Cosmetic surgery in the high BMI patient

Does BMI affect the safety and results of cosmetic surgery?

Yes, it does.   Higher BMI patients have a higher complication rate and are generally less satisfied with their results compared to patients with BMI's in the "normal" level.    At Dr. York Yates Plastic Surgery we take safety and results very seriously.

What is BMI?

BMI - Body Mass Index, is a calculation of how much fat a patient is carrying relative to their body frame.   It is simply calculated using the ratio of weight and height.   It is not a perfect measure of body fat percentage as it doesn't take into account the patient's build.   For example, a stalky, very muscular patient can have a high BMI but relatively little fat.

Why is a healthy BMI important for cosmetic surgery?

The ideal candidate for plastic surgery is in good health an at or near their ideal body weight.  Patients with high body weights (measured in BMI) are at increased risk of a number of complications.

  1. Blood Clots (DVT) and Pulmonary Embolism (PE) - This is the most feared complication in cosmetic surgery and patients at high BMI have a much higher risk of this life-threatening complication.
  2. Sleep Apnea - Overweight patients have a higher risk of sleep apnea which can be a problem both during or after surgery
  3. Fatty liver - High BMI patients are at risk of liver dysfunction associated with fat accumulation.  The liver plays a critical role in inflammation and wound healing.
  4. Surgical Site Infections - High BMI patients have a much higher risk of infection after surgery
  5. Other wound healing issues - Wound separation, tissue necrosis, and fluid accumulation are much more likely in the high BMI patient.
  6. Cosmetic - A  healthy BMI prior to surgery results in better cosmetic outcomes in most patients.   In the tummy tuck patient, as an example, the internal fat cannot be controlled with a tummy tuck alone.   Many of these patients will still have a rounded abdomen after a tummy tuck, a less than ideal cosmetic outcome.

What is a healthy BMI?

BMI is a standard assessment of weight to height ratio.   It is not a perfect measurement and body type and build should also be considered.  Here is a basic rule of thumb:

  1. BMI less than 18.5 - Underweight
  2. BMI from 18.9-24.9 - Normal weight
  3. BMI from 25-29.9 - Overweight
  4. BMI at or above 30 - Obese
  5. BMI at or above 40 -  Morbidly Obese

BMI isn't a perfect measure of health and it is possible to have a high BMI and have very little body fat, especially in muscular males.

Another indicator of health is waist circumference.   Excess body fat around the waist has been strongly linked to diabetes and heart disease.  Female patients with a waist circumference over 34.5 inches and males with a waist circumference over 40 inches are at particular risk.

But the only reason I want liposuction is that I feel overweight

It is frustrating, we know, but liposuction is not a treatment for weight loss or obesity.   Liposuction is a contouring procedure to sculpt and reshape the body by eliminating fat in specific areas.   It is not a procedure for general, total body fat removal.   For example, the fat volume that can be safely removed with liposuction only weighs around 10 lbs.  Without a complimentary change in diet and exercise habits, these 10 lbs may never be realized on the scale.  Many patients can eliminate 10 lbs in a couple of months of dedicated diet and exercise, a much safer and less expensive alternative.

What measures can a patient take to improve their BMI?

For most patients, losing weight is a slow process defined by hard work and discipline.   Most Americans eat far more calories than their bodies need.   Many Americans get less exercise than they need.  For some of us, genetics are simply not on our side and it seems that despite healthy dietary and exercise habits the weight simply won't go away.   For some of these patients, surgical weight loss such as gastric bypass surgery may be indicated.  It is important to note that surgical weight loss does not include cosmetic procedures such as liposuction or tummy tuck.   While these procedures do technically remove some weight, this is a relatively insignificant amount of weight compared that what can be accomplished by bariatric surgery.

Dietary Guidelines - Calorie needs

Physical Activity Guidelines

Bariatric surgery information

Dr. Yates BMI requirements for cosmetic patients

Cosmetic surgery by its nature is not "medically necessary".  As such, it needs to be held to a higher safety standard than almost any other surgery.  At Dr. York Yates Plastic Surgery, we have chosen to require a BMI of 28 or less for most of our cosmetic surgery patients.  There is a little flexibility with this number depending on the procedure's desired and extenuating circumstances.  We understand how frustrating weight can be for some patients and it is a very delicate and uncomfortable conversation.   Most patients appreciate that our requirements are ultimately in their best interests.   Optimal surgical results performed as safely as possible.

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