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

Question

One doctor I consulted with says I need to have a full physical exam with EKG before smart lipo procedure, not sure that the insurance will cover this so soon after my prior physical. I am in excellent health, but I am 55 years old, about 130 lbs, 5'3", size 4 pants, size 6-8 medium tops. I don't see the need for such an exam, am I correct?

Marco A. Pelosi III, MD, FACOG, FACS · Answer

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.

Anh-Tuan Truong, MD, FACS · Answer

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.

Erika Sato, MD, FACS · Answer

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.

Steven Wallach, MD · Answer

Many doctors require patience to get blood work and sometimes medical clearance prior to surgery, It really depends upon the patient's medical history.

Mats Hagstrom, MD (license on probation) · Answer

With all of the data available, you would think all of us surgeons would have some uniform set of standards for who needs EKGs, lab tests, etc., prior to elective surgery. There are a few variables.I personally do most of my liposuction with patients awake with mild sedation.Many plastic surgeons still prefer to use general anesthesia for liposuction.A request for blood work or an EKG is usually covered by insurance regardless if it's for a self-pay or insurance-based procedure.If you recently had a full workup, that may be sufficient.For now, each surgeon makes their own decisions.Remember that safety is always first.From the patient's perspective, I can see the concern with what might seem like an excessive workup.Try to see it from the surgeon's perspective. Over a career of doing thousands of procedures, all it takes is one fatality to destroy someone's career, reputation and create feelings of guilt remorse and regret forever.To me, it says your surgeon is cautious and conservative.That's better than a surgeon who is a cowboy (nothing personal against real cowboys). Always best to put safety first.Best of luck,Mats Hagstrom, M.D.

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

Answers (5)

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