Preparing for cosmetic surgery: the weeks before

The operation is not the only part of an operation. The weeks before a cosmetic procedure — the period after a decision has been made and before anyone is wheeled into theatre — are when a person can still change some of the risks they carry. Smoking, weight, medicines, fasting, the presence of a support person and the amount of leave booked from work all sit in that window. None of them is a bargain for a particular jawline or a particular waist. They are the unglamorous half of taking a regulated health service seriously.

This piece belongs in the recovery hub. It assumes that informed consent for cosmetic procedures has already happened: you know what is proposed, what it cannot do, and what the serious risks are. It should be read with recovery timelines after common cosmetic operations, which deals with the period after the dressings go on.

The consultation is not the preparation

By the time these weeks begin, Australian cosmetic-surgery pathways have usually already required a referral, a cooling-off period for major procedures, and at least one consultation that was not a sales meeting. The Medical Board’s guidelines on cosmetic surgery exist because the decision itself is part of safety. If those steps have been skipped, stop and deal with that before you buy front-button shirts.

Preparation is what happens once the date exists. It is practical. It is also a last chance to say that you do not want to proceed. Illness, a change in home support, a new diagnosis, or simple doubt are reasons to telephone the rooms. A deposit is not a clinical indication.

Write down the instructions you were given. If they are only verbal, ask for them in writing. Teams get tired of repeating themselves; they would still rather you asked than that you guessed.

Smoking, vaping and nicotine

Nicotine constricts blood vessels. Skin flaps, breast tissue, abdominal flaps and facelift flaps all depend on a blood supply that is already being asked to do something unusual. Smoking is one of the factors most consistently associated with wound problems, nipple or skin loss in selected breast operations, and slower healing. Vaping is not a clever exception. Nicotine replacement can also be a problem; the point is the molecule, not the ritual.

Treating teams commonly ask people to stop all nicotine for a period before and after surgery. The exact interval is theirs to set. Some will test. Some will cancel a list if a person arrives smelling of smoke. That is not punitive theatre. It is a judgement about whether the operation should happen that day.

Cannabis and other smoked substances are a conversation for the anaesthetist as well as the surgeon. Airway irritability and drug interactions are anaesthetic issues. Honesty in the preoperative questionnaire is not optional politeness.

If you cannot stop, say so early. An operation can be deferred. An ischaemic wound cannot be talked back into circulation.

Weight, nutrition and the body you will actually recover in

Body mass index is a blunt instrument, and it is one of the instruments hospitals use. Very high BMI is associated, in broad surgical literature, with more wound infections, more blood clots and more anaesthetic complexity. Very low BMI and recent rapid weight loss have their own problems: nutrition, temperature, and, in body-contouring work, the question of whether weight has stabilised. Treating teams set their own thresholds. This journal will not invent a number that makes you a “good candidate”.

Crash dieting in the fortnight before theatre is not preparation. Neither is a sudden gym programme that leaves you sore and depleted. Eat in a way you can sustain. If you have been told you are iron-deficient, diabetic, or protein-poor, that is a medical problem to deal with before someone makes an incision — with your general practitioner, not with a supplement advertised beside a waist trainer.

For people whose operation follows pregnancy or large weight loss, stability matters. A body that is still changing is a poor canvas for a planned contour procedure. Your surgeon’s view on timing is a clinical view. It is not a comment on discipline.

Medicines, supplements and the things people forget to mention

Bring a complete list to the preoperative assessment: prescription medicines, the contraceptive pill or other hormones, over-the-counter painkillers, fish oil, garlic, ginkgo, St John’s wort, weight-loss injections, and anything a naturopath sold you as “just natural”. Some of these increase bleeding. Some interfere with anaesthesia. Some affect blood sugar. Some should never be stopped abruptly.

Do not cease a blood thinner, an antidepressant or a cardiac medicine because a forum said so. The person who prescribed it and the person who will anaesthetise you need to agree a plan. That plan might be to continue, to withhold for a defined period, or to substitute. Get it in writing if you can.

Allergies belong on the same list, including reactions to tapes, iodine, latex and antibiotics. So do previous anaesthetics that were unpleasant or dangerous, obstructive sleep apnoea, and a family history of anaesthetic problems. Anaesthetists would rather hear a boring story twice than a surprising one in the induction room.

If you are unwell in the week before surgery — fever, productive cough, a urinary infection, a flare of a skin condition in the operative field — call the rooms. A postponed list is an inconvenience. An avoidable complication is not.

Fasting, thirst and the morning of the operation

Fasting exists because anaesthesia can abolish the reflexes that keep stomach contents out of the lungs. The traditional “nil from midnight” has, in many hospitals, been replaced by more precise instructions: a last meal at a named hour, clear fluids until a later hour. Follow the instruction you were given for this admission, not a memory of a previous one.

Clear fluids means what the hospital says it means, usually water and specified other liquids, not milk and not a protein smoothie. Chewing gum is sometimes restricted. A morning coffee from the hospital café is a common way to cancel a list.

People with diabetes need a specific plan for oral medicines or insulin. People who take medicines in the morning need to know which tablets are to be swallowed with a sip of water and which are to be withheld. Ask at preadmission. Do not invent a compromise at 6 a.m.

Shower as instructed. Some teams ask for a particular wash; some do not. Do not apply moisturiser, perfume, fake tan or nail polish if you have been told not to. Remove jewellery, including piercings in the operative field. Leave valuables at home. Wear something that opens at the front if the operation is on the chest or abdomen.

A support person is part of the discharge plan

Day-surgery units and short-stay wards discharge people who are still biochemically tired, still taking strong analgesia, and still wearing a dressing they cannot see. A responsible adult who can take you home, hear the discharge instructions, and stay as long as the team requires is not a nicety. Many units will not let you leave in a taxi alone. They are right.

That person should know where the hospital is, where to park, and how to contact the rooms after hours. They should know that you may be nauseated, emotional and poor at remembering a conversation. They should not be expecting you to host a dinner.

If you have young children, pets, or a job that will ring at 7 a.m., arrange cover before the day. The first seventy-two hours after a facelift, a breast operation or an abdominoplasty are a poor time to discover that no one can feed the dog.

For people travelling interstate for surgery — a common Australian pattern — the support plan includes where you will sleep for the first nights, how you will get back to clinic for review, and what happens if you cannot fly because of swelling or a drain. “I’ll work it out” is not a plan.

Time off work is a clinical estimate, not a personality test

Ask the surgeon, in the consultation, for a range of time away from your work: desk, driving, lifting, standing, public-facing, shift work. Write the range down. Book the longer end if you can. Employers do not need a photograph of a dressing; they need a certificate, which the rooms can supply without a cosmetic detail.

People underestimate facial swelling in video meetings, the weight of a toddler, and the effect of strong analgesia on decision-making. They overestimate their uniqueness. Recovery timelines are ranges; they are discussed in the companion piece. The point here is to book the leave before you are on the table bargaining with yourself.

Money belongs in this paragraph. If unpaid leave, a gap in income protection, or a credit-card deposit is the only reason the date is next month, say so to yourself before you say so to a surgeon. Financial pressure is a poor anaesthetic.

Skin, hair and the instructions that sound like folklore

Some teams ask people to wash with an antiseptic solution. Some ask for a particular hair arrangement if the incision is in the scalp. Some ask that fake tan and heavy makeup be gone so that the skin can be assessed and prepared. Some prescribe a cream. Follow your team. Adding a new acid peel, a laser, or a home “prep protocol” from a stranger’s account is how people arrive with irritated skin in the operative field.

Do not start a new supplement “for bruising” unless the treating team has agreed. Do not donate blood the week before. Do not book a dental extraction, a tattoo or an injectable treatment in the same window without telling the surgeon. Each of those is a small extra variable. The weeks before surgery are for reducing variables.

Clothes, pillows, a thermometer, the script for postoperative analgesia, and the after-hours number can be assembled at home in advance. So can simple meals you can eat with one hand. This is not wellness. It is logistics.

What preparation cannot do

You can arrive nicotine-free, fasted, and accompanied, with a tidy medicine list and three weeks of leave, and still bruise heavily, feel wretched, or face a complication. You can do all of that and still dislike a scar that has healed exactly as a scar heals. Preparation is not a contract with the future. It is a way of not adding avoidable risk to a procedure that already has risk.

If anything in the written consent is still unclear, these weeks are the time to ask — not the holding bay. If you do not want the operation, these weeks are also the time to say so. A serious practice will cancel a list. A practice that makes cancellation feel like a moral failure is telling you something useful about itself.

The recovery hub exists for the period after the anaesthetic wears off. The work of these weeks is quieter: tell the truth about smoking, take the medicines you are supposed to take, leave the ones you are supposed to leave, arrange a person, arrange time, and arrive having eaten when you were told you could eat. That is enough. It is also the part no photograph will ever show.