Medications you take
Bring the names, doses and dosing schedules of your medications, including the ones you take only occasionally. Include supplements, herbal products, hormones and diabetes or weight-loss medications.
Pre-op testing
I want to do more than collect results: I want to understand what they say about you.
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At a glance
Pre-op testing before a facelift in Londrina: at a glance
What tests do I need before a facelift?
I order tests and a surgical risk assessment, including an electrocardiogram, for every patient, children included. They follow the medical evaluation, and the anesthesiologist reviews everything before total intravenous anesthesia (TIVA). In my protocol, test results are valid for 3 months. Normal results don't guarantee there is no risk.
- Orders: blood work, such as a CBC and a metabolic panel, and an electrocardiogram for everyone, children included.
- Heart: a stress test isn't routine; the 2024 AHA/ACC guideline reserves it for selected cases.
- Medications: bring a complete list, including supplements, and don't stop anything on your own.
- Sending results: you can send them ahead of time, but I still see you in person for a follow-up visit.
- Valid for: 3 months; if surgery takes place after that, the tests are repeated.
- Abnormal results: an out-of-range result is interpreted and may change the date.
History
The first thing I need to know comes from our conversation.
A test result doesn't tell your whole story. So before looking at numbers, I ask about medical conditions, past surgeries, bleeding, healing and how you usually feel during everyday activities. Tell me, too, if you have ever had a problem with anesthesia.
Information that changes how we prepare
I need to know about allergies, sleep apnea, smoking, any past blood clots and heart or breathing problems. Also tell me about recent symptoms and, when relevant, whether you could be pregnant.
You don't have to decide on your own what matters: a list or photos of the medication packaging can help us talk it through without leaving anything out.
Tests ordered
Every test should answer a question.
Every patient, children included, has tests and a surgical risk assessment with an electrocardiogram; there is no age cutoff. Depending on your case, the orders may include additional medical evaluations. I explain what each one is for, rather than treating the orders as a list to copy from the internet.
Blood work and medical conditions
A CBC and a metabolic panel can help spot abnormalities that matter for your preparation. Which tests I order depends on your history and your surgical plan.
Your heart and anesthesia
An electrocardiogram is part of every patient's preparation. Whether you need an additional cardiology evaluation is discussed based on your health and the planned surgery. The anesthesiologist also reviews your information.
Earlier results
Bring recent test results and reports from the doctors who treat you. They help me understand trends and treatments; for surgery, the tests that count are those done in the last 3 months.
The NICE NG45 guideline organizes tests by the size of the surgery and your health conditions. It doesn't recommend a chest X-ray, an echocardiogram or a urine test routinely for everyone. It is a reference for choosing tests, not a checklist that replaces your evaluation in Brazil; in my protocol, every patient has an electrocardiogram.
The same guideline gives two examples of how your history changes what is ordered: an HbA1c test isn't ordered routinely for people without diabetes, but it is offered to people with diabetes who haven't had one in the last three months. A pregnancy test is done, with consent, whenever there is any chance of pregnancy.
Timing
How to organize your results without leaving it to the last minute.
1. Get your test orders
After the consultation, João helps with the next steps. Check where you plan to have the tests done and how long the lab takes to deliver results.
2. Agree on the timing
Tell the lab and the team your expected surgery date. Leave room for an extra visit or further testing, if needed. Test results are valid for 3 months: schedule your blood draw so they are still valid on the day of surgery.
3. Send everything
If you would like me to review them early, send your results through the WhatsApp number the team gives you. Send every page, with your name, date and reference ranges clearly visible; a cropped photo can hide something important.
4. Come back in person
Before surgery, I examine you, review your tests, take the planning photos and answer your questions. An initial online consultation doesn't replace this visit.
Planning starts with understanding your health.
At the consultation, I explain which evaluations make sense for you and how to plan the next steps, without getting tests on your own.
Abnormal results
An out-of-range result needs interpreting.
Finding an abnormal result can be worrying, especially when the date is close. Don't try to bring a number back to normal on your own or assume the surgery is canceled. I want to know what is going on and what needs to be done.
Sometimes we need to look more closely at a finding or ask the doctor who treats you for an opinion. In other cases, treating a condition and moving the date is the right choice. Being asked for another evaluation is part of your care, not an obstacle to get around.
The reverse matters too: results within range don't mean there is no risk. A new symptom, a change in medication or an infection after your blood draw must be reported. The ASPS includes a medical evaluation and a review of medications in facelift preparation.
Medications
Tests don't replace your medication plan.
Don't stop acetylsalicylic acid, blood thinners or other medications because someone told you “everyone has to stop.” The decision must take into account why the medication was prescribed and be coordinated with the surgeon, the anesthesiologist and, when needed, your own doctor.
Also, don't add vitamins or supplements to improve a result without guidance. Bring your questions so the team can explain what to continue, adjust or stop, and when to restart. Written instructions help you avoid mixing up similar medications or different dosing times.
This review is part of the pre-op instructions. The goal is to arrive at the hospital with everything checked and every decision understood, with nothing left to improvise.
Surgical risk
Who assesses your risk, and when your heart calls for more tests.
Surgical risk is assessed as a team: I examine you and review your tests, and the anesthesiologist reviews your history before total intravenous anesthesia (TIVA), the same anesthesia I use for almost all my surgeries. If you already see a cardiologist, endocrinologist or other specialist, that doctor's report is part of the decision.
A stress test isn't routine
The 2024 AHA/ACC guideline for noncardiac surgery reserves stress testing for very select patients with poor or unknown functional capacity and elevated risk on validated tools. For people at low risk with good functional capacity, it recommends against routine testing.
Symptoms change the plan
Shortness of breath, chest pain, fainting or fatigue out of proportion to your activity need to be reported before surgery. These signs may lead to further evaluation, regardless of what routine tests show.
Smoking is part of the evaluation too
Tobacco and nicotine interfere with healing after a facelift. How long you need to stay smoke-free is agreed on in the pre-op instructions.
In my protocol, test results are valid for 3 months. If surgery is postponed beyond that or something changes in your health, the team tells you what needs to be repeated.
Questions
Your questions deserve attention.
Can I get a full set of tests before my first consultation?
It's better to bring the results you already have and wait for my orders. The evaluation shows what is missing and avoids repeating tests or getting a set that doesn't fit the procedure.
Are all test results valid for 30 days?
No. In my protocol, test results are valid for 3 months. If surgery is postponed beyond that or your health changes, the team tells you what needs to be updated.
Does sending results on WhatsApp replace the follow-up visit?
No. Sending them can speed up my review, but I still see you in person before surgery to examine you, check the plan and answer your questions.
Does an abnormal result mean I can't have surgery?
It depends on the finding and your overall health. It needs to be evaluated; it may call for further evaluation, treatment or a new date. Don't take medication on your own to correct a number.
Does pre-op clearance guarantee nothing will go wrong?
No. Evaluations and tests help identify and manage risks, but they don't eliminate them. The decision also depends on the planned surgery, the anesthesia and your condition at the time of the procedure.
If you already have test results or questions about the orders, talk to the team to arrange how to send them and when I will review them before surgery.
References
References and authorship
The sources below support the general information on this page. When I describe how I work, I am describing my team's routine; the guidance for your surgery will be tailored to you.