BMI Requirement - do surgeons ever waive the BMI limit due to the inaccuracy of BMI as a measurement?

Question

Hello - with BMI being an outdated/inaccurate measurement of health and fat distribution, do surgeons ever waive the BMI limit? My body composition puts me at 38 and my lifestyle, mental, and heart health are all clear. Do surgeons ever make exceptions, or are there any surgeons who don't stick to a BMI limit? I have a lot of excess skin and would like to pursue an arm lift and eventually a thigh lift. I lift weights regularly and am a ballet dancer.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your insightful question about BMI requirements and the role it plays in determining eligibility for plastic surgery. While BMI, calculated using height and weight, offers a numerical representation of an individual's body proportion, it is not an exhaustive metric of health or surgical suitability.
Understanding that BMI doesn't capture the complete health picture or reflect weight loss history is essential. While BMI might be a factor for most plastic surgeons, it isn't the exclusive deciding criterion. Comprehensive health assessment, which considers conditions like high blood pressure, diabetes status, smoking habits, and more, holds greater significance.
There are plastic surgeons who may adhere to traditional BMI limits, often preferring a BMI under 30. However, many understand the limitations of BMI as an isolated measure and consider patients with higher BMIs if they are otherwise healthy.
If you're considering plastic surgery, prioritize research and consultation. Find a surgeon who values holistic health evaluations over rigid BMI cut-offs.
Best wishes on your journey.
Sincerely,
Dr. Katzen

James M. Economides, MD, FACS · Answer

It's true that BMI doesn't always provide an accurate reflection of health or body composition, especially for individuals who are very fit or have significant muscle mass, like yourself. Many plastic surgeons recognize this limitation and may be willing to make exceptions for patients with higher BMIs who are otherwise in good health.

Considerations Surgeons May Take into Account:
Body Composition: Surgeons who specialize in body contouring and weight loss patients often understand that BMI doesn't account for muscle mass versus fat. They may assess your overall body composition, skin laxity, and the specific areas you're targeting for surgery (e.g., arm lift and thigh lift).

Health & Fitness Level: Your regular weightlifting and ballet dancing likely contribute to your physical fitness, which is a positive factor for surgery. Surgeons are more likely to waive strict BMI limits if you're in good cardiovascular health, have stable weight, and can demonstrate a healthy lifestyle.

Excess Skin vs. Fat: Since you're focused on removing excess skin, rather than large amounts of fat, some surgeons may be more flexible with BMI limits, particularly if they feel that the surgery will improve your quality of life and physical mobility.

Surgeon Experience: Some plastic surgeons specialize in post-weight loss or athletic patients and are more likely to take an individualized approach rather than strictly adhering to BMI cutoffs. Surgeons with experience working with fit, muscular patients often understand that BMI can be misleading.

Ryan Rebowe, MD · Answer

While there are flaws in the measurement of BMI, it continues to be proven an accurate predictor of complications following most surgical procedures. In particular, the complications from body contouring procedures rise tremendously if the BMI rises above 35. While an in person physical exam may assuage some of the concern for a particular surgeons, many surgeons stick to the BMI of 35 requirement fairly religiously.

Daniel Barrett, MD · Answer

Dear gumball56,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Yes, many surgeons are not too strict about the BMI as long as there are no specific medical issues, especially diabetes. However, it might be best to do liposuction first and see how much skin shrinks. Renuvion can be added to boost skin tightening.

Leland Webb, MD · Answer

This is a great question. One of the difficulties with a BMI is that it does not capture everybody and accurately delineate their physique and physiology similarly. That being said, the use of a BMI is often more about the safety of the operation. I think that each person can be a valuated individually so that the safest operation can be decided for you. Have a frank conversation with your board-certified plastic surgeon about these concerns and also understand that they should have your best interest in mind and discuss that risks increase as BMI numbers increase as well. Safety is the primary concern. We are happy to help in any way we can.

Camille Cash, MD · Answer

BMI is one of the considerations when evaluating a patient for surgery, but there are others as each person is assessed individually.  Those with a higher BMI carry a higher risk of complications such as poor wound healing, infection, and substandard results.  I encourage you to visit with a board certified plastic surgeon near you to learn more.

BMI Requirement - do surgeons ever waive the BMI limit due to the inaccuracy of BMI as a measurement?

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