This is an area where many different doctors have many different approaches. In general, most will agree that if you are over 50 or have any medical conditions, you should obtain formal medical clearance prior to your operation–that is evaluation by a Family practice doctor/internist with supporting labs, EKG, chest x-ray et cetera. However, in cases where the patient is younger and healthy, there is no consensus as to the need for medical clearance. I would have a careful discussion about this matter with your plastic surgeon. It is vitally important that you seek the advice of a surgeon who is certified by the American Board of plastic surgery and has extensive experience in the procedure. I wish you the best. Dr. Gabbay.