What tests do I need for health clearance before my facelift?

Thank you for the question. First, I would offer a word of caution about traveling abroad for cosmetic surgery (or really any surgery).  Follow up care is essential in cosmetic procedures, and this is generally difficult with long-distance travel.  If there are any complications, you may have a difficult time finding a doctor at home to assume your care... or end up with a lot of medical bills that are not covered by your insurance. Second, pre-op testing is on a case-by-case. basis. In general, I follow the guidelines created by anesthesia and cardiology specialists. These dictate certain tests for men and women based on age.  The most common tests are blood tests for anemia, electrolyte levels, and coagulation capacity.  Other tests may include an EKG (heart rhythm) and chest x-ray (for patients with lung disease).  Patients with other specific illnesses, such as diabetes or liver disease, may require extra testing.

We do not typically require ANY tests as our procedures are performed under local anesthtesia.  This greatly reduces the risk of complication from anesthesia.

Pre-operative health clearance for a facelift (e.g. blood
work, PCP clearance, specialty test –EKG, etc.) depends on: 1) patient’s
medical conditions, 2) facelift surgeon’s practice policy, 3) Hospital or
Surgery Center Policy, and 4) State and State medical board policy. Patient
interested in undergoing facelift should discuss about the required
preoperative health clearance applicable to her/him with his Board Certified
Plastic Surgeon during the consultation.

In general, the tests would be directed by your general medical condition.  In my practice, I do laboratory tests on patients with diabetes, hypertension, heart concerns, etc...  Patients over 50 yrs old get lab work as well.  This is a question best directed at the surgeon and anesthesiologist performing your surgery as they will have to assume the responsibility for your safety during the surgery and recovery period.  Good luck and be safe.

The health & welfare of each patient is the most important issue before, during & after surgery.  With elective (cosmetic) surgery, a healthy patient is essential to begin with. All of us live in some level of health at any one time, and this can change.   Assuming a patient appears to be healthy (by history & current status), then issues such as smoking history and medication usage are important to evaluate. (Smokers may not heal as well. Certain medications affect clotting, for example.)  Once "medical clearance" is achieved, then certain tests can help reinforce the picture of health. Blood tests such as a CBC and blood chemistry are used. An EKG helps evaluate heart rate & rhythm. Platelet function tests are sometimes ordered.  Depending on type of anesthesia, a chest X-ray may be helpful. Summary:  "tests" are only part of the overall pre-operative evaluation in determining one's suitability for elective surgery. It is important to disclose all medical issues to your physician before any procedure! 

The specific preoperative workup varies from patient to patient depending on their physical condition. Most facelift patients are old enough to warrant basic lab work and an EKG.

Prior to a facelift, we typically order an EKG on any patient older than 50 years of age, a metabolic panel, CBC, PT/PTT, relevant additional laboratory tests for any intercurrent medical conditions the patient may have, and a complete preoperative consultation and physical examination that will allow a letter of medical clearance to be written by the patient's primary care physician, if there are no contraindications to the planned surgical procedure. But this boilerplate response in fact buries the lead.  What is the point of going to all this trouble in the first place? It is too ensure that your operation is done as safely as possible, that the chances of an excellent surgical result are optimized, and the risks of a significant complication or life-threatening emergency are minimized.  If this is the goal, and the reason for doing such a preoperative workup in the United States in the first place, then it defies logic to fly off to Kazakhstan to have your actual surgery performed there. What if there is a surgical complication? For how many weeks will you be able to stay there? What is their capacity to actually treat a serious surgical complication? What if a serious medical complication occurs during your procedure such as an intraoperative MI, stroke or DVT?  What is the quality of their hospital system, their cardiac care units and the medical professionals who staff them, their EMS and ambulance system? In the event of a serious complication, there will be many more people and institutions involved in your care than just your operating surgeon and his clinic. Going to the trouble to get all the proper preoperative laboratory studies and medical clearance, and then heading out of the country to undergo aesthetic surgery is a bit like meticulously packing your parachute, and then going up in a plane to go skydiving without it. It gives you the illusion of safety, but not the reality. 

Each doctor/surgery center has their own set of requirements based on your age and any medical condition that you might have.  The doctor who will perform your surgery can best advise you on the requirements for his/her practice.

I am aware of good and bad clinics for plastic surgery outside of the US. We discovered most of the good places from our flight attendant-patients. Even if you find a reputable clinic and physician overseas to perform a 3.5 hour facelift, your postoperative experience will be a lifetime, and any issues, even minor ones, become magnified by the long-distance relationship. Major issues like bleeding, scarring, or facial nerve paralysis could be a nightmare to deal with internationally. Before any facial plastic surgical procedure, if you're over 50, we would order CBC, CMP, EKG and Chest X-ray as a minimum. If there is a personal or family history of bleeding, we add Bleeding Time and PT, PTT to the testing. We get a "letter of medical clearance" written by your internist, after your testing, and if you have other pre-existing diseases, we may refer to an appropriate specialist for pre-operative clearance as well. I wish you all the best.Dr. Joseph

In patients above age 50, our routine is to order a CBC (blood count), a metabolic panel, and an EKG.  The most useful test is the EKG because it provides a baseline picture of your heart rhythm.  What is most important is that you are generally healthy and not having any active cardiac, respiratory, or metabolic problems.  If you are considering traveling out of country, please follow the link to my article below about medical tourism.  Make sure you understand all of the issues involved beyond a lower price.