Does one need to have a full physical prior to smart lipo, including EKG?

I've had more than a few "healthy" people test positive for cancer, heart disease, pulmonary disease, liver disease, etc on the basis of a few simple screening tests that form the basis for pre-surgical evaluation. When you're treating a medical problem, you take more risks in proceeding with surgery because the medical problem is worse than the surgical risk. When you're going for cosmetic surgery which offers no medical benefit, taking such risks is unacceptable.

Most of the written guidelines for pre-operative testing applies to procedures requiring general anesthesia.  If a procedure like Smart Lipo is performed with mild or oral sedation only, the recommendations are less clear and usually surgeon (hopefully you're seeing a surgeon) - dependent.  Because most qualified surgeons will have had training and experience with major surgical procedures including emergencies and trauma training, they understand true operative risks.  Even for minor procedures, the very minimum should be a thorough history and physical exam to determine if you have any risk factors that would require additional testing.  One of the risk factors I use is age over 50, for which I usually require recent basic bloodwork, CXR, and EKG.  Otherwise a medical clearance from your primary care physician if these tests were already performed during a routine physical within the past year.  Remember even a procedure like Smart Lipo done under mild sedation causes trauma to the body including stress to heart, lungs, and fluid shifts.  If I were you, I would abide by your surgeon's recommendations because at your age you should have those tests done anyway.  Insurance should cover them.

If you recently had a full physical and can obtain those results with a clearance letter from your PCP for elective plastic surgery your PS may be okay with that. It is best for you to ask your PS. Even if patients are "healthy", we usually ask for clearance if patients are 50years or older or have any medical problems. It is always best to be safe even if it means you may have to pay for the tests. The risk is more for the anesthesia and not so much for the liposuction specifically.