Preparing for Cosmetic Surgery

How to prepare for surgery

Preparing for plastic surgery starts once you have had your consultation, had at least two weeks to think it over in the cooling-off period, and booked your date. From then on, a few things make a real difference to how safely and comfortably you recover: your pre-operative assessment, stopping smoking and some medicines in good time, getting a little fitter, and arranging help at home. This guide covers the weeks before; for the night before and the morning itself, see our pre-surgery FAQs.

Where this fits in the bigger picture is set out in the cosmetic surgery patient journey, and if you have not chosen a date yet, choosing your surgery date has a planner that works out the milestones below for your own date.

Preparing for plastic surgery: a week-by-week timeline

1. Four weeks or more before Stop smoking, vaping and all nicotine, and stay off it until four weeks after surgery. Arrange your responsible adult for the first 24 hours, your time off work and help at home.
2. At your pre-operative assessment Health questions, measurements and any tests you need, ideally completed at least two weeks before surgery.
3. Two weeks before Stop aspirin (unless it is prescribed for your heart or after a stroke) and herbal supplements. Make sure your compression garment and prescribed medicines are ordered.
4. One week before Return your pre-operative forms. Try on your garment. Get your home ready for your recovery.
5. In the days before Your patient coordinator confirms your arrival time and your fasting instructions.
6. The night before and the morning of surgery Follow your fasting instructions and bring what you have been asked to bring.

Tick off each step as you go: your ticks are saved on this device, and you can print the list or copy it to your phone.

What happens at a pre-op assessment?

Your pre-operative assessment checks that you are well enough for surgery and anaesthesia, and gives you the chance to ask practical questions. It is led by our nursing team, and for people travelling from further away it can often be done on the same day as the consultation. Expect:

• a detailed health questionnaire, covering your medical history, previous operations and anaesthetics, allergies and the medicines and supplements you take
• your blood pressure, pulse, height and weight
• any tests you need, such as blood tests
• a check of what to stop before surgery and when, and what to bring on the day

We may ask your GP for a summary of your medical history. If you have a significant medical condition, you may be asked to see the anaesthetist before surgery, a little like a second opinion on how your anaesthetic should be planned: our guide to TIVA and your anaesthetic review explains more.

What blood tests are done before plastic surgery?

Not everyone needs blood tests. Which tests you have depends on your age, your health and the size of your operation, in line with NICE guidance, which recommends testing according to each person’s health rather than routinely for everyone^[1]. If you do need them, have them done at least two weeks before surgery, so that anything that needs attention, such as anaemia, can be sorted out in good time.

Which medicines and supplements should you stop before surgery?

Tell us about everything you take, including medicines from your GP, anything you buy over the counter, vitamins and herbal remedies. We will tell you what to stop and when. The general rules are:

• Aspirin: stop at least two weeks before surgery, unless it has been prescribed for your heart or to prevent a stroke. In that case, do not stop it yourself: we will discuss it with you and the doctor who prescribed it.
• Herbal remedies and supplements: stop vitamin E, fish oils, ginkgo, garlic, ginseng and other herbal supplements two weeks before surgery. A review of herbal medicines in JAMA ↗ found that garlic, ginkgo and ginseng can increase bleeding, kava and valerian can deepen the effect of anaesthetic medicines, and St John’s wort changes how quickly the body clears many drugs used around surgery^[2].
• Anti-inflammatory painkillers such as ibuprofen and naproxen can affect bleeding too. Ask your surgeon whether and when to stop them, and what you can take instead if you need a painkiller.
• Prescribed medicines, including blood thinners, antidepressants, diabetes and blood pressure medicines, the contraceptive pill and HRT: never stop or change them without advice from your surgeon or anaesthetist and the doctor who prescribed them. Some need to continue right up to surgery.

Stopping smoking and vaping before surgery

We ask everyone to stop smoking, vaping and all nicotine at least four weeks before surgery and to stay off it for at least four weeks afterwards. Nicotine narrows the small blood vessels that heal your wounds. A 2012 meta-analysis in Archives of Surgery ↗ of 140 studies found smokers had more than three times the odds of tissue death, twice the odds of wound breakdown and almost twice the odds of infection compared with non-smokers^[3]. A meta-analysis of trials in the American Journal of Medicine ↗ found that stopping before an operation cut complications by 41%, with the benefit growing for every week of stopping and clearly greater after four weeks or more^[4].

This includes vapes and e-cigarettes. If you use nicotine patches, gum or other nicotine replacement, talk to your surgeon about it at your consultation. Read more about stopping smoking before surgery and vaping before surgery.

How long before surgery should you stop drinking alcohol?

Cut down in the weeks before surgery, and avoid alcohol completely in the day or two before your operation unless your instructions say otherwise. Heavier drinking is the main concern: a meta-analysis of 55 studies in the Annals of Surgery found that drinking before surgery was linked with more complications, infections and wound problems afterwards, while light to moderate drinking showed no clear link^[5]. Alcohol also thins the blood a little and can interact with painkillers. Our guide to alcohol and surgery covers when you can drink again afterwards.

How to prepare your body for surgery

Being a little fitter and healthier before an operation helps you recover. The Royal College of Anaesthetists’ Fitter Better Sooner advice is to do some activity that leaves you out of breath at least three times a week, starting slowly and staying within your limits^[6]. Alongside that:

• Eat well. Plenty of protein, fruit and vegetables help healing: see what to eat before surgery.
• Keep your weight steady. Many operations have a BMI limit, and a stable weight gives a more lasting result.
• Sleep and rest well in the week before.
• Stay well. If you get a cold, a chest infection or a fever before surgery, tell us early: read what happens if you get a cold before surgery.
• After a baby, breast surgery waits at least six months after the birth, and at least three months after you have completely stopped breastfeeding.

Your compression garment and medicines

After body contouring and many breast operations you wear a compression garment. Your surgeon advises the type, and the supplier helps with the size. Try it on before surgery: it should feel snug rather than loose. Compression garments and prescribed medicines are bought separately and confirmed in advance, so order them in good time and bring them with you, or collect them, as your coordinator advises.

Arranging help at home

A responsible adult must take you home after surgery and stay with you for the first 24 hours: you cannot drive, walk home or travel on public transport alone after TIVA or sedation, and you should not sign anything important or make big decisions during that time. After many operations, 24 hours of help is enough; after larger operations such as a tummy tuck, most people need help for five to seven days. Plan ahead for:

• children, school runs and pets, especially anything involving lifting
• shopping, cooking and housework for the first week
• time off work: usually one to two weeks for a desk job, and longer for physical work
• getting your home ready: our tips for recovery at home include a list of what to have ready

If you are coming from outside London, read travelling to us for surgery for how to plan the journey home.

Fasting before surgery

Your coordinator confirms your fasting times with your arrival time. The usual rules are no food for at least six hours before your admission time, and clear fluids, such as still water or black tea or coffee, until two hours before. Milk counts as food. Take your regular medicines with a sip of water if you have been told to. These timings follow European anaesthetic guidance, which encourages clear fluids up to two hours before planned surgery rather than fasting from midnight^[7]. Our pre-surgery FAQs answer the questions people ask about the night before and the morning itself.

Most of what makes recovery smooth happens before the day of surgery. Patients who have stopped smoking properly, told us about every tablet and supplement, and have someone at home to help, are the ones who recover most comfortably.

Dr Spyridon Vlachos, Specialist Plastic Surgeon and medical reviewer

Our hospital at 95–97 Baker Street is CQC-regulated, and your patient coordinator is there to help with any part of your preparation. To understand what can go wrong and how preparation lowers the risk, see the risks of cosmetic surgery.

References

Guidance comes from the official sources listed.

1. NICE. Routine preoperative tests for elective surgery (NG45) ↗. April 2016.
2. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001;286(2):208–216. doi:10.1001/jama.286.2.208 ↗
3. Sørensen LT. Wound healing and infection in surgery: the clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012;147(4):373–383. doi:10.1001/archsurg.2012.5 ↗
4. Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144–154.e8. doi:10.1016/j.amjmed.2010.09.013 ↗
5. Eliasen M, Grønkjær M, Skov-Ettrup LS, et al. Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2013;258(6):930–942. doi:10.1097/SLA.0b013e3182988d59 ↗
6. Royal College of Anaesthetists. Preparing for surgery: Fitter Better Sooner ↗.
7. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28(8):556–569. doi:10.1097/EJA.0b013e3283495ba1 ↗