Are You Physically and Mentally A Good Candidate for Plastic Surgery?

By Dr. Stanley Poulos

In 2009, then-Governor of California, Arnold Schwarzenegger, signed the Donda West Plastic Surgery Law, requiring health checks be conducted prior to all major plastic surgery procedures in the state.

This was following the death of rapper Kanye West’s mother. It was later determined that her heart attack was spawned by a combination of numerous postoperative complications and pre-existing coronary artery disease.  Today, many womencovet a perfect pout, perky derriere and firm breasts seen on Instagram models. Just because you may want cosmetic surgery does not mean you are physically or mentally fit for it now. As a board-certified plastic surgeon, I take steps to  ensure the health and safety of my patients during surgery and post- operatively.

Here are some indicators I look for in assessing patients for surgery.

First, it’s essential for a surgeon to take a good medical history and exam of the patient.  Current and past illnesses, especially cardiac or pulmonary problems, surgeries, and medications should all be discussed.  Lab tests may be required depending on patient history and planned procedures.

Urinalysis

When it comes to preparation for a plastic or cosmetic surgery procedure, a urinalysis can inform the doctor if a patient has certain types of infections, like a urinary tract infection (UTI), bladder, or kidney infection. Urine tests are also effective in detecting high blood pressure and diabetes.

Blood Count Test

Also known as a complete blood count (CBC), this blood test literally counts your blood. It takes note of the number of red blood cells, white blood cells, and platelets. This tells physicians if you’re anemic (i.e. have a red blood cell deficiency) or have a blood clotting disorder like hemophilia. CBC tests also detect infectious bloodborne diseases like HIV or hepatitis.

Electrocardiogram (ECG or EKG)

Essentially, the ECG is a medical test that tells if your heart is in good condition through detecting any heart abnormalities by measuring the electrical activity of the heart when it contracts. Cosmetic surgery causes tremendous stress on the body, with the heart being one of the most important organs when it comes to stress response. That is why it is crucial for the doctor to assess whether your heart can endure the trauma during the operation.

Chest X-Ray

The Chest X-Ray is also one of the tests that may be required for your procedure. This is usually carried out to check the condition of your lungs and see whether you have breathing difficulties when you are put in anesthesia. This test is especially requested if you are a smoker or have a history of smoking. Signs of pneumonia or any breathing disorder may result in the postponement or cancellation of your surgery.

Mixing nicotine use with surgery can cause problems:

• Loss of cheek skin, nipples or tummy skin after a facelift, breast lift, breast reduction, or tummy tuck surgery
• Infections
• Death of fat cells (fat necrosis), causing hard lumps
• Delayed wound healing
• Thick, wide scars
• Blood clots, which can be fatal
• Increased pain
• Permanent small vessel damage; a risk even if you have quit
• Loss of Breast Implants
• Life-threatening complications like stroke, heart attack, blood clots, and pneumonia.

Mammogram

The mammogram is typically required for women who want to get breast augmentation or breast lift done. This is to help detect signs of breast cancer.

Psychological Screening

Although there is no formal psych test to assess a patient’s readiness and motives for cosmetic surgery, I take time with my patients to learn their reasons for desiring cosmetic change. Immediate red flags include having surgery to try to keep a wayward spouse; an exaggerated concern over a minor problem; someone who seems addicted to cosmetic surgery; or someone with body dysmorphic disorder. This syndrome is most appropriately treated by psychological treatment, not surgical intervention.

Alcohol Habits

It is important not to drink alcohol before undergoing plastic surgery – or any type of surgery for that matter – as it can cause unforeseen complications and seriously impact final results and the way you heal. Alcohol, especially when excessively consumed, can dry out your skin, which can then result in cracks appearing. If you’re having a plastic surgery procedure where skin is stretched (facelift, breast augmentation or abdominoplasty, for example) then dry, cracked skin will make it harder for the surgeon to staple or stich the skin together, resulting in a less-than-optimum result and possibly a scar.

Body Weight

Sometimes patients will enter a plastic surgeon’s office excited about a decision to finally move forward with breast or body contouring surgery, but then afterwards emerge having found out they are not currently a candidate because of excess body fat. This scenario is not only disappointing, but it can be an emotionally deflating and potentially embarrassing experience for patients. I sympathize with the emotional pain that such patients feel, and I want to help them realize their goals. However, there are several specific reasons that your plastic surgeon might recommend weight loss prior to undergoing a procedure.  In addition, the results that you can achieve are likely to be much better if your weight is in a better range. Consider an overweight woman who wants breast reduction surgery.  Even when the breasts become smaller and more uplifted, it is extremely difficult for us to deal with the fullness lateral to the breasts (the “bra roll”), which significantly compromises the aesthetic result. In addition, it is much harder to get a beautiful transition between the breast and the abdomen due to the excess weight. On the other hand, let’s consider the patient who is overweight and wants a tummy tuck or liposuction. In this instance, the surgeon will not be able to remove all the excess fat in these areas, as it is technically challenging and can look odd because it is out of proportion to the surrounding fatty deposits. Even large volume liposuction cannot fully solve this problem. Body contouring surgery is great for shaping your body, but it is not a method or substitute for weight loss or weight control.  At my clinic there is a full-time wellness/weight loss coordinator who helps patients achieve a healthy body composition ( body fat percentage and lean muscle mass balance) before undergoing body contour procedures.

What is an option for those who need to lose weight to be a better candidate for cosmetic surgery?

There is an FDA approved “Gastric Balloon” procedure that I perform. It is appropriate for patients who have not had previous weight loss surgery and who have a BMI (Body Mass Index) of 30 to 40. Patients diagnosed with bulimia, binge eating, compulsive overeating, high liquid calorie intake habits or similar eating-related psychological disorders are not good candidates. I’ve now treated numerous patients who have successfully lost up to 20% of their body weight with the balloon procedures and have gone on to aesthetic body contouring with much improved results.

How does the balloon method work?

This non-surgical outpatient procedure begins with a diagnostic endoscopy to ensure that it is safe to perform. Once the patient is mildly sedated and comfortable, the procedure can begin. The deflated gastric balloon is inserted through the esophagus and into the stomach. A syringe is then used to fill the balloon with a sterile saline solution. Once the weight loss balloon has been filled with saline, it expands to approximately the size of a grapefruit. The entire procedure takes about 20 minutes. Patients can usually return home within 30 minutes. Over the last 20 years this procedure has helped over 277,000 people. The gastric balloon encourages portion control while patients make healthy changes to diet and lifestyle.

How long does the balloon stay in place?

The balloon remains in the stomach for the first six months after the procedure. With the stomach balloon and Dr. Poulos’ support team, patients usually see the most drastic results in the first six months. It is very important to use this time to develop healthy habits that will continue for the rest of one’s life.

What to expect after the balloon placement.

Over the first 14 days after placement, patients may experience nausea or vomiting. I recommend a liquid diet for his patients during the first week to help manage these symptoms.  Also prescribed are effective anti-nausea drugs to help the patient through the initial stage.

How is the balloon removed?

Once the stomach balloon has been in place for six months the balloon is removed. The simple and non-surgical procedure is very similar to the placement process. Once the gastric balloon has been removed, it is very important to continue working closely with my team and coaches to follow the personal diet and exercise plan provided. This will help to keep patients in a positive and healthy mindset while achieving your weight loss goals.

About Dr. Stanley Poulos

Dr. Poulos specializes in cosmetic breast surgery and body contouring procedures. He helped pioneer the quick lift facial rejuvenation surgery in California and is recognized as one of the leading plastic surgeons in Marin County and the entire San Francisco Bay area.  Dr. Poulos and Plastic Surgery Specialists have extensive experience in body contour procedures. A graduate of the University of Texas Medical School, Dr. Poulos completed his internship and residency at UC San Francisco. He completed a plastic surgery fellowship at St. Francis Hospital in San Francisco and is certified by the American Board of Plastic Surgery. For more information, click here.