Do You Need To Lose Weight Before Cosmetic Surgery?

There’s a lot that goes into preparing for cosmetic surgery. Choosing a procedure and finding the right board certified plastic surgeon are paramount. You’ll also need to make necessary plans for recovery (we’ve got a guide for that). But all of this is naught if you are not physically fit to undergo the surgical or non-surgical procedure you are interested in. As we’ve covered, cosmetic surgery is not a substitute for weight loss, nor is it safe or effective to treat patients who are not at a healthy weight. It increases the risk of complications and lessens the likelihood of an optimal result.

Because of this, it’s important to understand what role weight and body mass index (BMI) play in cosmetic surgery. From there, you may also be curious as to how you should safely go about losing any necessary weight. While taking the time to drop the lbs will cost you exactly that – time – it will almost certainly lead to a safer and more satisfactory outcome. Here, we’re breaking down what you need to know about getting in shape before cosmetic surgery.

The Relationship Between BMI & Cosmetic Surgery

You want to be at your healthiest before undergoing any elective procedure — including cosmetic surgery. From an aesthetic perspective, it is often recommended to be as close to your ideal weight as possible prior to surgery to maximize the results. “For body contouring procedures, ideal weight on your surgery day is within five to 10 percent of your goal weight,” says Olivia MaDan, MD, a board eligible plastic and reconstructive surgeon in Nashville. “Maintaining this weight range post-operatively should allow for long-lasting surgical results.”

But, depending on your weight, there are additional, non-aesthetic factors to consider. In 2011, an American Society of Plastic Surgeons (ASPS) task force classified patients with a BMI over 35 as ‘high risk.’ A more recent 2018 study, meanwhile, determined a BMI over 30 – coupled with other factors – to be ‘high risk.’ Today, it is generally accepted that ‘high risk’ patients include those with body mass index between 30 and 35, with an elevated BMI being identified as an independent risk factor for surgical complications.

BMI is meant to act as a measurement of body fat based on height and weight, though all you have to do is think back to your high school health class to remember that BMI is not a perfect measurement. Even so, it can be helpful marker. “Sometimes an elevated BMI can be an indicator for other medical comorbidities – like diabetes, obstructive sleep apnea, hypertension,” Dr. MaDan explains. All of these conditions can interfere with both the surgery itself and the recovery process.

Why Lose Weight Before Cosmetic Surgery?

The goal of any cosmetic procedure (surgical or otherwise) is to achieve a safe and effective result. Being in the best possible shape pre-op is an important part of that. “I view surgery as a partnership with the patient,” Dr. MaDan shares. “The patient may not be concerned about their weight, however, when it affects patient safety, I explain to them why I may not want to take that risk as a surgeon.” In such cases, they can work together to “develop a plan to optimize patient safety and surgical outcome,” she notes.

As Dr. MaDan explains, elevated BMI carries a “significant increased risk” of wound healing problems. This is especially true of patients with comorbidities. “Strict blood sugar control is essential to facilitate wound healing and minimize risk of infection,” she says. “Strict blood pressure control can help to minimize the risk of bleeding (hematoma) after surgery.” Furthermore, “patients with obstructive lung disease or obstructive sleep apnea may not be candidates for the ambulatory surgery setting and may be more appropriate in the hospital setting,” she adds.

While every surgeon will have their own parameters, Dr. MaDan has a “strict rule” of only operating on patients with a BMI under 35 for body contouring surgeries. “For patients in the 30 to 35 range, I review some before and afters that aren't dramatic transformations – but not necessarily suboptimal – to gauge the patient's expectations,” she explains. “I tell them that a similar result is a realistic outcome and that I would rather disappoint them before surgery instead of afterwards.” This, she says, is usually what kickstarts a discussion about weight loss to achieve more optimal results.

Depending on the circumstances, Dr. MaDan says she has “bariatric surgeon and a weight loss clinic” to whom she refers prospective patients. While she offers “check-ins” during the journey, she believes these cases are often best managed by experts, especially when medications, nutrition, and other factors may be involved. Once the patient has made progress, “I will re-evaluate the patient in further consultation before booking surgery,” she explains. This will likely involve both a virtual and in-person appointment. “If a patient is not within that goal weight range, I do not schedule surgery,” she says.

There are, however, some notable exceptions to the rule. “In my practice, I discuss the risk factors associated with elevated BMI and have some leniency when considering certain procedures,” Dr. MaDan notes. A prime example: breast reduction. “Some breast reduction candidates have elevated body mass index,” she shares. “It can be understandable – the patient can't necessarily exercise easily due to the size and weight of their breasts.” As such, most patients she treats with elevated BMI are undergoing a breast reduction surgery.

How to Safely Lose Weight Before Cosmetic Surgery

To start, we have to acknowledge just how personal weight loss is. Each and everyone of us has a different relationship with our body. Regardless, the goal should always be about improving overall health in a safe and sustainable way. That will hopefully parlay itself into a lifetime commitment to your health and wellbeing, which is why we are here to remind you to be patient and kind to yourself on the journey.

Whether you are preparing for a weight loss surgery or a cosmetic procedure, proper nutrition will be vital to success. “It’s important to note that weight loss surgery patients who achieve some weight loss before surgery actually get better results than those that leave it to surgery alone, and this includes aesthetic procedures such as CoolSculpting® and CoolTone®,” says Jennifer Hanway, a board certified holistic nutritionist. Education, or a lack there of, has a lot to do with this. “[Surgery] does not help the client with the negative effects of overweight or obesity, nor does it help to educate them on which foods nourish the body or build great eating habits,” she notes.

Regardless of whether you are preparing for surgery or not, Hanway approaches all clients who are looking to “achieve healthy weight loss and improve their metabolic health” in a similar way. “My approach is not about rapid fat loss or fad diets, as these can lower the metabolism and a client’s ability to lose weight,” she explains. “I help my clients to improve all aspects of their health, including insulin resistance and inflammation, which, in turn, leads to healthy weight loss.” Achieving “optimum health” is particularly important for those in a pre-op stage because “they will need to be able to recover quickly and easily post-surgery,” she shares.

For this sustained success, Hanway offers the following tips:

1. Focus on Food: In Hanway’s estimation, 80 to 90 percent of weight loss comes down to nutrition alone. But that doesn’t mean you shouldn't be working out. “Combining exercise with a strategic weight loss diet is the best way to get results fast – and results that last,” she notes.
2. Don’t Count Calories: “There is a big difference between ‘diet culture’ and eating foods that create a state of optimum health in the body,” Hanway emphasizes. From the 1970s until about five years ago, the focus was (wrongly) on calorie counting, low fat diets, and deprivation. “New nutrition science actually shows us that these methods do not contribute to healthy weight loss and can actually be harmful to metabolic health,” she cautions. Instead, she says the key to “achieving a healthy weight” is “eating foods as close to their natural state as possible” and “minimizing processed foods.”
3. Skip Sugar: This likely goes without saying, but sugary, processed foods are no one’s friend. “Blood sugar balance and insulin sensitivity is the key to helping your body burn fat for fuel and boosting your metabolism,” she explains. “When we eat foods that are high in added sugar and refined carbohydrates, they spike your blood sugar.” That increase tells the pancreas to release insulin. “When insulin is present in the body, we store our food as fat, rather than burning it for fuel,” she says.
4. Treat Food as Fuel: “Eating a diet that is high in veggies, protein, and healthy fats keeps your blood sugar and insulin levels low, allowing your body to tap into its stored body fat for fuel,” Hanway shares.
5. Work With a Pro: “It can be hard to switch from that calorie counting mindset that so many people grew up with, but I love to educate my clients on how to eat foods that nourish their body, help them feel full and satiated, and help them achieve a healthy weight,” Hanway shares. In addition to private coaching, she developed her Lean & Clean 8-Week Online Program with this in mind.

Just as no two cosmetic surgery patients are the same, no two weight loss journeys are alike. With the correct approach, however, there are some general rules of thumb for what is feasible. But, for starters, you have to be clear about what you are working towards. “It’s important to clarify that when we are talking about ‘weight’ what we actually mean is body fat, as we do not want to lose any lean muscle mass as that will actually lower the metabolism,” Hanway says.

With that in mind, she typically likes to see a 20 pound weight loss over the course of three months in clients that have 30 (or more) pounds to lose. “For me, this means that the client is losing body fat — not water or muscle mass — and will actually keep that weight off in the future,” she explains. From there, a 40 to 50 pound weight loss can be achieved in six months, with up to 100 pounds in a year.

The Takeaway

Deciding to undergo a cosmetic procedure is an extremely personal decision, as is deciding to be at your healthiest prior to proceeding with it. If you are unsure about whether or not you are a candidate for surgery, a consultation with a board certified plastic surgeon will shed light on the safest and most effective course of treatment for your anatomy and goals. If lowering your BMI is necessary, working with a nutritionist or weight loss specialist can help ensure you do so in a sustainable way. Whatever you choose, it’s all about feeling healthy and confident in your body!