Ideal Weight for Cosmetic Surgery

Recently, I consulted with a patient who had lost 80 pounds after bariatric surgery. It was her intention to lose more weight. During our visit, she asked the question I hear so often regarding weight loss, “Should I lose weight before cosmetic surgery?” My answer is most always the same, “Yes.” Multiple reasons lead me to this answer. Some reasons are related to the general health risks of even mild obesity, while others are related to anesthesia and surgery itself.

We all struggle with extra pounds, me included. This is one of the blessings of living in an affluent society, access to food-a-plenty. These extra pounds may put us at risk for serious medical problems. These include diabetes, heart disease, and many forms of cancer. Reduced physical activity increases a women’s risk for osteoporosis. Severe obesity contributes to joint problems and serious skin conditions. Extra abdominal weight also increases the risk of gastric reflux or heartburn.   Reflux of stomach acid or gastric juice into the lungs may lead to life threatening pneumonia.  General anesthesia and sedation carry risks, also when carrying extra weight. The most serious is airway or breathing related problems. Decreased ability to take very deep breaths, along with actual partial breathing passage closure can pose significant threats during anesthesia.  

Several measures taken after surgery may often reduce some risks.  I have found that cosmetic surgery results are far better when the fat layer  beneath the skin is as thin as possible before surgery. In the case of skin tightening procedures, the skin can be stretched more easily to give a better result. I also believe that wound healing is more efficient, there are fewer complications and patients see the best results  when  at lower body weight  .

Patients presenting for cosmetic surgery consultation who are carrying extra pounds frequently change their minds regarding which procedures they want following weight loss. This is most evident with breast surgery. A woman considering breast reduction before weight loss, will frequently choose breast enlargement after weight loss!  Patients considering liposuction before weight loss, choose different areas for treatment after weight loss. Skin appearance often responds better when weight loss is gradual and exercise is part of the program.

I know the idea of having surgery first, followed by weight loss and conditioning has been popularized on reality TV. It has never made sense to me. Why take this shortcut if there are increased risks, potential medical problems and compromised cosmetic results? Please consider being within 20 pounds or less of your ideal weight before considering cosmetic surgery. It is the best advice that I can offer my patients.


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