Labs, hemoglobin and medical clearance for plastic surgery

Common pre-op tests

Your practice decides what you need. These are the tests patients most often report being asked for before cosmetic surgery:

Why hemoglobin matters so much

Liposuction, BBL, tummy tucks and combined procedures cause real blood loss, and large-volume liposuction removes fluid along with fat. Starting surgery with low hemoglobin leaves less reserve, which can mean more fatigue, dizziness, a longer recovery, or the need for a transfusion.

There's no single safe number. Ask your surgical and anesthesia teams how they evaluate hemoglobin for your health and planned procedure, and get their requirement in writing. A clinic’s cutoff is not a guarantee of safety, and abnormal results need medical evaluation rather than simply reaching a target number.

If your hemoglobin is low, or high

• Talk to a doctor early. Low hemoglobin has causes (heavy periods, diet, other conditions) that are worth knowing about, not just fixing for surgery. It's one of the most common reasons surgery gets delayed.
• Oral iron is slow. It usually takes weeks to move your numbers. Starting the week before rarely works.
• IV iron is an option some doctors offer when time is short or tablets aren't tolerated.
• Can't swallow large pills? A common question in patient groups. Ask a pharmacist about liquid, chewable or smaller forms rather than skipping doses.
• Food helps over time: red meat, beans, lentils, dark leafy greens and fortified cereals, with vitamin C to help absorption.
• High hemoglobin worries patients too. Mayo Clinic lists possible causes including dehydration, smoking, testosterone therapy, high altitude, sleep apnea and some heart, lung and blood conditions. Tell your surgeon and see a doctor rather than adjusting it yourself.

Medical clearance

A preoperative evaluation documents your health, risks and recommendations for the surgical team; it does not guarantee that surgery or anesthesia is safe. It may come from your own primary-care doctor or from a clinic that offers pre-surgical evaluations.

• Bring your surgeon's clearance form, your lab results and a full medication list to the visit.
• If you have a heart, lung, clotting, blood-sugar or blood-pressure condition, you may also need specialist clearance. Ask at the consultation, not weeks later.
• Ask the practice to confirm in writing that your clearance was received and accepted. Patients often report waiting for this.
• A clearance doesn't override the surgeon. The surgeon or anesthesiologist can still postpone surgery.

If insurance won't cover it

Expect to pay for it yourself. Most health plans don't cover cosmetic procedures, so the clearance visit and labs may be billed to you. Options patients use:

• Ask your doctor's office for self-pay prices for the visit, labs and an EKG, if needed.
• Use a clinic that does pre-surgical evaluations, if your surgeon accepts outside clearances.
• Ask whether the practice runs pre-op labs in-house, and what that costs.

Can I have surgery with high blood pressure, diabetes, sickle cell trait or thyroid disease?

Often yes, if the condition is well controlled and documented, but your team decides. Raise it at your consultation, not the week before.

• High blood pressure: bring recent readings and your medication list. Very high readings on surgery day can lead to postponement, and blood-pressure pills often come with day-of instructions.
• Diabetes: expect questions about blood-sugar control, often an HbA1c test, and instructions for your medicines around surgery.
• Sickle cell trait: tell the anesthesia team. It's usually low-risk, but the CDC notes that dehydration can contribute to rare complications. Ask how they'll handle fluids and fasting.
• Thyroid conditions: bring recent thyroid labs, and ask whether to take your usual dose that morning.
• GLP-1 drugs (semaglutide, tirzepatide): 2024 guidance from several medical societies says many patients can continue them, but some are asked to hold a dose or follow a liquid diet first. Tell your team early.

Do I have to stop Zyn, vaping, marijuana and alcohol before surgery?

Yes, expect to stop all nicotine and to disclose any cannabis or alcohol use. Your surgeon sets the timing.

• Nicotine in any form, including cigarettes, vapes, Zyn and other pouches, gum and patches, narrows blood vessels and raises wound-healing problems. Some practices test for it. If you slip, tell your surgeon. ASPS says it's better to delay than to risk tissue death.
• Marijuana, including edibles and vapes, can affect anesthesia, heart and lung risks, nausea and pain control. The ASA advises telling your anesthesiologist about any use.
• Alcohol: ASPS notes surgeons commonly ask patients to cut back before surgery. Never combine it with post-op medicines.

Which vitamins and supplements should I stop before surgery?

Ask your surgeon for a list, and bring every bottle to pre-op. The FDA doesn't approve supplements before they're sold, and the ASA warns that some can increase bleeding, prolong anesthesia, raise blood pressure or interact with medicines.

• Supplements the ASA names include garlic, ginkgo, ginseng, vitamin E, St. John's wort, kava and valerian.
• Iron, vitamin C or folic acid for your labs: take only what a doctor advises, at that dose.
• Arnica, bromelain, "detox" teas and weight-loss products: ask before you take them.

See medications surgeons ask you to pause and the two-week mark of the pre-op countdown.

Can I wear piercings during surgery?

Usually not. Expect to remove all jewelry and body piercings, including tongue, belly and nipple piercings. The Association of periOperative Registered Nurses (AORN) explains that metal can cause burns from surgical energy devices, and that swelling can trap rings. If a piercing can't come out, tell the team before surgery day. Ask about nails, lash extensions and hair clips too.

What time do I arrive for pre-op, and when should I book my flight?

Your surgery center sets the arrival time, and it can change, so build in slack. For a BBL, Florida law requires the in-person exam by the day before. Don't fly in on surgery morning.

• Land early. Our travel guide suggests two or three days before surgery. ASPS's safety checklist flags long sitting, such as long flights, in the two weeks before surgery as a clot-risk question.
• Fasting: follow your anesthesia team's instructions exactly.
• Book flexible fares in case your surgery date or your clearance to fly home changes.

A simple timeline

The full six-week pre-op countdown · What the first six weeks after surgery look like

General education only; your surgeon and anesthesiologist decide what you need. MiamiSurgeryGuide doesn't rank or recommend providers.

Sources: American Society of Plastic Surgeons, Managing the Risks of Smoking in Plastic Surgery Patients (2024): plasticsurgery.org/documents/health-policy/resources/2024-managing-risks-of-smoking.pdf; ASPS, How nicotine sabotages plastic surgery: plasticsurgery.org/news/blog/how-nicotine-sabotages-plastic-surgery; ASPS, Preparing for your plastic surgery procedure: plasticsurgery.org/news/articles/preparing-for-your-plastic-surgery-procedure; ASPS, Pathways to Preventing Adverse Events in Ambulatory Surgery: plasticsurgery.org/documents/medical-professionals/health-policy/ASPS_PathwaystoPreventionGuide.pdf; American Society of Anesthesiologists, pregnancy testing and consent, preanesthesia evaluation, Herbal and Dietary Supplements and Anesthesia: madeforthismoment.asahq.org, and Cannabis and Surgery: madeforthismoment.asahq.org/preparing-for-surgery/risks/cannabis-surgery-made-moment/; ASA, 2023 Practice Guidelines for Preoperative Fasting, Anesthesiology 2023; Multisociety clinical practice guidance on GLP-1 receptor agonists (2024): asahq.org/about-asa/newsroom/news-releases/2024/10/new-multi-society-glp-1-guidance; American College of Surgeons, Marijuana and Surgery: facs.org/for-patients/preparing-for-surgery/marijuana-and-surgery/; U.S. FDA, Dietary Supplements: fda.gov/food/dietary-supplements; CDC, What Is Sickle Cell Trait?: cdc.gov/sickle-cell/sickle-cell-trait/; Mayo Clinic, High hemoglobin count — causes: mayoclinic.org/symptoms/high-hemoglobin-count/basics/causes/sym-20050862; AORN, The Electrosurgical Unit: aorn.org/article/the-electrosurgical-unit; Florida Statutes § 458.328: flhouse.gov/Statutes/2024/0458.328/. Individual treatment plans vary.