I have become more focused on whole body evaluation when doing plastic surgery. When you meet with me directly for an hour, it is a true hour of discussion of your whole body health, what bothers you, and what are potential fixes.

Aging better involves many levels– your overall health, your biologic age, glucose control, cholesterol levels, weight, your mitochondria, hormone levels, and nutrition. Yes, some issues only surgery will help. Many of the surgeries I perform- breast lifts and breast reductions, abdominoplasties, and eyelid surgery- help you FUNCTIONALLY as well as aesthetically.

I am an advisor for a menopause company and for a healthspan “biohacking” company. In my roles for both, I have done extensive education on what it means to age better. There is much data on how to improve your health. Some improvements are based on medications, some are habits (or quitting bad habits), some are understanding what YOUR issues are. Many of the changes are simple. This non surgical component is important, and I usually want people to figure much of this out before they do surgery. Being healthy and having good nutrition is important for healing. Losing weight before surgery helps your surgical result and lowers complications (BMI alone is a risk factor for complications).

You cannot throw the kitchen sink at aging. It is too broad. The key is figuring out what you need to focus on. If you are going to institute changes, the earlier you start the better. How you are at 50 lays the foundation of how you will be at 70. Major areas to evaluate:

HORMONES
WEIGHT
BLOOD GLUCOSE
HEART HEALTH
BIOLOGIC AGE
BRAIN HEALTH
SLEEP
NUTRITION

When I meet with you, we may touch on many of these. For those things we do not treat personally, I will help you figure out next steps and who to go to.

Weight Loss Advice

Generally higher protein diet/lower carbohydrate diet.
Keep your calorie count STEADY. Do not cut calories too much- this leads to slowing of metabolism and the weight rebounds when you eat normally again.
Look for easy ways to improve- sugary drinks or juices, that dessert before bed, a daily glass of wine.
If you are in perimenopause or menopause, hormone therapy may help. I recommend going to www.joinmidi.com It is covered by insurance and they are great at advising on hormone issues around menopause.
Do not weigh yourself daily. Healthy weight loss takes time.
Intermittent fasting. I love this. It really addresses insulin insensitivity and can lower your HBA1c in addition to helping you lose weight. The baseline is 16/8, where you eat for 8 hours, fast for 16 hours. Some people extend the window to 18/6 or 20/4. For a great synopsis of this, I recommend the Obesity Code book by Dr. Fung
Be active. Take the stairs. Clean up the house. Studies show doing 2-5 minutes of walking after meals significantly improves blood sugar levels.
Metformin.
Semaglutide and tirzepatide. We do tirzepatide injections here in our office.

Ideal Weight

Weight is so important for whole body health and healing.

Reasons to lose weight prior:

Losing weight after surgery can ruin some results, particularly for any surgery which is tightening the skin- breast lift, breast reductions, and abdominoplasties. If you lose weight after the lift, your breast will droop again. Or your tummy will hang again.
Where your weight comes off varies. Proportion is important. We need to know the size and ratio of your breast, abdomen, and hip to each other. If you lose 20 pounds does it come 10 off the breast and 10 off the belly? Or 20 off the belly?
If your BMI is high, you may have sleep apnea and an obstructed airway. Please take this test to see if you may have unknown sleep issues HERE. Why do I care about apnea? First, it makes your airway and intubation for surgery harder and riskier.
Second, apnea affects oxygenation to your tissue. This impairs healing, scarring, infection risk. And last, most pain medications cause respiratory depression. Apnea already has respiratory issues. The most dangerous time is when sleeping at night. This can be made better by weight loss and/or CPAP.

Our outpatient surgery center has a cut off of 34 for BMI.

Normal BMI is up to 24.
If above 27 with an additional medical issue (diabetes, high blood pressure) or a BMI over 30, Dr. Greenberg strongly urges you to lose weight prior to surgery to improve SAFETY & OUTCOME. A BMI over 30 is considered obese.
If above 34, weight loss is mandatory if possible, and your surgery must be done at an inpatient hospital for safety reasons.

THERE ARE MANY CHOICES TO HELP.

Whole body Health

Many women come to see me around middle age. Optimizing your health will help your entire body and if doing surgery, lower your surgical risk and help you heal better. This is where I am not a typical plastic surgeon. In my own health journey and interests, I have become incredibly knowledgeable about menopause, blood sugar control, heart risk, and antiaging.

What does this look like?
When you come in, I will want to know your entire medical history.

Herbals and supplements (yes this includes collagen and whatever you add to smoothies)
Past history, surgeries, allergies, pregnancies
Habits like smoking, vaping, edibles
Where you are in menopause (big changes happen predictably around perimenopause and then again in menopause)
What have you done before. This includes lasers, fillers, botox, ulthera, threading, coolsculpt, morpheus and more.
If you have had prior surgery in the areas of interest, please get a copy of the operation report.
For other general recommendations of what I may ask for, see here.

Potential Health Benefits of Plastic Surgery Procedures

Breast Lift + Reduction:

As a plastic surgeon, if you have large drooping breasts, it affects your posture and your ability to exercise. Doing a breast reduction or breast lift is not just cosmetic. It allows you to have better activity, that will help you as you age. This is not to minimize the psychological improvement of feeling better. Particularly as you age and are over the age of menopause, women start to feel blah. matronly. wider. invisible. Surgery can help.

Studies show improvement in posture, exercise amount, kyphosis (neck), back and shoulder issues.
If you have dense breasts, it may make imaging easier
If you have dense breasts, removing tissue lowers your risk of breast cancer as you have less breast tissue.
I have patients report all sorts of improvements: I can jog, I feel comfortable in my body, I breathe better, I stopped clenching my teeth, my finger numbness went away, my headaches went away, my shoulder indents are better, my bra is comfortable.

Abdominoplasty:

Particularly if you have had major weight loss or pregnancies and are 5’4″ and shorter, have had multiple pregnancies or large babies, you may have skin laxity (which also makes your anterior thigh skin looser) and diastasis- a separation of your abdominal muscles. Fixing the muscle helps functionally. One patient I had woke up for years 4-5 times a night to pee. After her tummy tuck, she sleeps now through the night. Not only does her belly look better, but I can’t stop thinking about how her tummy tuck made a true improvement in her sleep, Studies show how good sleep is vital to other health issues- weight risk, dementia risk, and more. Her tummy tuck did much more than just flatten her tummy. I think it has ramifications for improving her health in other areas.

Studies show statistical improvement in low back pain and urinary incontinence (when you laugh/run and pee a little)
It improves posture and core strength from tightening the muscles.
Skin hygiene and rashes improve for those with hanging skin, as it removes the apron of skin.
Patient reports of improvements: “my bowel habits are better,” “I have stronger orgasms,” “I no longer get up in the middle of the night to pee,” “my golf game improved,” “My running improved,” “I can do headstands again in yoga class,” “It repatterned my body in a way I could not do with diet and exercise.”

Liposuction:

Liposuction repatterns the body, particularly good for those areas that are diet and exercise resistant with weight loss. It also has some health benefits.

It is not a source of weight loss. But liposuction changes the body shape and can lower pant sizes.
It has health benefits: A published study showed improvement in BMI, significant improvements in blood triglyceride, glucose, insulin, and leptin levels.

Upper Eyelid Surgery:

Lower eyelid surgery is always cosmetic, but the upper lid is functional. As you get extra upper eyelid skin, you compensate by raising your forehead, which causes wrinkles, but also headaches and strain. When you are hooded, it causes visual field impairment. That is a physical danger- you are like a horse with blinders, so a skier or car “comes out of nowhere” because you don’t see it.

In the office, there are also non surgical products and procedures we do which have health benefits.

Whole Body Care