that incisions may be slower to heal, there can be infections, and there can be an overall poorer cosmetic result. This is extremely important with procedures requiring long incisions such as tummy tucks and breast reductions.

What are the Body Mass Index (BMI) Recommendations for Surgery?

Based on this data, Board Certified Plastic Surgeons generally require that their patients have a BMI of 30 or below before proceeding with elective cosmetic surgery. This means that they are likely to decline to perform surgery on you if your Body Mass Index is above 30. This makes sense, since we certainly would never want to place you at risk, especially for an elective cosmetic procedure. Of course, if you needed life-saving surgery, the surgeon will perform the procedure no matter what your BMI is, and you would accept the added risk.

But plastic surgery is different since it is not medically necessary and we try to minimize all risks as much as possible.

Criticism of Body Mass Index (BMI)

The criticism of using a BMI calculator and Body Mass Index calculations is that it is imprecise and doesn’t always accurately reflect someone’s actual level of obesity. Critics argue that since it is so imprecise, it is not a good indicator for surgical risk level. This is definitely true. A simple calculation using your height and weight does not take everything into consideration. A BMI calculator does not consider things like:

  • gender differences
  • bone mass
  • muscle mass
  • excess skin
  • fat distribution.

Men tend to have a higher BMI and this doesn’t necessarily mean that they are more obese. A muscular man may have minimal fat but a very high BMI. For example, NBA superstar Shaquille O’Neal stands 7’1” tall and 324 pounds. Using a BMI calculator this makes his BMI 31.5 and in the obese range, but no one would consider this elite athlete to be too obese for surgery.  Also, patients who have lost a lot of weight will usually still carry significant excess skin.

A person who has successfully lost 100 pounds and has no fat left on their body, may be carrying 20+ pounds of extra skin. Using a simple BMI calculator, they may have a BMI over 30 only because of the extra skin they are carrying around, even though it is not weight loss that they need. There is no Board Certified Plastic Surgeon that would deny skin removal surgery in this case, even though the BMI is above the accepted limit of 30. This is a case in which the patient is at a healthy body weight for a surgery that will positively impact their life, despite it appearing otherwise according to simply BMI.

Also, the location of the excess body fat is very important, and not considered when using a BMI calculator. There is a difference between peripheral and central body fat. Peripheral fat is excess body fat in the extremities, like thighs and legs. Central body fat is found in the abdomen, flanks, and back. Central fat is more dangerous since it has a higher correlation to obesity-related illnesses.

Peripheral fat, however, is not as directly related to obesity risks. Basically, an apple shape is more dangerous than a pear shape. These are some of the things that cannot be evaluated with a BMI calculator, but must be considered when analyzing someone’s BMI and whether they are a safe surgical candidate. 

A surgeon will probably be more willing to operate on someone with elevated BMI, if their excess body fat is found in the legs.  However, if the excess fat is located in the core, such as the abdomen, the surgeon is likely to deny elective cosmetic surgery.

My Personal Philosophy

Body Mass Index is an important metric but it is not the end-all, be-all.  BMI is a guide and needs to be used together with other things like a surgeon’s experience and physical evaluation of the patient.  In my practice, I absolutely use Body Mass Index to help me decide if I am going to operate on a patient. When someone calls to schedule a consultation, we always ask for a current height and weight, allowing us to calculate their BMI. 

Since I recognize that BMI is not totally accurate, I will allow people to be seen in consultation with a max BMI for surgery of at, or below, 32. I will then evaluate them in person and decide if it is safe to perform elective cosmetic surgery the way they are. This involves evaluating things like bone structure, excess skin, body fat distribution, and the desired plastic surgery procedure.

I may tell the person that they need to lose a few more pounds, in order to get their BMI for surgery below 30, and a healthy ideal body weight before I will agree to operate on them. I also find that I can offer a better cosmetic result when the BMI is closer to normal.

So, BMI is definitely something you should be aware of, since Board Certified Plastic Surgeons care about it.  You should google a BMI calculator and plug in your numbers to see what your specific BMI is.  This will help you be most prepared for your consultation and give you an idea whether or not you will be required to work on weight loss prior to your surgery. Your goal should be to have your BMI below 30 and as close to normal as you can. This will minimize your risk of surgical complications and also help to optimize your cosmetic result.

What to know about BMI and Weight Loss Surgery

Many come to understand that they want plastic surgery after a life change and weight loss. Some took months working to achieve weight loss through diet and exercise. Others, have lost weight through surgery as well as diet and exercise. What is important to note about weight loss surgery is that just because someone goes through a weight loss surgery doesn’t mean their BMI is at the right level for us to proceed with surgery. Assuming one is at a good BMI, a common surgery to be performed after losing weight by way of weight loss surgery or diet is a tummy tuck. 

What is Bariatric Surgery?

If you are considering undergoing bariatric surgery before pursuing plastic surgery, there are some things you need to know. According to health and human services, bariatric surgery is a weight loss surgery that diminishes the capacity for food intake and absorption by reducing the size of the stomach. Through bariatric surgery, this can be achieved through various methods, such as excising a portion of the stomach, encircling the stomach with a band, or altering the connection between the stomach and the small intestine. Metabolic and bariatric surgery is sometimes sought out before pursuing plastic surgery. It is important to note that bariatric surgery is not a surgery that is performed by a plastic surgeon. Bariatric surgery is performed by a bariatric specialist in order to help a patient lose weight.

Bariatric surgery is a serious surgery. According to health and human services, typically, bariatric surgery patients undergoing weight loss surgery can expect to be discharged from the hospital within 1 to 3 days. Resuming regular activities after bariatric surgery is feasible approximately 4 to 6 weeks post bariatric surgery. However, sustained, positive lifestyle modifications are essential for maximizing the benefits of bariatric surgery.

During the initial 6 to 8 weeks post bariatric surgery, a majority of bariatric surgery patients, irrespective of their specific weight loss surgery, are likely to experience a weight loss of approximately 10% of their excess weight. Subsequently, over the next 4 to 5 months, bariatric surgery patients can anticipate a cumulative weight reduction of around 50% of their excess weight. Some have questions about whether or not their insurance company will cover their weight loss surgery. Ultimately, it comes down to whether or not you satisfy the requirements of your insurance provider, which you very well may.

There isn’t a predetermined weight requirement for eligibility for bariatric surgery or other weight loss surgery procedures. Nevertheless, your doctor will assess your attempts at weight loss through diet and exercise, considering whether you encounter challenges in achieving weight reduction independently. This will help for your doctor to decide whether you are a good candidate for bariatric surgery. If you undergo bariatric surgery, it will be important for you to fully recover from your weight loss surgery before you pursue plastic surgery. Make sure to talk to your plastic surgeon about your prior weight loss surgery. Bariatric surgery is a serious weight loss surgery and it will be important that you are patient with your results, allowing yourself to fully heal before considering any other surgery.

Schedule your Consultation

Maximum BMI For SurgeryIf you would like to see if you are right for the procedure you want, are curious to know if you will need to lose weight before surgery, or if you are at a healthy weight currently, you can set up a consultation with Matthew Schulman M.D., New York City Board Certified Plastic Surgeon.


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