Body Mass Index (BMI) and your 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. There are dozens of free BMI calculators 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 is reflects your risk of obesity-related health problems such as diabetes, high blood pressure, and heart disease, among other conditions. This is why you should be aware of your own Body Mass Index and modify your diet and activity level if needed.

BMI is also very important in the surgical world since it also reflects surgical risk. 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. These can be serious and even fatal.  Additionally, we know that people with 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 with 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. BMI 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. 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.  There is no Board Plastic Surgeon that would deny skin removal surgery in this case, even though the BMI is above the accepted limit of 30.

Also, the location of the excess fat is very important, and not considered in the BMI calculations. There is a difference between peripheral and central fat. Peripheral fat is excess fat in the extremities, like thighs and legs. Central 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 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 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 if their BMI is 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, fat distribution, and the desired procedure. I may tell the person that they need to lose a few more pounds, in order to get their BMI below 30, 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 lose weight 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.

Schedule your Consultation

If you would like to see if you are right for the procedure you want, you can set up a consultation with Matthew Schulman M.D., New York City Board Certified Plastic Surgeon.

Everything you need to know about Botox?

What is Botox?

Botox, or botulinum toxin, is a medication that is injected into muscles of the face to temporarily paralyze the muscles. By paralyzing the muscles, facial animation is reduced and wrinkles will smooth. Botox will not paralyze all the muscles of the face. It only affects the very specific area it is injected into. A skilled injector knows where to inject very small amounts of the toxin, thereby targeting the muscles that are causing the lines and wrinkles that you want to disappear. The most common areas to inject are the forehead, between the eyebrows, and around the eyes. This can soften or eliminate the furrow lines of the forehead, the “elevens” between the brows, and the “crow’s feet” on the side of the eyes. The result is a more rested appearance. The effect is temporary with most people get good results for 4 months.

How common are Botox injections?

Botox injections remains the most common non-surgical cosmetic procedure in the United States. According to the official statistics of the American Society of Plastic Surgery (ASPS), 7.6 million botox injections were performed in 2019. This represents a 900% increase in the number of botox injections compared to 2000. The second most common non-surgical cosmetic procedure was fillers, and is a very distant second place at 2.7 million injections for 2019.

What is the right age to start getting Botox?

There really is no right answer to this question, since every person is different. According to the American Society of Plastic Surgery, 1.4 million injections were performed on men and women between the ages of 30 and 39, compared to only 112,000 on people 20-29. This indicates that age time to start getting Botox injections. This seems to make sense, since we know that many other non-surgical cosmetic procedures become more common at age 30, such as laser, fillers, and chemical peels. The most botox injections were performed on men and women between age 40 and 54 (4.4 million). However, since Botox is designed to reduce the activity of facial muscles, younger people with very active muscles of facial expression choose botox injections.

How is it administered?

Botox is injected into the desired areas using small needles. During each needle stick, a very small amount of toxin is injected just beneath the skin. This delivers the botox to the muscle that is causing the line or wrinkle.

Does it hurt?

A very small needle is used, but since it is still injections, you will feel a small pinch and slight burn. However, this is extremely well-tolerated and most women compare it to having their eyebrows plucked.

Does it work right away?

Botox takes a few days to a week to work. This is because the toxin works by blocking the nerve impulse to the muscle and this process takes some time.

How long will it last?

Most people report that the results last about 3-4 months. The effect wears off slowly, so you may notice that the lines and wrinkles return slowly over the course of several weeks. Botox may last longer in some people and in certain areas of the body.

Can there be complications?

Botox is a very safe procedure with a very low risk of complications when administered by a qualified doctor such as a board certified plastic surgeon or dermatologist. Because it is administered using a needle, there can be bruising. Also, if the toxin is injected into the wrong area, it can paralyze a muscle that was not intended to be paralyzed. The result will depend on which muscle was mistakenly treated. For example, injection to the muscle that keeps the eyelid open can cause the eyelid to droop. Injection into the muscles around the mouth may cause difficulty pursing your lips, whistling, or drinking from a straw. The good news is that these complications are temporary and will usually improve as the toxin wears off. More serious complications have been reported when botox from unofficial suppliers have been used. This is why it is important to select a physician who is obtaining their toxin from a reputable supplier and not cheap suppliers who may be providing counterfeit medications.

How much does it cost?

The price for Botox injections will vary depending on several factors: who injects it, where you are located, and how much you require. Obviously, certain areas of the country may have higher or lower prices. A med-spa will likely charge you less than an experienced Board Certified Plastic Surgeon but as with everything, beware or prices that seem too good to be true.

Do I have to keep doing it?

No. You can stop having botox injected at any time. Your wrinkles and lines will return and will not be any better or any worse. Additionally, if you have had botox injections and for whatever reason are not happy with the results, you can just let it wear off and there will be no permanent issues.

How do I know if I need Botox or Fillers?

You may complain of lines and wrinkles, and sometimes botox is the answer and sometimes it is not. If you have lines and wrinkles that are the result of facial animation (i.e., the lines get worse as you scrunch your face), then botox will relax the muscles and soften the lines. However, if you have deep lines that are not directly related to the muscle animation, then Botox will not help. These lines are commonly between the nose and the mouth (naso-labial lines) and also the lower mouth (marionette lines). Treating these lines requires filler. Fillers such as Restylane and Juvederm are injected into these lines to fill them and soften them. Your physician should be able to tell you if filler or botox is best for your lines. Commonly, fillers and botox are done together for full correction.

Besides lines and wrinkles, will Botox treat anything else?

One less common, but effective, use for botox is treating hyperhidrosis. Hyperhidrosis, or excess sweating, can occur in the underarms, palms, feet, and scalp. Botox will paralyze the tiny muscle that surround each sweat gland. This will reduce the amount of sweat. Botox is approved for this use and treating hyperhidrosis can be life-changing for those who suffer. Excess sweating can be unsightly and commonly cause low self-esteem, and social anxiety.

Are there other names for Botox?

“Botox” is a brand name, just like q-tip or Xerox. Since Botox brand has been around for so long, it is commonly used to describe all botulinum toxin. However, there are actually three separate brands of botulinum toxin. Botox, Dysport, and Xeomin. Each is manufactured by different companies, but are extremely similar. One may argue that each acts slightly different and some individuals find that they prefer one brand over the other. But again, most people use the term “botox” when they are really referring to the active ingredient, botulinum toxin. Even your physician may use the term Botox when really referring to the other products. In our practice, in order to avoid this confusion, we use the term “toxin” to describe all three brands and only use the term botox when specifically referring to botox brand botulinum toxin.

To learn more about having your botox treatments, or other non-surgical cosmetic treatments in New York City with Dr. Matthew Schulman, please contact our office today.

Most Popular Non-Surgical Treatments

Cosmetic Surgery continues to increase in popularity and demand. Procedures such as Breast Augmentation, Liposuction, Tummy Tucks, Nose Surgery, and Brazilian Butt Lifts top the list of procedures that our patients request. However, not everyone needs, or wants, a surgical procedure. They still want to improve their appearance, but desire to do it in a non-surgical way. Luckily, improvements in technology now allow us to make changes to the face and body without surgery. This allows people to improve their appearance without the pain, recovery, and expense associated with surgery.

Let’s take a look at the most popular non-surgical treatments for the face and body.

  • Botox

Botox has a strong hold on the number one spot for non-surgical cosmetic procedures. Botox is the most popular non-surgical treatment to reduce or eliminate fine lines and wrinkles on the face. During the treatment, Botox is injected into the desired areas using a small needle. The toxin blocks the nerve impulse to the muscle, temporarily paralyzing the muscle, and allowing wrinkles to relax. This is most commonly used between the eyebrows (“the 11’s”), in the forehead, and around the eyes (“crow’s feet”). Botox can also be used around the mouth to help elevate the corners of the mouth or reduce those “smoker’s lines”. Botox treatments are popular among both men and women of ages. The effect of Botox starts to work in a few days to a week, and lasts for about 3-4 months.

Another less know uses of Botox include treatment of hyperhidrosis, or excess sweating of the underarms, palms, and feet. Injections of Botox to these areas will decrease sweating and the results can last up to a year.

  • Injectable Fillers

The number 2 spot belongs to injectable fillers. There are a variety of fillers available, each with it’s own unique characteristics. In fact, there may currently be about a dozen to choose from. The most common names that you have likely heard of are Restylane, Juvederm, and Radiesse. Each filler has slightly different qualities. Some are very thick, while others are very thin. This allows doctors to chose different options depending on what we are treating. Fillers can be used to smooth deep lines on the face, or fill under eye hollows. Fillers can also be used to inject into the nose, performing a non-surgical nose job. Fillers have also been injected into depressed scars, acne scars, and even to plump aging earlobes!

The treatment is performed in the office with minimal discomfort. There can be some bruising or swelling depending on exactly what area is being treated. We tell patients that the filler will look best starting about 1 week after the injection. The fillers can last anywhere from a few months to a few years, depending on the area treated and the specific filler used.

  • Non-Invasive Fat Reduction

Liposuction, or the surgical removal of fat, still remains the best way to remove unwanted fat that is resistant to diet and exercise. As effective as liposuction is, it does come with pain, recovery, and expense associated with a surgical procedure. For those looking for non-surgical options, there are a few. Modern technology has figure out a way to destroy fat cells without surgery. This can be done using either cold or hot temperatures. These devices will cool, or heat, the areas of unwanted fat through the skin. This injures the fat cells, and the fat cells will ultimately die. The body will then eliminate the dead fat cells through a normal excretory function and will be passed in your urine. This process can take up to a few months and oftentimes, multiple treatment sessions are needed. The advantage of these non-surgical fat reduction options is that the procedure is painless and since there is zero required recovery, you can return to normal activities immediately.

There are some disadvantages though. Realistically, you can only expect a 20-25% reduction in fat, so these non-surgical options are not as effective as surgical fat removal. Also, while the cost may seem much lower than surgery, keep in mind that if you are treating multiple areas, and require multiple treatment sessions, the cost can increase to more than you would have spent to treat the same areas with surgical fat removal like liposuction.

Some well known names for these devices are Coolsculpt, Trusculpt, and Sculptsure, but there are about a dozen similar devices and more coming. As technology continues to improve, you can expect that the amount of fat reduction that can be achieved will increase.

  • Facial Chemical Peels

There are some simple treatments that can be done to improve the appearance of your face. Chemical peels are a great way to treat active acne, reduce irregular pigmentation and sun-spots, smooth lines and wrinkles, and stimulate collagen. There are a variety of different chemical peels and each is customized to your specific needs. Peels can be superficial, meaning that they remove only the outer areas of skin. The advantage of superficial peels is that there is virtually no down time. Patients may notice some minor redness and irritation for a day or two. The disadvantage is that since it only treats the outer layers of skin, the improvement will be limited. Also, superficial peels are best when done at regular intervals, usually monthly.

Deeper peels will be more effective at treating lines, wrinkles, and irregular pigmentation. However, deeper peels can leave the face raw and irritated for more time. Some deep peels will require two or more weeks of downtime. Of course, there are also intermediate peels that may provide decent improvement in the skin with an acceptable 7-10 days of downtime.

Chemical peels can be done on the body as well. For example, peels can treat the skin of the neck. Anti-acne peels are also very popular for the back and buttock.

  • Lasers

Lasers are similar to chemical peels in that they are designed to treat the skin at varying depths. Lasers emit light energy and are very specific for what they are going to treat. Specifically, a laser designed to treat irregular pigmentation is different from a laser designed to treat wrinkles. There are also lasers designed to treat spider veins, dark spots, rosacea, and acne. The advantage that lasers have over chemical peels is that modern lasers can treat deep layers of the skin, but do it by punching small holes in the skin. This is called “fractionated” and allows for deep treatment without the long recovery. Fractionated lasers do require multiple treatments but are very well tolerated. Like chemical peels, laser treatments can be performed anywhere on the body.

Combining Non-Surgical Procedures

Non-surgical procedures are often combined with each other. For example, if someone is looking to achieve a “non-surgical” facelift, it would require a combination of treatments. It is likely that the patient would require a laser or chemical peel to improve the overall quality of the skin and to smooth the texture. He or she would also likely require injectable fillers to smooth deep lines in the nasolabial or marionette region, or to fill those undereye hollows.

Non-surgical procedures can also be combined with surgical procedures. For example, it is not uncommon to utilize the non-surgical fat reduction technologies to help during the recovery process from liposuction, or to help smooth any contour irregularities. Additionally, botox, filler, lasers, and chemical peels are commonly utilized during a surgical facelift to improve the cosmetic outcome.

To learn more about whether a non-surgical procedure is right for you, make sure to contact a Board Certified Plastic Surgeon.