Medical Clearance for Surgery: The Safest Path to the New You
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.
Donda West, the woman whose untimely passing was honored by the legislation, happened to be the mother of rapper Kanye West, who actively championed the law after her fatal heart attack in 2007, in Marina Del Rey, California.
West’s unfortunate passing is made further notable by the fact that she’d recently undergone liposuction and breast reduction surgery. It was later determined that her heart attack was spawned by a combination of numerous postoperative complications and a pre-existing coronary artery disease.
Most medical professionals, along with West’s family, believe that had her condition been uncovered prior to her surgery, she would have rightfully been turned away.
Ask Your Surgeon About Medical Clearance
While this California law establishes the health screening requirements for plastic surgeons operating within the state, many other states lack such oversight. Nevertheless, qualified plastic surgeons understand the importance of ensuring their patients are healthy enough for certain procedures and tend to practice a degree of self-regulation.
Regardless if your prospective doctor requires you to undergo certain tests in advance of surgery, you still need to appreciate the seriousness of all surgeries and should inquire about any tests that could ensure your continued health and safety.
To this end we’ve looked into some of the more common assessments you might be subject to during a medical screening and reviewed the specific personal health conditions your plastic surgeon should be aware of prior to operating on you.
Medical Screening Tests: What to Expect
Keep in mind that the types of tests you undergo will vary based on a variety of factors. Different procedures are more or less taxing on the body and, therefore, require different preoperative assessments. After all, a simple Botox injection needs less oversight than a tummy tuck or liposuction, both of which require anesthesia.
Your cosmetic surgeon will also look at your age and medical history to determine if further testing is required.
Ever been asked to pee into a cup? If so, then you’ve have a urinalysis done. This standard procedure is used to test for drugs in the workplace and read hormone levels in pregnant women.
When it comes to preparation for a plastic or cosmetic surgery procedure, a urinalysis can inform the doctor if you have certain types of infections, like a urinary tract (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 (red blood cell deficiency) or have a blood clotting disorder like hemophilia. CBC tests also detect infectious bloodborne diseases like HIV or hepatitis.
This series of blood tests focuses on measuring the quantity of certain elements in the blood, such as sodium, potassium, and glucose. It’s typically used to gain an overall sense of someone’s health. It can clue physicians into the health of the organs, signifying liver disease, renal failure, and more. It can also let physicians know if you have diabetes or a dangerous electrolyte imbalance.
Imagine a patient is plugged into a beeping heart monitor from various nodes positioned on their chest and body. This is called an electrocardiogram (EKG) and is used to test for heart irregularities, such as palpitations and murmurs.
It will typically only be called for if you have a history of heart disease or heart beat irregularities or if you’re above a certain age. Most plastic surgeons have cut off ages (typically between 50 and 70) where they will insist this test be performed no matter what. An EKG is also more likely to be performed prior to surgeries that require general anesthesia.
Cardiac Stress Test
This is similar to an EKG, except you’re not lying down while doctors monitor your resting heart rate. Instead, you’re likely jogging or speed walking on a treadmill. The goal is to see how your heart responds to stress with similar intensity to exercise.
It’s unlikely you’ll be asked to complete one prior to surgery as they’re typically only performed after an EKG has revealed an issue of concern warranting a more thorough investigation.
CT Scans and X-rays
You might find yourself getting a chest X-ray in anticipation of major plastic surgery. Chest X-rays help your physician or prospective surgeon to assess your respiratory health. They reveal damage to the lungs from smoking and respiratory illnesses like pneumonia. They may also reveal signs of congestive heart failure, which can be a deal breaker when it comes to getting that coveted surgery.
In more extreme cases, a full CT scan (also known as CAT scan) may be required. However, a CT scan is rarely conducted for standard preoperative medical evaluations.
This test is exclusive to those seeking breast surgeries. Mammograms are intended to detect lumps, which may indicate breast cancer. If a plastic surgeon cuts into or under the breast and accidentally ruptures a cancerous tumor that he or she was not expecting to find, it could cause the cancer to spread.
It’s much simpler to check for cancer first in order to avoid making a bad situation worse.
This standard procedure is obviously exclusive to women. Even if you’re sure you’re not pregnant, a plastic surgeon may insist that you be tested just to be absolutely certain of it. General anesthesia and other medications associated with major surgery can be fatal to a developing fetus.
Why These Tests Are Important
Why are so many procedures necessary prior to a major surgery? If you’re getting a rhinoplasty (nose job), do you really need to worry about that heart murmur or get tested for infections? Isn’t this just a little overkill?
More often than not the concern is with anesthesia. Most plastic or cosmetic surgery procedures, from facelifts to tummy tucks, require either general or local anesthesia. Sometimes you’ll even be given a combination of local anesthesia and sedation.
If you have problems with your heart, lungs, or other organs, you could be putting yourself at unnecessary risk. Trouble breathing now? Imagine how hard it will be when you’re sedated. Is your heart not as strong as you’d like it to be? How do you think it will react to sedation? There’s a reason an entire discipline revolves around administering anesthesia, after all, and it’s not because it’s easy.
The other common concern involves bleeding. It may not be pleasant to think about, but most plastic surgery procedures constitute major surgery and therefore involve a decent amount of blood loss. If you have a condition that affects your body’s ability to heal, like hemophilia or Von Willebrand’s Disease, then you could potentially lose a dangerous amount of blood during surgery.
Of course, you don’t need a rare disease for this to be a concern. Even something as simple and common as hypertension (high blood pressure) can cause excessive bleeding during surgery.
It’s not only your safety that your prospective surgeon should be concerned about. If you carry a bloodborne disease then those operating on you are at risk of exposure. In many cases, plastic surgeons will flat-out refuse to operate on patients with HIV, hepatitis, or a similarly life-threatening, contagious infection.
The following conditions present the highest risk to prospective plastic surgery patients. This list draws from several sources, including a 2011 Brazilian study that sought to create a standard preoperative assessment checklist for those seeking plastic surgery.
How old is too old? It depends on who you ask. The study mentioned above drew the line at 70. That’s not to say that a 73-year-old couldn’t seek plastic surgery, only that they’re putting themselves at greater risk if they do.
If your hypertension (high blood pressure) is easily managed with medications, your surgeon will likely still operate on you. However, systemic hypertension, which affects those arteries bringing oxygenated blood from the heart to the rest of the body, is particularly dangerous and may present serious complications.
Type I Diabetes
Type I Diabetes, also known as Juvenile Diabetes, is the more dangerous form of the disease. The insulin required to manage it can react negatively with the anesthesia. While it’s not impossible for someone with Type I Diabetes to undergo plastic surgery, special arrangements need to be made with the anesthesiologist in advance. Plus, the risk of complications arising is substantially higher.
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is actually a blanket term for a variety of lung related illnesses, such as bronchitis, emphysema, or asthma. As mentioned earlier, breathing problems can cause serious complications when paired with anesthesia.
Advanced Renal Failure or Liver Disease
The 2011 study categorizes these as high-risk diseases. It should come as no surprise that the advanced stages of any kind of organ failure won’t mesh well with major surgery. It’s likely best to avoid aggravating your system further.
Obesity by itself is not a major concern. Rather, it’s the health complications obesity leads to, breathing and heart problems often among them. If you’re above a certain weight, your surgeon may ask that you have tests done to check your heart and lungs. Obesity can also affect the healing process. Added weight puts pressure on incision sites and may lead to unsightly scarring.
As with obesity, the problem is not smoking in and of itself, but instead with what smoking can lead to. Smoking affects your breathing and increases the risk of hypertension. It also interferes and complicates healing.
In fact, smoking’s impact on the healing process can be so substantial that some plastic surgeons flat-out refuse to operate on heavy smokers. Most, however, will insist that you drop the habit at least 2-3 weeks prior to the procedure.
There are other conditions not mentioned here that can also affect your safety and overall success with plastic surgery. However, most are easily managed with certain procedural precautions. The specific conditions listed above are far more likely to be deal breakers for many plastic surgeons than anything we’ve neglected to list here.
That being said, if you do suffer from one of these conditions, don’t lose hope. Some of them, like obesity and hypertension, are manageable or reversible, meaning you can still get that surgery you’ve been dreaming about with patience and a little hard work.
The Question of Psychological Evaluation
An increasing number of plastic surgeons have started considering more than just your physical health before performing a surgery. The aforementioned 2011 Brazilian study noted that many surgeons considered patients currently receiving psychiatric care and/or taking psychotropic medications to be high risk.
Of course, the biggest concern is centered around Body Dysmorphic Disorder (BDD), in which people obsess over their looks and hold unrealistic beliefs about their appearance. With more and more people coming out to talk about the dangers of BDD recently, the disease has gained quite a lot of attention in the plastic surgery community.
If a plastic surgeon suspects you might suffer from BDD or be psychologically unfit to undergo elective surgery, they will ask you to first go for a psychological evaluation and be approved for surgery by a licensed mental health professional.
Be Honest with Your Doctor
You may be tempted to lie about your medical history for fear that something in it could stand between you and the tummy tuck you’ve always wanted. But we can’t stress this enough: do not keep anything from your doctor.
In most cases, your plastic surgeon will review your medical history and the results of any tests to inform the surgery in order to make it safer for you. This is absolutely in your best interest. If the plastic surgeon does refuse to conduct the surgery because your health could be compromised, then you can always get a second opinion.But don’t lose sight of the fact that they have likely refused you for good reason.
Sometimes certain things are just too dangerous to be worth the risks they present, no matter how badly we think we want them.
Cover photo: Donda and Kanye West.
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