Eat to Heal: What the Evidence Says About Nutrition & Plastic Surgery

When you are a patient planning an upcoming aesthetic surgical procedure, you are likely to have a million questions on your mind. While questions about the procedure itself, risks, and recovery are front and center, an often-overlooked topic by both surgeons and patients is how nutrition can play a role in optimizing healing. At PHASE Plastic Surgery, we employ an ERAS (Enhanced Recovery After Surgery) protocol to help guide patients on improving pain and surgical outcomes, but nutrition is often not the focus. 

In addition, GLP-1 agents are increasingly being utilized by patients for weight loss prior to surgery, which can further compromise nutrition if not properly managed. Most studies in plastic surgery nutrition examine body contouring or tummy tuck patients, since these are longer procedures that are more stressful on the body with higher complication rates than most elective plastic surgery procedures. There is little high-quality data to help guide physicians on this topic, but there are some general recommendations in both the plastic surgery and anesthesia literature that are actionable and consistent.

Screening

The first pillar involves accurate and complete preoperative screening. Patients should disclose a complete medical history, surgical history, and all medications that they take, even supplements or over-the-counter medications not prescribed by a doctor. This allows us to screen the patient for any risk factors for bleeding, poor wound healing, or malnutrition. This also helps guide any additional testing, including lab work, cardiac testing, and screening for other nutritional deficiencies that may be present. Nicotine exposure and diabetes are two major risk factors for poor surgical outcome, and if these are present and lab work indicates that you are currently using nicotine or your diabetes is not well controlled, surgery will be delayed until these issues are resolved. We want to ensure that you are generally healthy enough to proceed to surgery and manage the recovery period, and if any parameter appears suboptimal, this should be corrected prior to proceeding to the next step.

Protein

Protein is an important foundation of healing and recovery. While often utilized for supplementation purposes, this is essential for patients undergoing the stress of a surgical procedure. Protein deficiency can impair collagen production, angiogenesis (creating new blood vessels), and the immune system response, all of which are mechanistically central to wound healing. There are ways to screen for protein deficiencies in your bloodwork, and albumin is a general marker of protein status and fluid balance that is used to assess chronic malnutrition. If this level is too low, this may indicate that you are not ready for surgery. 

Another useful lab marker is prealbumin, which can assess short-term changes, mostly useful for patients with recent weight loss. Supplementation with protein has been shown in studies reviewing outcomes of tummy tuck patients to decrease rates of wound healing complications, lower rates of seroma (fluid collections under the skin), and even aid in faster healing. Post-operative aesthetic surgery patients should aim for 60-120 grams per day of protein to optimize their recovery and lower their risk of complications, especially patients with recent weight loss or taking GLP-1 medications. We also offer more specific recommendations depending on your overall medical status. 

Fasting

Widely studied in surgery, anesthesia, and nutrition spaces, we know that the more calories and energy your body can take in after surgery (within reason!), the better your recovery will be. While some degree of fasting prior to surgery is necessary to prevent anesthesia-related complications, a small amount of carbohydrate loading prior to a major surgical procedure can help your body heal. Even though you may not feel particularly hungry after surgery and unable to eat a “normal” diet, it is also important to restart eating after surgery as soon as you are able. Surgery is stressful and places your body in a catabolic state, meaning your body is breaking down fat and muscle to release energy to respond to that stress. Helping to feed your body and replenish those stores is essential in the early stages of recovery. 

Micronutrients

Now you know that you need protein and carbohydrates, but what about the many vitamins and minerals that your body also requires daily? For bariatric and GLP-1 patients who are predisposed to a deficit of key nutrients due to alterations in the movement and absorption of food through the GI tract, it is especially vital to screen for iron, vitamin B12, and protein deficiency. Unfortunately, there are no high-quality studies looking at all vitamins and minerals, and it is not prudent or necessary to screen every patient for all micronutrients. 

Much of what we know about supplementation of micronutrients comes from wound healing literature for patients with chronic wounds. Vitamin C and zinc have been shown to be critical for collagen formation and other cellular processes. Vitamin A is essential for steroid-dependent patients to restore the early immune response to allow wounds to heal and strengthen. Barring these select compounds, there is no quality data to support further supplementation. Many herbal adjuncts carry individualized risks to patients and are not well studied, particularly in the post-operative period. Adding in these or other vitamins and minerals routinely for well-nourished patients is not recommended. There are compounds, such as L-arginine and Omega-3 fatty acids, that may be useful in select patients, but there is simply not enough data available at this time to produce any definitive guidelines. 

Contact Us To Learn More About The Importance of Nutrition

Patients will see all the above recommendations reflected in our nutrition screening protocol. From the first consultation, we examine your medical status and stratify you into what level of nutritional support you will require. The 14 days before and after surgery are most critical for building nutritional stores that then may be maintained and utilized after your procedure. For healthy patients who take no medication and have no medical issues, we will recommend increasing protein intake before and after surgery. In older patients or individuals with chronic medical conditions, we not only recommend increasing protein intake, but you will also undergo basic lab work evaluation and possible additional testing to ensure you are optimized prior to surgery. For post-bariatric surgery patients, massive weight loss patients, or patients with baseline nutritional deficits, you will be counseled about additional micronutrient supplementation and regimented daily protein intake. This is not a one-size-fits-all approach, and like most things in plastic surgery, we tailor our recommendations to your health and body. Contact us today for more information.

Sources

1. Evidence-Based Perioperative Nutrition Recommendations: Optimizing Results and Minimizing Risks. Plastic and Reconstructive Surgery. 2020. Knackstedt R, Oliver J, Gatherwright J.
2. Early Protein Supplementation Enhances Wound Healing and Reduces Complications Following Abdominoplasty: A Controlled Study in Non-Bariatric Patients. Aesthetic Plastic Surgery. 2026. Bruno A, D’Antimi A.
3. Nutritional Challenges in Post-Massive Weight Loss Body Contouring: Guidance for Plastic Surgeons on GLP-1 Agonists and Sleeve Gastrectomy. Plastic and Reconstructive Surgery. 2025. Mehta M, Rometo D, Gusenoff J, Rubin JP.
4. Perioperative Nutrition: Recommendations From the ESPEN Expert Group. Clinical Nutrition. 2020. Lobo DN, Gianotti L, Adiamah A, et al.
5. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesthesia and Analgesia. 2018. Wischmeyer PE, Carli F, Evans DC, et al.
6. Pre-Operative Nutrition and the Elective Surgical Patient: Why, How and What? Anaesthesia. 2019. Gillis C, Wischmeyer PE.
7. Nutrition and Wound Healing: An Update. Plastic and Reconstructive Surgery. 2011. Kavalukas SL, Barbul A.