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By Dr. Walter Zamarian Jr. · Updated: 18/02/2026

Pre-Surgical Preparation: your complete guide to a safe and smooth surgery

If you have already booked your plastic surgery with me or are considering doing so, know that the success of the procedure begins long before you enter the theatre. In fact, I dare say that pre-operative preparation is just as important as the surgical technique itself. A well-prepared patient heals better, experiences fewer complications, recovers more quickly, and achieves superior results.

Over more than twenty years performing plastic surgeries in Brazil, with over eight thousand procedures, I have learned that the best results do not come solely from the surgeon's hands. They arise from a genuine partnership between doctor and patient, where every guideline is followed with discipline and every detail is attended to with care. For international patients considering medical tourism in Brazil, proper preparation is especially important — and this guide covers everything you need to know, whether you are local or travelling from abroad for cosmetic surgery in Brazil.

Here you will find all the guidelines I personally provide during the first consultation: from the tests you need to undergo, to the medications you should stop taking, to how to care for your sleep, diet, and emotional state in the weeks leading up to your surgery. If you prefer, I also offer online consultations for patients from other cities who wish to start this planning remotely.

Read carefully, save this page, and refer to it whenever you have questions. Your preparation starts now. You may also find it helpful to review the post-surgical recovery guide, explore our before and after gallery, and read patient testimonials.



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Pre-operative tests: the foundation of your safety

Every surgical procedure I perform requires a battery of preliminary tests. This is not medical bureaucracy. Each test has a reason for being and provides me with fundamental information to ensure that your surgery is absolutely safe.

Mandatory laboratory tests

I request the following blood and urine tests for all my surgical patients, without exception:

  • Full blood count (FBC): evaluates your blood cells, detects anaemias that could compromise tissue oxygenation during and after surgery, and identifies possible hidden infections.
  • PT with INR and APTT: these are the coagulation tests. They check if your blood coagulates properly, which is essential to avoid excessive bleeding during the procedure.
  • Creatinine and urea: assess the function of your kidneys, the organs responsible for eliminating anaesthetic medications from your body after surgery.
  • Fasting blood glucose: detects diabetes or pre-diabetes, conditions that directly affect healing and the risk of infection.
  • Total proteins and fractions: reveal your nutritional status. Patients with low protein levels heal worse and have a higher risk of complications.
  • Urinalysis: identifies urinary infections that need to be treated before surgery, as any infectious focus can contaminate the surgical site.

Pre-operative cardiac assessment

Regardless of your age or the size of the surgery, I request a complete pre-operative cardiac assessment that includes an ECG and fitness-for-surgery classification by the cardiologist. This assessment confirms that your heart is prepared to withstand anaesthesia and surgical stress. In some cases, depending on your history, the cardiologist may request additional tests such as echocardiogram or stress test.

Validity of tests

Laboratory tests are valid for thirty days. If your surgery is postponed for any reason, new tests will be necessary. I advise you to have all tests done at least two weeks in advance, so there is enough time to address any abnormalities found.

Bring all the results to your pre-operative consultation. I personally analyse each test and discuss with you any relevant findings. Your safety is non-negotiable.

Medications that must be stopped before surgery

This is one of the most critical points of the entire pre-surgical preparation, and I need you to take it extremely seriously. Various commonly used medications interfere with blood coagulation and can cause dangerous bleeding during and after surgery. Stopping these medications in a timely manner can make the difference between a smooth surgery and a serious complication.

Two weeks before surgery, you must stop:

  • Acetylsalicylic acid (Aspirin, AAS, Bufferin, Melhoral, Doril): even in low doses used for cardiovascular prevention, aspirin irreversibly inhibits platelet function for up to ten days. This means your blood loses the ability to form clots properly.
  • Non-steroidal anti-inflammatory drugs (Ibuprofen, Naproxen, Diclofenac, Nimesulide, Piroxicam, Ketoprofen): all alter coagulation to varying degrees. If you need pain relief during this period, use paracetamol, which does not affect coagulation.
  • Oral anticoagulants (Warfarin, Rivaroxaban, Apixaban, Dabigatran): these medications require special management. Never stop anticoagulants on your own. I always discuss the case with your cardiologist or haematologist to define a safe replacement protocol, which may include low molecular weight heparin as a bridge.
  • Antiplatelet agents (Clopidogrel, Ticagrelor, Prasugrel): if you are using any of these medications after stent placement or for arterial disease, the discontinuation needs to be coordinated between me and your cardiologist. The risk of surgical bleeding needs to be balanced with cardiovascular risk.

Other medications that deserve attention

Inform me about absolutely everything you take, including medications you consider harmless. Some antidepressants, for example, can interfere with anaesthesia. Medications for thyroid, blood pressure, and diabetes are generally maintained, but with adjustments that I define on a case-by-case basis.

If you take any continuous medication and are unsure whether to stop, contact my team via WhatsApp. Today's doubt can prevent a serious problem tomorrow.

Vitamins, supplements, and herbal remedies: the invisible danger

Many patients are surprised when I say that vitamins and natural supplements can be as dangerous as medications before surgery. There is a widespread belief that, because they are "natural", they pose no risks. This is a dangerous myth that needs to be dispelled.

Stop at least seven days before surgery:

  • High doses of Vitamin E (above 400 IU): Vitamin E is a potent platelet aggregator inhibitor. In high doses, it hinders clot formation and significantly increases the risk of bruising.
  • Omega 3 (fish oil): the fatty acids EPA and DHA have a well-documented anticoagulant effect in the medical literature. Even in nutritional doses, I recommend stopping.
  • Ginkgo biloba: this popular herbal remedy for memory and circulation inhibits platelet activating factor (PAF), considerably increasing bleeding time.
  • Ginseng: interferes with both coagulation and glucose levels, potentially complicating anaesthesia.
  • Garlic capsules: supplemental garlic contains allicin, which inhibits platelet aggregation. Garlic in food in normal amounts is not a problem.
  • Concentrated green tea: in capsule form or concentrated extracts, it can interfere with coagulation and anaesthetic medications.
  • Arnica: although widely used post-operatively to reduce bruising, oral arnica should be stopped before surgery due to its anticoagulant effect. After surgery, depending on the case, I may allow it.
  • Turmeric (curcuma): curcumin has potent anti-inflammatory properties and interferes with platelet aggregation.

Collagen and other proteins

Hydrolysed collagen, whey protein, and isolated amino acids can generally be maintained, as they do not interfere with coagulation. In fact, a good protein intake is beneficial for healing. However, always confirm with me before maintaining any supplement.

The golden rule is simple: when in doubt, stop and ask me. It is much easier to resume a supplement after surgery than to deal with unexpected bleeding during the procedure.

Alcohol and nicotine: the two biggest enemies of your surgery

If there is one thing I could engrave in capital letters in the mind of every patient, it would be this: alcohol and tobacco seriously compromise the outcome of your plastic surgery. This is not my exaggeration. It is not conservatism. It is pure physiology and irrefutable scientific evidence.

Smoking: the number one villain

Nicotine causes vasoconstriction, meaning it narrows the blood vessels that supply oxygen and nutrients to the skin and tissues I am operating on. In a surgery like a facelift, for example, where the skin is lifted and repositioned, blood circulation needs to be perfect for the tissues to survive in the new position.

Patients who smoke have up to twelve times the risk of skin necrosis, widened scars, and infection. These are not numbers to scare you. They are data from the global medical literature, confirmed by my personal experience over more than two decades of practice.

My requirement: total cessation of smoking for at least two weeks before and two weeks after surgery. This includes conventional cigarettes, electronic cigarettes, vapes, hookah, cigars, pipes, and any product containing nicotine, including patches and nicotine gum. Yes, electronic devices are equally harmful, as the nicotine is the same.

Alcohol: do not underestimate its effects

Alcohol interferes with surgery in multiple ways. It dehydrates tissues, compromises liver function necessary to metabolise anaesthetic medications, alters blood coagulation, and depresses the immune system. Additionally, it interacts dangerously with painkillers and antibiotics that will be prescribed post-operatively.

My guidance: complete cessation of alcoholic beverages for at least seven days before surgery. After the procedure, alcohol should be avoided for a minimum of two weeks, or until I allow your return to moderate consumption. If you drink regularly, speak to me honestly during the consultation. This is not judgement. It is care for your safety.

Sleep and rest: preparing your body to regenerate

Sleep is probably the most underestimated factor in preparing for surgery. We sleep for a third of our lives, and it is during deep sleep that the body performs its most important repair and regeneration functions. If you arrive on the day of surgery with a sleep debt, your body will have fewer resources to heal.

What science says

During the deep stages of sleep, especially slow-wave sleep, your body releases growth hormone (GH), which is essential for tissue repair. The immune system also functions better during adequate sleep, with increased production of anti-inflammatory cytokines and defence cells. Studies show that patients with sleep deprivation experience healing that is up to thirty percent slower and a higher risk of infection.

My guidelines for the two weeks before surgery

  • Sleep between seven and nine hours a night: this is the ideal range for most adults. If you usually sleep less, start adjusting your routine two weeks in advance.
  • Maintain regular schedules: go to bed and wake up at the same times every day, including on weekends. A regular circadian rhythm optimises hormone production.
  • Avoid bright screens before bed: the blue light from phones and computers suppresses melatonin, the hormone that induces sleep. Turn off screens at least one hour before bedtime.
  • Avoid caffeine after three o'clock: the half-life of caffeine is five to six hours, which means that a coffee at four o'clock will still be affecting your sleep at midnight.
  • Create a conducive environment: a dark, quiet room with a pleasant temperature. Invest in a good mattress and pillow if necessary.

On the night before surgery, it is natural to feel some anxiety that may hinder sleep. If this happens, do not worry excessively. A poor night's sleep does not compromise the surgery. But weeks of inadequate sleep do.

Hydration and nutrition: fuel for recovery

Your body is an extraordinary biological machine, and like any machine, it needs quality fuel to function well, especially when facing the challenge of surgery. Proper hydration and nutrition in the weeks leading up to the procedure create the ideal conditions for quick and uncomplicated healing.

Hydration

Water makes up more than sixty percent of your body and is involved in absolutely all biochemical reactions, including healing. Dehydrated tissues heal worse, are more susceptible to infections, and respond poorly to anaesthesia.

  • Drink at least two litres of water a day in the two weeks before surgery. If you exercise or live in a hot climate, this volume should be higher.
  • Observe the colour of your urine: it should be light yellow. If it is dark, you are dehydrated.
  • Reduce the consumption of coffee and diuretic teas: they increase fluid loss.

Pre-operative nutrition

In the two weeks before surgery, prioritise a diet rich in nutrients that favour healing:

  • High biological value proteins: lean meats, fish, eggs, dairy. Proteins provide essential amino acids for tissue repair, including proline and lysine, which are fundamental for collagen synthesis.
  • Colourful fruits and vegetables: rich in vitamin C, necessary for collagen production, and antioxidants that protect cells during surgical stress.
  • Zinc: found in red meats, pumpkin seeds, and nuts. Zinc is essential for cell division and healing.
  • Iron: important for the formation of haemoglobin, which transports oxygen to tissues. Red meats, beans, and dark green vegetables are good sources.
  • Vitamin A: found in carrots, pumpkin, and sweet potatoes. It participates in epithelial regeneration and the immune response.

The pre-operative fasting

On the eve of surgery, strictly follow the fasting guidelines that my team will provide. Generally, for surgeries under general anaesthesia, the fasting for solids is eight hours and for clear liquids is two hours. However, each case may have particularities. Fasting is essential to prevent pulmonary aspiration during anaesthesia, a rare but potentially fatal complication.

Attention: do not follow restrictive diets before surgery. Arriving malnourished at the theatre is much worse than arriving with one or two extra kilos. Your body needs reserves to recover.

Anaesthesia: understanding what will happen

The fear of anaesthesia is one of the most common among patients preparing for surgery. This fear is understandable, but it is usually based on outdated information or exaggerated stories. Modern anaesthesiology is one of the safest specialties in medicine, with extremely low rates of serious complications.

Types of anaesthesia I use

Depending on the procedure, I may use different anaesthetic modalities:

  • General anaesthesia: used in larger surgeries such as facelift, abdominoplasty, and breast surgery. You are completely asleep and feel absolutely nothing. An experienced anaesthetist monitors every vital parameter from start to finish.
  • Sedation with local anaesthesia: for smaller procedures. You are in a state of deep relaxation, conscious but without anxiety, while the surgical site is anaesthetised locally.
  • Epidural or spinal: regional block that anaesthetises half of the body. It can be combined with sedation for greater comfort.

The pre-anaesthetic assessment

Before surgery, the anaesthetist will conduct a specific consultation with you. In this consultation, they will assess your medical history, your tests, possible allergies, previous experiences with anaesthesia, and determine the best technique for your case. If you have ever had an adverse reaction to anaesthetics, please report it in as much detail as possible.

On the morning of surgery

Take only the medications that I or the anaesthetist expressly authorise, with the minimum amount of water necessary to swallow the tablet. Arrive at the hospital or clinic at the scheduled time, wearing comfortable clothes and without makeup, nail polish, jewellery, or piercings. Nail polish, for example, needs to be removed because the pulse oximeter measures oxygen saturation through the nail.

I work with anaesthetists whom I have known and trusted for years. They will be by your side throughout the procedure, monitoring heart rate, blood pressure, oxygenation, body temperature, and anaesthetic depth. You will be in good hands.

Informed consent and LGPD: your rights and our responsibility

The relationship between doctor and patient is, above all, a relationship of trust. And trust is built with transparency. That is why I dedicate significant time to explain every aspect of your procedure and ensure that you make a truly informed decision.

The free and informed consent form

Before any surgery, you will sign a consent form that details:

  • The procedure that will be performed and its alternatives
  • The expected benefits and realistic limitations
  • The risks and possible complications, no matter how rare they may be
  • The type of anaesthesia and its specific risks
  • The necessary pre and post-operative care
  • The estimated recovery time

This document is not a bureaucratic formality that you sign quickly and forget. It is the record of our conversation, and I hope you read every word carefully. All your questions must be answered before signing. If there is any lingering uncertainty, the surgery can wait. Your peace of mind is priceless.

Protection of your personal data (LGPD)

As a doctor and responsible for your clinic, I have an absolute commitment to protecting your personal and health data, in accordance with the General Data Protection Law (Law 13.709/2018). In practice, this means:

  • Your medical data is confidential: records, tests, photographs, and any information about your treatment are stored in secure systems with restricted access.
  • Pre and post-operative photographs: are an essential part of medical documentation. They will be used only for clinical purposes, comparison of results, and surgical planning. Use for educational or promotional purposes only occurs with your express and specific consent, and always preserving your identity when possible.
  • Sharing with other professionals: your data may be shared with the anaesthetist, laboratories, and other doctors involved in your care, always within what is strictly necessary for your treatment.
  • Your rights: you can request access, correction, or deletion of your personal data at any time, as provided by law.

I take my patients' privacy as seriously as I take surgical technique. Both are non-negotiable.

Physical exercise: when to stop and why

If you are a physically active person, you are probably wondering when you need to stop your workouts before surgery. This is an important question because physical exercise has both positive and potentially negative effects in the pre-operative period.

The benefits of being in good shape

Patients who exercise regularly tend to have better cardiorespiratory capacity, better blood circulation, more muscle mass, a more efficient immune system, and faster post-operative recovery. Therefore, I am not saying you should abandon physical activity. On the contrary, maintain your exercise routine until the appropriate time to stop.

Reduction schedule

  • Up to two weeks before: maintain your normal exercise routine, including weight training, running, swimming, or any activity you usually practice.
  • From two weeks to one week before: reduce the intensity to seventy per cent of your usual. Avoid strenuous exercises that could cause last-minute muscle or joint injuries.
  • Last week before surgery: only light activities such as walking, stretching, and gentle yoga. Nothing that significantly raises the heart rate or causes muscle pain.
  • Forty-eight hours before: rest. Your body needs to be rested and free of any residual muscle inflammatory processes.

Exercise and bleeding risk

Intense exercise in the days leading up to surgery can increase capillary fragility and the risk of bruising in the post-operative period. Additionally, micro muscle injuries elevate inflammatory markers that can interfere with healing. The gradual reduction I described above minimises these risks without sacrificing the fitness benefits you have built over time.

After surgery, I will guide the gradual return to physical activities as your post-operative recovery progresses. Each procedure has its specific schedule.

Pre-surgical psychology: preparing mind and emotions

I decided to include this section because, over two decades, I have realised that emotional preparation is as important as physical preparation. The body and mind are not separate entities. The psychological state directly influences the physiological response to surgery, pain tolerance, healing quality, and satisfaction with the outcome.

Pre-operative anxiety: it’s normal

Almost every patient feels some degree of anxiety before surgery. This is absolutely normal and, to some extent, even healthy, as it indicates that you are taking the procedure seriously. The problem arises when anxiety becomes debilitating, causing severe insomnia, panic attacks, or catastrophic thoughts.

If this happens to you, talk to me openly. It is not weakness. It is sensible to recognise that you need support. In some cases, I recommend brief psychological support in the pre-operative period, which makes a huge difference in the overall experience.

Realistic expectations: the key to satisfaction

The happiest patient is not the one who achieves the perfect result, because perfection does not exist in medicine. The happiest patient is the one whose expectations were aligned with reality from the start. Therefore, I make a point of being absolutely transparent during the first consultation:

  • I show what is possible to achieve and what is not
  • I explain the limitations of each technique
  • I discuss the individual factors that influence the outcome, such as skin quality, age, and anatomy
  • I make it clear that every scar is permanent, although my technique aims to make them as discreet as possible
  • I emphasise that the final result can take six months to a year to fully establish

Support network

Organise your support network before surgery. You will need someone to accompany you on the day of the procedure, take you home, help in the first twenty-four to forty-eight hours, and be available for any needs in the first week. Knowing that you will have adequate support significantly reduces anxiety.

Practical preparation of the home environment

  • Keep the house organised and clean before surgery
  • Prepare light meals and freeze them in individual portions
  • Provide extra pillows to keep your head elevated if necessary
  • Place essential items in easily accessible locations, without the need to bend down or climb on stools
  • Install grab bars in the bathroom if the procedure limits your movements
  • Notify your work, family, and commitments about the period of absence

The more prepared you are, both physically and emotionally, the smoother the surgical experience will be overall. The surgery lasts a few hours. The preparation and the result last a lifetime.

Frequently asked questions about pre-surgical preparation

How long before should I start preparing for surgery?

The ideal is to start preparation at least thirty days before the procedure. During this period, you will undergo tests, adjust medications, discontinue vitamins and supplements, organise your sleep, diet, and physical activity routine, and prepare the home environment for recovery. The sooner you start, the smoother the process will be.

Can I take my blood pressure medications on the day of surgery?

In most cases, yes. Antihypertensives are generally maintained on the day of surgery and taken with a minimal sip of water on the morning of the procedure. However, each case is individualised. During the pre-operative consultation, the anaesthetist and I will determine exactly which medications to keep and which to discontinue.

What if I have a cold close to the date of surgery?

If you have a cold, flu, fever, urinary infection, or any infectious process in the days leading up to surgery, contact me immediately. In most cases, we will postpone the procedure until you are fully recovered. Operating with an active infection dramatically increases the risk of complications, including infection at the surgical site.

Does the pre-operative fasting include water?

The fasting of solids is eight hours before surgery. For clear liquids such as water, tea without milk, and strained fruit juice, the fasting is generally two hours. However, strictly follow the specific guidelines that my team will provide, as they may vary according to the type of anaesthesia and your individual conditions. Chewing gum is also prohibited during the fasting period.

Can I paint my nails before surgery?

No. Remove all nail polish from your hands and feet at least one day before surgery. The pulse oximeter, a device that monitors your oxygenation throughout the procedure, needs the nail free to function correctly. Dark polishes, gels, and porcelain nails interfere with the reading and can mask a drop in oxygenation.

Should I follow any special diet before surgery?

I do not recommend restrictive diets. The ideal is a balanced diet, rich in proteins, fruits, vegetables, and minerals such as zinc and iron. Arriving at surgery with nutritional deficiencies compromises healing and immunity. If you follow special diets for conviction (vegetarianism, veganism), we can supplement the necessary nutrients with proper guidance.

Can I drive to the hospital on the day of surgery?

No. You must have an adult companion on the day of surgery, both to take you to the hospital and to pick you up after discharge. After any procedure with sedation or general anaesthesia, it is prohibited to drive for at least twenty-four hours. Plan this in advance.

Do I need to shave the hair at the surgical site?

Do not shave anything on your own. The shaving, when necessary, will be performed by the surgical team in theatre, with the appropriate technique and at the right time. Shaving the skin at home can cause micro-injuries that increase the risk of infection.

How to deal with anxiety on the eve of surgery?

It is perfectly normal to feel anxious. Some strategies help: deep breathing techniques, guided meditation through apps, a light walk in the late afternoon, a relaxing warm bath, and avoiding researching about the surgery on the internet the night before. If the anxiety is intense, contact my team. In some cases, I may prescribe a mild anxiolytic for the night before.

What should I bring to the hospital on the day of surgery?

Bring personal documents, health insurance card (if applicable), all test results, the pre-operative cardiac assessment, comfortable and loose clothing to wear upon discharge (preferably button-up in the front), slippers, and basic personal hygiene items. Leave jewellery, watches, and valuable items at home. Also, bring the phone charger for your companion.

Book via WhatsApp

If you are preparing for plastic surgery and want to ensure that you are doing everything right, book a consultation with me. International patients travelling to Brazil for cosmetic surgery can start with an online consultation to begin preparation remotely. My team is ready to assist you, answer your questions, and find the best time for your assessment.

These guidelines are especially relevant for patients of facelift, rhinoplasty, blepharoplasty, and intimate surgery. After the procedure, consult our guidelines for post-surgical recovery. Also, learn about the cost involved and our clinic.

Ready to take the next step? Book now!


Dr. Walter Zamarian Jr.

Plastic Surgeon in Brazil

Rua Engenheiro Omar Rupp, 186
Londrina - Brazil
ZIP 86015-360
Brazil



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