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Preoperative Guide – Video Transcription

Dr. Karlinsky:

Hello and welcome to your preoperative video. I’m Dr. Victoria Kalinsky, I’m a cosmetic surgeon and I work in Miami, Florida.

The reason why I’m doing a series of these videos now is because a lot of my patients are from out of state, out of town, and sometimes even out of country. And over the years I’ve created several fairly unofficial videos which were designed to really help patients get ready for their surgery since very often they don’t come until just a day or two before their operation. And so this is really meant to help my patients to prepare for their operation, hopefully alleviate some of their concerns, their worries, and give you as a prospective patient a peace of mind, and make sure that you know that you’re getting everything that you need to prepare for your operation. This video in particular, I’d like to take a few minutes and inform my prospective patients, or patients who are already scheduled for surgery, about the necessary tests that you need to prepare, so preoperative testing for your operation.

I keep it fairly simple. If you are under 40 years of age, and you have no medical problems at all, you take no medication, all you need to do is get necessary labs, which include your CBCC, which is your blood count, SMA 20, which is a comprehensive metabolic panel that tells me about your potassium, your sodium, your sugar, your kidney function, and so on, your PT, BTT and INR, these are parameters that we use to ensure that your coagulation is normal, a urine analysis, a pregnancy test for my female patients, HIV test for all the patients that undergo surgery, and that’s essentially all that you need, and as long as these labs are normal, you can get an operation if you’re under 40 and have no medical problems.

Now, if you’re 40 or above, I do require that my patients also get medical clearance. Assuming that still you’re healthy, you would get the same lab work and also a note from your primary care doctor stating that you are in good health and he or she has no problems with you having an elective operation, as well as an EKG, a chest X-ray to confirm that your lungs are working fine and there’s no issue with general anesthesia.

Now, for patients who are 50 years old or above, on top of what I already discussed, there’s also a need for a cardiology clearance, and a lot of times I’ll get a little bit of pushback from patients. People feel like it’s a waste of time because they don’t really have any cardiac issues, but the reason for the cardiology clearance for patients who are 50 or above is really not meant to make your life difficult. It’s a safety thing, because very often patients who are 50 or above, typically if they don’t have any problems, will not go to see a cardiologist, but not infrequently, when they do, they find underlying issues that have not yet surfaced up. And certainly, I don’t want my patients to find out that they have potential cardiac issues when they’re getting cosmetic surgery. It’s just a very dangerous and inappropriate way to put somebody in potential harm’s way for an elective aesthetic operation. So that is the reason why it is important to see a cardiologist if you’re 50 or above, even if you’ve never had any cardiac problems.

Now, if you’re a patient who is 60 years old or above, on top of the things that I just discussed, I also ask that my patients get a stress test and an echocardiogram with their cardiologist. Again, only designed to ensure patient safety for an elective aesthetic operation.

If you are any age, but you have any medical problems like hypertension, rheumatologic issues like lupus or diabetes or any other issue that has come up in the past and you had to deal with with a specialist, I do require that you get a clearance from your specialist for that specific problem. I just need to know that the doctor who is managing your medical condition has no problems with you having an elective operation and having general anesthesia.

Now, I want to talk a little bit about BMI requirements, which is part of your preoperative workup in order for you to properly prepare for your surgery. There’s a lot of talk about BMI on social media and YouTube, and I can only of course speak for myself and to help my patients prepare for the operation. Medically legally, anybody with a BMI of 40 or above cannot undergo elective operation in an office-based surgery setting. Now, office-based surgery setting is where typically cosmetic surgeries are performed. This is where I perform my operations for my patients. So any patient with a BMI of 40 or above cannot undergo surgery in that setting and would need to be taken to a hospital in order to have surgery safely. You’ll hear that everybody has different requirements, BMI 30, BMI 32, no more than 34. I look at it in a very different way, and I always tell my patients that a BMI is a number that cannot be used just as that. Everything depends on the patient because we’re all different. Remember that a bodybuilder could have very little fat, but have a very high BMI because they have very high muscle mass. So that’s why BMI by itself is not a very accurate indicator, and that’s why I always ask my patients, I ask my coordinators, to always send me a picture of a patient who is interested in having an operation and what operation they’re interested in.

In general, please remember that the higher the BMI, the higher are the potential risks for complications like tissue necrosis and infection and poor wound healing and anesthesia related complications. So that is a given fact. However, it doesn’t mean that if you have a BMI of 37, you cannot have surgery. As long as you’re properly informed, and as long as you’re a good candidate for a procedure that you’re interested in, you can still have the operation, but it’s on a case by case basis. I have to know what you’re interested in, I have to know your medical history, I have to see your pictures to understand better if it is safe for you to have an operation or if the risks are too high and the benefits do not even close outweigh the risks of the surgery.

Now, with that said, typically anybody with a BMI of 32 really needs to get medical clearance, even if you’re young and you’re healthy. Because you’re now in the category of obesity, you should get medical clearance. Certainly anyone who is 40 or above gets medical clearance, but even under if your BMI is 32 or above. If you’re even under 40, you need to get medical clearance from your doctor. I need to know that you’re in good health and your doctor has no problems with you having an operation. Now, if somebody has a BMI of 34 or above, at this point, I require that you also get a cardiology clearance. Even if you’re in your twenties, I ask that you see a cardiologist, you get an EKG. Your cardiology doctor may not ask you to get an echo or a stress test because they feel that you are very healthy and even though you are obese, you don’t need any further testing. But I do want that as yet another layer of protection for my patients to know that everything is okay and you are fine to undergo an operation.

So what you need to know is if you do have a high BMI, it doesn’t necessarily mean that you cannot have surgery, but it has to be decided on a case by case basis. It’s not a cookie cutter, I’m always standing by. As I’ve mentioned in prior videos, if you go on my Instagram, Dr. Kalinsky, there’s a cell phone number there. Please send me a WhatsApp message. Let me know your age, your medical problems, if any, send me a picture with no face for privacy reasons and let me know what you’re interested in. I will be able to advise you if this is something that’s reasonable, that’s safe to do, or if you need to lose weight prior to considering cosmetic surgery. I hope this helps.