The four candidacy questions
Before any body contouring procedure, four candidacy questions are asked. They are asked in this order because each one can change the answer to the next — there is little point discussing which operation suits the tissue while the weight is still falling, and little point planning a date before the tissue is in a condition to heal.
Weight stability and BMI
Asked plainly: has the weight held steady long enough for a result to hold its shape? Body contouring removes skin and fat sized to the body present on the day of surgery. Stability for at least 6 months — ideally 12, within a 2–3 kg fluctuation — is the standard, because later weight gain stretches the surgical result and may distort scars, while continued loss produces new redundancy that the original procedure could have addressed had it been postponed.
BMI is the second half of the same question, and it matters because it changes the risk profile rather than the appearance of the result: below 30 is the standard risk profile; 30–32 is acceptable for most procedures with conventional perioperative care; 32–35 is case-by-case with meaningfully elevated complication rates; above 35, complication rates are not acceptable for elective surgery and further weight loss comes first. Why these thresholds exist →
Healing capacity
Asked plainly: will the incisions heal? Nicotine causes acute vasoconstriction of the small vessels supplying skin and subcutaneous tissue, and carbon monoxide reduces oxygen delivery. At an incision line, where blood supply is already compromised by surgical dissection, that combination is the main driver of wound healing failure — which in body contouring can mean skin necrosis, prolonged open wounds, infection and severe scarring. Complete cessation — no cigarettes, no vaping, no nicotine replacement, and no cannabis — for a minimum of 4 weeks before and 4 weeks after surgery applies to every body contouring procedure. The healing mechanism in detail →
The same question covers the medical background: diabetes controlled (HbA1c under 7% in the ideal candidate; above 8% is a reason to defer and optimise first), blood pressure controlled, and obstructive sleep apnoea treated rather than untreated.
Matching the operation to the tissue
Asked plainly: is the operation being considered the one this tissue actually needs? This is settled by examination rather than by photographs, and the pinch test is usually decisive. If the skin retracts crisply when released, liposuction alone is generally appropriate. If it sags or shows visible redundancy, skin excision — tummy tuck, arm lift, thigh lift or body lift, depending on the area — is the right operation. Getting this wrong, and performing liposuction on a patient who needs skin excision, produces a worse contour than before surgery.
The same examination determines how much can reasonably be done under one anaesthetic. Some combinations are routine; others are too much for a single operation and are staged 3–6 months apart. How staging decisions are made →
Timing, support and expectations
Asked plainly: is this the right moment in a life, not only in a body? Pregnancy after abdominoplasty stretches the repaired tissues, so patients planning a future pregnancy are advised to defer abdominoplasty or mommy makeover until their family is complete. Major procedures require one to two weeks of help at home, and returning home alone after a lower body lift, mommy makeover or extensive brachioplasty meaningfully raises complication rates. Decisions made during major life upheaval, during an active eating disorder, or driven by external pressure rather than personal goal are unlikely to satisfy.
Expectation is part of the same question. Permanent scars and a real recovery period are part of every one of these operations, and a patient seeking perfect symmetry or a scarless transformation is likely to be disappointed however well the surgery goes. When we defer or decline →
- The answer is rarely a simple yes or no. Very few patients meet every criterion ideally; most are appropriate candidates with one or two areas requiring optimisation first.
- "Not yet" is usually a path forward, not a refusal — lose further weight first, stop smoking and return in three months, manage the diabetes first, complete childbearing first, build the support first.
- Doing nothing is a legitimate outcome. The procedures do not go anywhere; they remain available when conditions are right.
- Individual results vary, and suitability is confirmed by personal consultation and examination — no general statement on this page substitutes for it.
Each question in detail
Each of the four questions has its own page, written as the assessment is actually made rather than as a checklist — including the situations in which the honest answer is to wait.
Who is the ideal candidate? →
A composite of the factors that predict good results — weight stability, BMI, age, health status, realistic expectations.
BMI and weight stability →
The two most important physiological predictors of body contouring outcomes. Why thresholds exist and what to do if you're outside them.
Smoking and healing →
Why smoking is a near-absolute contraindication to elective body contouring, what counts as smoking, and how long cessation needs to last pre-operatively.
When not to have surgery →
The patients we ask to defer or decline. Honest discussion of why "wait" is sometimes the right answer.