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When is Plastic Surgery a Bad Idea?
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When is Plastic Surgery a Bad Idea?

Episode 43: When is Plastic Surgery a Bad Idea?

When is plastic surgery a bad idea? Before we get into the thick of answering this important question, I just wanted to clarify that we're specifically addressing aesthetic plastic surgery or cosmetic plastic surgery here. Which consists of purely elective procedures. This discussion doesn't apply to reconstructive plastic surgery, which consists of procedures that are necessary to restore form and function either due to a congenital anomaly, or birth defect, or a traumatic accident. So this discussion refers to things like facelifts, and breast augmentations, and liposuction, and tummy tucks, and procedures along those lines.

Having said that, plastic surgery is a major undertaking from a psychological perspective, a financial perspective, and a time perspective. So when you make the decision to have an elective surgical procedure or a cosmetic treatment, it's important to take a number of things into account and make sure you're doing this for sound reasons and at a time in your life, that is best for you. It's important to take a step back and not be pressured into surgery, or be pressured into procedures. You might go to consultations, you might see advertisements, you might get very excited. But it's a good idea to step back and reflect on your goals, reflect and where you are in your life, and make sure that what you're doing is really the best thing for you at a given point in time. So let's go through a few common pitfalls that might be less than optimal reasons to be having a plastic surgery procedure.

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Why do people have plastic surgery?

One of the biggest red flags that we see here is the patient that is not having a plastic surgery procedure for themselves. This is to say they are not driven by an internal desire to have the procedure. They're thinking about plastic surgery to achieve some external goal. Frequent examples of this kind of scenario occur when a patient is being pressured by a parent or a spouse to alter something about his or her appearance. And this is just never a good idea, because plastic surgery is something that you should undertake to fulfill a personal goal. It's something that you should be doing to better align your physical appearance with your personal goals, for how you would like to look. And there is simply no external person or influence that should be powerful enough to have you undergo a plastic surgery procedure. And in its most basic form, the reasoning here is that your body is something that should be entirely under your own control. And moreover, imagine having a plastic surgery procedure to satisfy some external condition or person, then having that condition or person no longer be a part of your life. Then you've created a major personal change for external reasons.

And you'll be left in a very disappointing position. Also along these lines, it's not a good idea to have plastic surgery to help you get over a major personal trauma. Something like the loss of a relationship or the loss of a job. It's one thing to decide that you'd like to do something nice for yourself after getting out of one of these scenarios, but it's not a good idea to have plastic surgery specifically to make yourself feel better after getting out of a relationship or out of a job. To be a bit more specific, if you feel like there is a certain physical attribute that you'd like to address, because you think it might help you up your dating game, or it might help give you more confidence to land a great new job, that's fine. But if you are feeling general sadness from the loss of relationship or a job, and you're looking to alter your appearance, just to change something for the sake of a change to cheer yourself up, that is something that is a much less rewarding proposition.

Do I have to be healthy to have plastic surgery?

Another reason to hold off on having elective plastic surgery procedures is if you're not in optimal physical health. So while many plastic surgery procedures are minimally invasive or even noninvasive, there are some that are truly major surgeries. And regardless of how invasive a given surgical procedure or treatment is, there is going to be some element of risk involved. And having an underlying health condition that has not been medically optimized, is going to increase your risk of having some complication due to the procedure. And since these plastic surgery procedures are purely elective, the risk benefit analysis just does not come out in favor of having one of these elective procedures, when you are not at your optimal level of health. Frequent things that we see here are cardiac, or heart issues, or lung, or pulmonary issues. For heart issues these might be things like cardiac output problems, or a history of heart attack, or a high risk of a future heart attack.

For a lung issues, it might be things like asthma or emphysema, problems having to do with endocrinology like diabetes can also negatively impact your results and recovery process from plastic surgery. As can a lack of nutritional optimization. And things like cardiopulmonary or heart and lung issues can directly affect the safety of your procedure and anesthesia, a lack of nutritional optimization, or a ongoing not well controlled case of diabetes can cause issues with healing and recovery. Another big issue with a lot of plastic surgery procedures in terms of physical health is smoking. Smoking can both make anesthesia more dangerous and also lead to issues with wound healing and scarring. So before you have your plastic surgery procedure, it's important to have a thorough conversation with your board certified plastic surgeon to go over all aspects of your health history, to make sure that you are in great shape to have the best possible outcome in the safest manner available. Psychological health is just as important as physical health in determining your readiness for a plastic surgery procedure. Things like eating disorders can contribute to the decision to have a plastic surgery procedure, as can things like body dysmorphia. And it's very important to discuss these conditions with your plastic surgeon and also go through them with a mental health professional to ensure that you are seeing your goals and assessing your risks from a healthy perspective.

How much should I weigh before plastic surgery?

It's also important to be at or near your goal weight when you're considering a plastic surgery procedure. If you're planning to lose a significant amount of weight, it's best to hold off to have your procedure, until you've arrived at your goal weight. Because imagine a scenario in which you're having an abdominoplasty or tummy tuck to get rid of excess abdominal skin. And procedure is performed, you have a wonderful result, but then you proceed to lose a significant amount of weight. This will result in the recurrence of significant skin laxity, and you'll have gone through the recovery time, undertaken the risk, and also had the financial outlay of a plastic surgery procedure, just to essentially have it undone.

Similarly, it's a good idea to make sure that you can remain at your goal weight for at least a few months, before having a plastic surgery procedure. Because if you arrive at your goal weight and you have a procedure, you may find that it's more difficult than you anticipated to stay there and you could gain some weight back and essentially change the results that you've worked so hard to achieve.

Can I have plastic surgery if I’m getting pregnant?

Another specific life circumstance that's a good reason to hold off on a plastic surgery procedure, is a planned pregnancy. Because just like weight loss or weight gain, undergoing pregnancy causes significant changes to your body, especially of the breasts and abdomen. So if you know that you're going to be having a pregnancy in the near future, it's a good idea to hold off on things like a breast augmentation, or breast lift, or tummy tuck, or abdominoplasty, until you've had your pregnancy.

And also until after you've completed breastfeeding. And in fact, we always recommend waiting at least three to six months after completing pregnancy and breastfeeding to ensure that the hormones of pregnancy and breastfeeding are out of your system. So that your body can return to its baseline of fat distribution before we embark on a surgical procedure. One workaround here for women that really want to improve the contour of certain areas of their body, specifically their abdomen, even though they may be planning a pregnancy in the near future, is to have some liposuction with the understanding that they cannot achieve as much of a change in their abdominal contour in many cases with liposuction, as they might be able to with an abdominoplasty. And we'd invite you to listen to earlier episodes on who would benefit more from an abdominoplasty versus liposuction? But even women that would benefit more from an abdominoplasty than from liposuction, may choose to have liposuction instead of an abdominoplasty, and accept a less dramatic result in order to be able to do something, before they undergo a pregnancy.

The reason that liposuction is a more favorable procedure to have, as compared to a tummy tuck before pregnancy, is that with a pregnancy you're going to really stretch out your skin and abdominal musculature that you would have tightened with an abdominoplasty or tummy tuck. Whereas with liposuction, this is the permanent removal of fat cells and this in itself, isn't going to be that dramatically affected by pregnancy. But all things being equal, it is best to hold off until after a pregnancy and breastfeeding, before having an aesthetic surgery procedure.

What other factors might affect my decision to have plastic surgery?

Aside from physical factors, lifestyle factors are important to optimize as well before having plastic surgery. First off, it's important to make sure that you're financially ready for plastic surgery. Plastic surgery is a significant investment. While there are practitioners that can be significantly less expensive, these should make major warning bells go off. hese might be people with less experience, they might not be board certified, they might not have as good training, or more cynically, they may be cutting corners. They may be rushing procedures, and they may even be cutting corners with regards to safety. Specific things to look out for here is a lack of staff in the operating room, not performing adequate monitoring in the operating room, and also to be using a less expensive or subpar facility. And these are things that you should really specifically ask about. If you're having a procedure that involves anesthesia, you should make sure that there is a board certified anesthesiologist that's responsible for your anesthesia care. You should also make sure that you're hooked up to a heart monitor for any kind of procedure that you're having that involves any kind of anesthesia or even any kind of oral sedation. And you should also ask specifically about the staff that will be present for your procedure.

So, as we mentioned, in the case of an operation in which you're having some kind of anesthesia, a board certified anesthesiologist should be present. And in all plastic surgery procedures, you should make sure that there is a registered nurse present. In terms of the facility that you're having your procedure at, this should either be at a hospital or at an ambulatory surgery procedure that's accredited by one of the recognized accreditation bodies for these freestanding surgical facilities. All of these things, a quality surgeon, excellent staff present in the proper numbers, monitoring equipment, and a safe facility costs money. So if things seem like they are too inexpensive, it's a very good idea to investigate exactly what's going on, and making sure our critical corners are not being cut. In addition to financial readiness for a plastic surgery procedure, you should also make sure that you have a support system in place.

While a lot of plastic surgery procedures are relatively minor and may not require much support at all after surgery, like a limited amount of liposuction, other plastic surgery procedures, like an abdominoplasty can require a fair amount of help for a couple of weeks. So you want to make things like childcare is in place, that you have helped for things like your activities of daily living, and that you've also arranged to take an adequate amount of time off of work for your recovery. So this is something that it's very important to speak to your surgeon about in detail, to make sure that you're set up for a smooth postoperative experience. So while I'm a plastic surgeon and I certainly love to operate, it's very important to me that my patients are set up for the best possible outcomes in a safe manner each and every time. So please take the time to have these conversations with your surgeon and make sure that you are set to go.

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  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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