Get Fit First: Why Plastic Surgery Isn't A Sub For Weight Loss

The allure of the before-and-after photo can be so tantalizing: A patient showing off the seemingly instant gratification of a life-changing body transformation completed in a matter of hours. But do those snapshots — ubiquitous on social media — tell the whole story? The short answer is no.

While certain plastic surgery procedures (think: facelift, breast augmentation, rhinoplasty) are relatively straightforward in their pre- and post-op immediacy, others — especially those related to the body — often have a backstory involving a commitment made months (or even years) prior to adhere to a healthy lifestyle. And, as it turns out, such discipline is the only way to truly guarantee long-lasting success after an aesthetically-altering procedure. Sure, some providers promise radical physical transformation in the blink of an eye, but there are a growing number of plastic surgeons who are taking a more holistic approach.

Prioritizing Health

“When I first meet a body contouring candidate, I talk to them about where they are in their health and fitness journey,” says Richard J. Brown, MD, a Scottsdale-based board certified plastic surgeon and author of The Real Beauty Bible. “Are they trying to lose weight or are they happy in their own skin?” His goal: create a practice that caters to patients who understand that a successful external transformation begins with an internal shift in mindset. “Surgery is not a weight loss procedure,” he explains. “It’s not a substitute for what you’re trying to achieve in your life.”

Krissy, for one, came to see Dr. Brown toward the end of her own fitness and weight-loss journey. The busy mom of five had gradually stopped exercising and eating well, which left her feeling “stuck” — until she began making small changes to her diet and lifestyle.

After subbing her fast food and coffee habit for healthy meals at home, she immediately lost 10 pounds in the first month. Easing back into her exercise routine, she dropped 10 more. And while the number on the scale was changing, Krissy wasn’t satisfied. “I realized as the weight was coming off that I was left with this mess of sagging skin, and I couldn’t really even see the results that I was working so hard for,” she says. “I didn’t feel better when I was looking in the mirror.”

Through research, she realized that plastic surgery could be a solution for her excess skin and ended up booking a consultation with Dr. Brown. “It was very scary for me to be feeling super self-conscious and to go in and show a stranger all of my insecurities,” she recalls. “But his office is so kind, so compassionate, and so loving.”

Dr. Brown believed Krissy could have a great result, but he said it would be even better if she continued to get fit prior to surgery. Taking his advice, Krissy upped her cardio, continued her clean diet, and lost five more pounds before scheduling her “mommy makeover,” which included a breast lift, breast augmentation, abdominal muscle repair, liposuction, and tummy tuck.

Unsurprisingly, the hard work paid off. At four weeks post-op, she looks and feels like her “pre-mom” self. “It was definitely worth it to put in the extra effort before surgery,” she says. “If I hadn’t, I wouldn’t have had such an amazing transformation.”

The Risks of Operating On Patients Who Don’t Lose The Weight

While some surgeons perform what has become known as the “plus-size tummy tuck" (i.e. cosmetic surgery touted as weight loss surgery), operating on overweight patients can carry serious risk. “We know that if your body mass index (BMI) is above 30, you’re at higher risk for pulmonary, cardiac, and healing complications,” says Dr. Brown.

Obese patients have an increased likelihood of experiencing infections like pneumonia as well as potentially fatal pulmonary embolisms, and, post-surgery, patients with a high BMI are more likely to encounter issues with wound healing due to a propensity for insulin resistance, chronic high blood sugar, and/or poor circulation. “Chronic high blood sugar narrows blood vessels, so basically there’s minimal blood flow through the tiny blood vessels,” Dr. Brown explains. “These patients don’t build strong wounds, so they can rip open their incision, and, suddenly, we’ve got a chronic wound that we’re battling.” It’s also more likely for diabetics to get flesh-eating diseases that a healthy system could normally fight off and kill, he adds.

The simplest way to reduce the chance of such complications is for a plastic surgeon to thoroughly assess a patient’s health prior to any procedure. The first thing Dr. Brown does during a body contouring consultation (be it for liposuction, abdominoplasty, brachioplasty, thigh lift, or body lift) is evaluate the patient’s fitness for surgery. And, while he’s been known to turn down patients looking for quick fixes, it’s never without a plan. “I explain to them that I could cut off this big ol’ thing of skin and they’d feel great, but guess what’s gonna happen in six weeks if they don’t have a healthy lifestyle in place, or if they continue to eat a bunch of junk,” Dr. Brown says. “They’re gonna be right back where they started before surgery.”

After giving birth to twins, Jocelyn* lost 60 pounds of pregnancy weight through a healthy diet and exercise. It was only then that the Arizona mom decided to look into a mommy makeover procedure. She met with four different doctors, and ultimately chose Dr. Brown for her mini tummy tuck (to eliminate the loose skin of her lower abdomen) and a breast lift/implant exchange procedure because of his extensive medical training and holistic approach. She couldn’t be happier with her results. “It’s an extremely vulnerable moment — you already feel awful about your body, and you’re standing there having someone pick you apart,” she shares. “I felt like when I met with Dr. Brown, I wasn’t meeting with just a doctor but a friend.”

Considering All The Factors

Dr. Brown is quick to acknowledge that matters of weight aren’t always black and white. While BMI is a helpful tool, it doesn’t always present the full picture. “I don’t always take a hard stance on the number,” he says, noting that increased muscle mass can elevate a healthy person’s BMI. “Part of the process is me looking at the patient and saying, ‘Yeah, your BMI is high, but clearly you’re healthy. You have a bunch of extra skin on your belly because you’ve lost all this weight and built all this muscle. So your BMI may be 35, but you’re an exception to the rule.’”

When faced with a potential patient who is not far enough along in his or her fitness journey, Dr. Brown doesn’t mince words. “When I’m honest with them and I smack them in the face with real talk about losing weight and getting healthy, they’re like, ‘Yeah, I knew that,’” he says, adding that he recently met with a woman who appreciated the candor. Having already met with three surgeons who were ready to operate, “she said, ‘Every single one of them gave me a quote and said they hoped to see me back for surgery. Not one of them told me that to have the best result I needed to lose weight, and I appreciate you saying that.’”

Dr. Brown understands that this philosophy costs him patients with a “want it now” attitude, but it’s a sacrifice he’s willing to make. While he used to operate on patients with a BMI around 32 or 33 who still had weight to lose, he now knows it’s not worth it for either party involved. “I’ve shifted my thinking with this whole wellness mindset,” he says. “I’d rather lose them as a patient than do a surgery that’s not really doing them any service.” For those willing to look at the bigger picture, however, the results can be transformative. “If they want to engage in the process and they’re with me 100 percent on this life-long change, that’s the person I want,” he says. “That’s who I’m after.”

*Patient’s name has been changed