Before surgery: indications, contraindications and preparation

Absolute contraindications are conditions where anaesthetic and bleeding risk outweigh any aesthetic benefit: decompensated heart failure, untreated coronary artery disease, inherited coagulation disorders, severe hepatic or renal impairment.

Temporary contraindications are far more common: breastfeeding, elevated HbA1c, uncontrolled hypertension, anaemia, dental or cutaneous infection near the operative field, and significant weight fluctuation within the previous three months. These simply require stabilisation before proceeding.

One contraindication receives less attention but matters greatly at RASA: body dysmorphic disorder. Patients in this group are rarely satisfied with any surgical result because the difficulty lies in body perception rather than anatomy. This is why RASA developed the RAPI screening instrument to assess expectations before surgical consultation.

There are three clinical reasons for this interval. Anaesthetic and analgesic agents pass into breast milk. Lactating breast tissue is highly vascular, which increases bleeding and seroma risk. And the abdominal wall needs time for natural rectus muscle recovery, so operating too early can mean intervening more than necessary.

Weight stability matters as much as elapsed time. If you are still losing weight, liposuction or abdominoplasty results will continue to shift. RASA requires weight to remain within a 3kg range for three consecutive months before scheduling.

If you plan further pregnancies, consider deferring abdominoplasty until after your last delivery. The procedure tightens the rectus fascia, and a subsequent pregnancy can stretch that repair again.

A caesarean scar alters perfusion of the lower abdomen. Performing liposuction before the scar has matured raises the risk of fat necrosis and impaired wound healing. Twelve months marks the point at which the scar enters stable remodelling.

A combined presentation is common in this group: skin laxity, thickened fat and rectus diastasis together. Liposuction alone does not address this; abdominoplasty is required to excise redundant skin and plicate the fascia. Which indication applies can only be determined at an in-person assessment.

An existing caesarean scar is usually addressed during the abdominoplasty itself, as the incision for that procedure sits lower and can excise the skin carrying the old scar.

The three-month figure is not arbitrary. After weaning, breast tissue needs roughly three to six months to involute back to baseline size and vascularity. For breast surgery specifically, operating before this point also distorts assessment of volume and ptosis, since the breast will continue to change afterwards.

For non-surgical treatments such as botulinum toxin or filler, the same caution applies: RASA does not perform these during breastfeeding, given the limited safety data.

There is no fixed upper limit. What matters is general health and anaesthetic risk, not chronological age. RASA has performed facial rejuvenation on healthy patients over 65, and has equally postponed surgery for a 40-year-old with uncontrolled comorbidity.

Some indications under 18 are genuinely medical rather than cosmetic: symptomatic breast hypertrophy causing spinal pain and postural change, congenital facial anomalies, and post-burn contracture scars. These are assessed on their own terms.

The extent of testing follows the scale of the procedure and the type of anaesthesia rather than a single fixed list. Longer anaesthetics or patients with comorbidities will have further studies requested by the anaesthetist.

For women of reproductive age, a pregnancy test is performed routinely close to the operative date regardless of stated history.

Breast surgery usually adds breast ultrasound, with mammography for patients over 40 or with a family history of breast cancer. The purpose is to exclude pre-existing pathology before intervening and to establish a baseline for future comparison.

An abnormal result does not mean cancellation. Most lead to rescheduling while the issue is corrected, for example iron supplementation for anaemia or adjustment of antihypertensive therapy.

Supplements and herbal products are frequently omitted from medication histories because patients do not regard them as drugs. Many have meaningful antiplatelet activity. Bring every medication and supplement box to your preoperative appointment.

Oral contraceptives and hormone replacement therapy raise the risk of deep vein thrombosis. Depending on the procedure and other risk factors, discontinuation 3 to 4 weeks preoperatively may be required.

For patients anticoagulated for cardiac disease, discontinuation must be directed by the treating cardiologist and often requires a bridging plan. This is why RASA requires a full comorbidity disclosure at the first consultation.

This is one of the few risk factors entirely within the patient’s control, and one of the largest determinants of scar quality. In facelift surgery the skin furthest from its blood supply is the preauricular region, which is precisely where necrosis occurs in smokers.

E-cigarettes and nicotine patches are not substitutes. The principal mechanism is nicotine itself rather than smoke alone, so nicotine replacement products produce comparable vasoconstriction.

Regular passive smoke exposure is also worth disclosing, particularly for large-flap procedures.

Where necessary, light and low-risk procedures can still go ahead during menstruation. This is a case-by-case decision in which the surgeon weighs the scale of the intervention against your particular circumstances.

The most convenient window is usually 3 to 10 days after menstruation ends. For breast surgery, avoiding the premenstrual phase also allows more accurate volume assessment because the breast is not engorged.

If your period arrives unexpectedly on the day of surgery, tell the nursing team. Minor procedures can usually proceed. Major surgery is typically deferred by a few days.

Hyperglycaemia impairs leucocyte function and collagen synthesis, delaying healing and increasing surgical site infection risk. This is why the HbA1c threshold is set strictly.

Uncontrolled hypertension raises the risk of postoperative haematoma, particularly in facelift surgery where haematoma is the most common early complication. Blood pressure is monitored closely intraoperatively and afterwards in these cases.

RASA’s approach is to coordinate with the patient’s treating specialist rather than adjust medical therapy independently.

Excessive fasting is also harmful. Preoperative dehydration causes hypotension at induction and worsens postoperative nausea. Modern guidance therefore permits clear water up to the two-hour mark rather than fasting from midnight as in older practice.

If you have eaten, or had milk, milky coffee or pulp-containing juice within the restricted window, tell the team honestly. Concealing this is far more dangerous than delaying the operating time.

The longest part is usually not surgical technique but clarifying expectations. RASA uses the RAPI instrument to structure this, helping both surgeon and patient see the gap between what is wanted and what is achievable before any decision is made.

RASA does not ask for a commitment at the end of the consultation. Taking further time is encouraged, particularly for major surgery. Where the surgeon judges that an operation would not deliver proportionate benefit, that is stated plainly rather than substituting an alternative procedure.

Worth preparing beforehand: a list of current medications, any recent health check results, and a few reference images of the outcome you have in mind.

To make an online consultation useful, prepare photographs of the area from three angles (front, left oblique, right oblique), taken in natural light without beauty filters or editing.

RASA does not issue a final quotation online. Figures given at this stage are indicative; the confirmed price follows the in-person examination and definition of the operative scope.

The ideal candidate has a reasonable BMI and stable weight but retains localised fat deposits unresponsive to diet and exercise, typically in the lower abdomen, flanks, inner thighs and submental region.

Patients with a high BMI are usually advised to lose weight first, for two reasons: lower anaesthetic risk, and a more defined contouring result once the underlying fat layer is thinner.

Fat removed does not regenerate at that site. However, if you gain weight, remaining adipocytes elsewhere still hypertrophy, producing a different distribution than before. Maintaining weight is the condition for a durable result.