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Why BMI Matters in Plastic Surgery: Complications, Risks, Healing

In some cases, patients who come to Glamour Plastic Surgery and Med Spa seeking plastic surgery procedures are disappointed to learn that they may not qualify for these procedures due to an excessively high Body Mass Index or BMI.


There are many reasons why plastic surgery is not recommended for patients with higher than normal BMI. Below are Dr. Bachilo’s concerns regarding BMI and plastic surgery, as well as her recommendations for reducing Body Mass Index, so that you may qualify in the future for the procedures you desire.


What is BMI and How is It Calculated?


Body Mass Index (BMI) is an index that determines the amount of body fat an individual is carrying relative to their height and frame.  BMI is a standard assessment of body fat calculated as a weight to height ratio.


What is Considered a Healthy BMI?


Your body mass index should fall within a healthy range, as determined by the following general guidelines. While other factors must also be taken into consideration to determine an individual’s overall qualification for plastic surgery, these guidelines provide a general rule of thumb when determining the healthy range of BMI.


  • A BMI below 18.5 is considered underweight and unsuitable for plastic surgery
  • A BMI between 18.9 to 24.9 is the optimal BMI that is considered normal and healthy for your height
  • If your BMI ranges between 25 and 30 you are considered to be overweight and, depending on other factors, may not be a suitable candidate for plastic surgery
  • A BMI that is higher than 33 is considered obese and you will be advised to lose at least 10% of your weight before considering plastic surgery
  • A BMI of 40 or higher is considered morbidly obese, and definitely unsuitable for plastic surgery without prior weight loss.


While BMI is used to determine a patient’s body fat, it does not necessarily measure a patient’s health accurately, and other factors must be taken into consideration in order to determine if a patient is in fact at a healthy weight.  For example, the ratio of muscle to fat may affect your health, because fat and muscle differ in their weight. So, a patient with a muscular body type may be healthier than their BMI might indicate, and it is not uncommon for some individuals to have a high BMI while actually having very little body fat, particularly in the case of athletes, body builders, and others with muscular frames.

Are There Other Ways to Measure Body Fat Besides BMI?


Another indicator that is used to measure an individual’s health, in order to account for muscle weight, is the circumference of the waistline, which gives the doctor a clearer idea of how much fat an individual is carrying in their midsection. Patients who exhibit an excess of body fat around the waist are at higher risk for serious medical conditions such as diabetes and heart disease.


Typically, the waist circumference in female patients should not exceed 34.5 inches. In male patients, waist circumference should not exceed 40 inches to avoid this increased risk.


How Does Body Weight Affect a Patient’s Safety During Plastic Surgery?


Patients with a higher BMI tend to have a higher risk of complications, and will typically feel less satisfied with the results of their procedures in comparison to individuals who have a normal or healthy BMI and waist circumference. While Dr. Bachilo would like to provide desired procedures for all her patients, her concerns regarding safety must take precedence over any other factor when considering whether to recommend a patient for cosmetic surgery.


The ideal candidate for cosmetic surgery should be in overall good health and be as close as possible to their ideal body weight.  While many patients come to us seeking procedures such as liposuction to lose weight, we remind them that liposuction and other cosmetic procedures are body contouring procedures as opposed to weight loss treatments. While they trim and tone the body, they don’t eliminate a significant amount of weight. Although these treatments remove some fat from the midsection, body contouring treatments do not significantly alter your weight – and if you undergo surgery with a high BMI, you may be at a higher risk for complications.


What are the Risks Associated with Plastic Surgery in Patients with High BMI?


There are several risks associated with plastic surgery if you have a higher than normal BMI.

Some of the most dangerous complications that may arise include:


  • Blood Clots (DVT) and Pulmonary Embolism (PE) – This is the most dangerous complication that doctors must protect their patients against when considering cosmetic surgery. Patients with higher BMI are at a much higher risk of developing life-threatening blood clots that may form in the legs and gradually work their way up to affect such vital organs as the lungs or brain.


  • Sleep Apnea – While this is a less threatening condition, patients with a higher BMI tend to be at a greater risk of developing sleep apnea, which can cause dangerous complications both during and after a surgical procedure, as well as increasing the risks associated with anesthesia, which are relatively minor in healthy patients who are not overweight.


  • Liver dysfunction – Individuals with higher BMI, and particularly those with waist circumference above the recommended measurements, are also at a much higher risk of developing fat around the liver. Fatty liver disease can cause dysfunctions in metabolism and affect the healing process. The liver’s critical function of cleansing the blood, and thus controlling infections, inflammation, and wound healing, may be impaired when excess fat accumulates around the liver.


  • Infections at the Surgical Site – The risk of infection at the surgical site following cosmetic surgery increases significantly in patients with higher BMI.


  • Impaired wound healing – Patients with a higher BMI are also at risk for other wound healing complications, such as tissue necrosis, wound separation, and accumulation of excess fluids, which delays the healing process. Because blood flow is reduced in fat tissue, blood may not effectively circulate to the surgical site, leading to delayed healing of wounds.


Diabetes is also a common side effect of obesity, and also increases the risk of complications such as post-surgical infections and delayed wound healing.


Cosmetic Results in Patients with High BMI


In general, individuals with a healthy, normal BMI at the time of surgery see more comprehensive and pleasing aesthetic outcomes following their procedures, leading to a higher satisfaction rate among these patients.


For example, procedures such as liposuction or a tummy tuck do not remove sufficient fat from the abdominal area to produce a taut, flat abdomen in patients with higher BMI and waist circumference as they would in normal, healthy BMI patients. Liposuction and other body contouring procedures such as a tummy tuck, are designed to sculpt and tone the body by reducing fat from specific problem areas, but do not accomplish a significant amount of fat removal from the overall body.   The fat volume that may be safely removed using liposuction or body contouring procedures amounts to only about 10 pounds of fat, which in a patient with a high BMI won’t make a significant difference.


Additionally, a healthy diet and exercise regimen is essential to maintain the results of a body contouring treatment, so it’s best to establish these habits well before you come in for surgery.  These procedures work best on individuals who are within 20 pounds of their ideal weight.


What are My Options if I am Considered Overweight or Obese?


If you are only slightly overweight, you may lose 10 to 20 pounds in a few months through a disciplined diet and exercise regimen, which will bring your BMI down to a healthier number and make your surgery much safer. This method is also less risky and far less expensive than surgical weight loss solutions.


Patients who are considered obese or morbidly obese may be referred for bariatric surgery in order to dramatically reduce body fat before undergoing any cosmetic surgical procedure. Surgical weight loss procedures don’t include cosmetic treatments such as liposuction, tummy tuck, or a body lift to trim away excess skin that remains behind after weight loss surgery.   Typically, patients will schedule these body contouring procedures shortly after recovering from surgical weight-loss.


How Can I Improve My BMI?


The simplest way to lose excess weight and reduce fat around the abdomen is through a dedicated, disciplined regimen of diet and exercise.   Most Americans consume a lot more calories – and especially more fat and carbohydrates – than our bodies actually need.   In fact, maintaining a healthy intake of lean proteins, fresh fruits and vegetables, and a relatively low amount of fats and carbohydrates can successfully help you reach your weight loss goals, particularly if you reduce your caloric intake to about 1500 calories a day.


You must also commit to daily exercise, even if it’s just walking an hour a day, though you will get far better results if you commit to a total body workout at the gym at least 2-3 times weekly.


How Do I Know if I am a Good Candidate for Cosmetic Surgery?


Your first step should be to contact us at Glamour Plastic Surgery and Med Spa and schedule a consultation with Dr. Bachilo. She will best advise you if you are a candidate for cosmetic surgery. In some cases, depending on body type, weight circumference, lifestyle, and other factors, Dr. Bachilo may approve patients with a BMI as high as 39 for surgical procedures.  But if she determines that your BMI is too high, she will recommend the proper course of action for you to take to help you achieve your aesthetic goals.


Don’t give up! It may be a longer journey, but your safety and the results you’ll achieve at the end of it are well worth it!

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