Tag Archives: cortisol

Cosmetic Surgery Scheduled at 7 am?

Early morning cosmetic surgery


It’s 7 a.m. and I am waiting for my cosmetic plastic surgery patient to arrive at the surgery center for a gynecomastia surgery and a tummy tuck procedure. a cosmetic surgery scheduled weeks ago.  He may still be sleeping, but hopefully he is just late because of traffic.

I have written about pre-operative preparation for cosmetic plastic surgery in the past;



Why surgery starts early

There are several reasons why surgery of all types, including cosmetic surgery, traditionally starts early in the morning. These include medical reasons and non-medical ones.


Medical reasons for early morning cosmetic surgery

1. Hormonal cycle

Perhaps the most important medical reason for starting surgery early in the morning is the body’s normal cycle of contra-stress hormones.

Cortisol is the major anti-stress hormone in our bodies. It has a “diurnal” rhythm of its levels. It is at its lowest level at around midnight and rises sharply to its maximum between 6 a.m. and 9 a.m. It falls during the afternoon.

High cortisol levels protect the body against stress, psychological or physical. In the early morning, the associated high cortisol levels provide a little extra protection against surgery stress. Other hormones also play a similar role in stress reduction, but cortisol is the most important.


2. Blood sugar levels

Before any surgery requiring general anesthesia, cosmetic plastic surgery patients are required to fast for eight hours. This is important in preventing having any food in the stomach and decreases the risk of aspiration of stomach contents into the lungs—a condition that can be fatal!

The fast makes sure that your blood sugar levels are low in the morning. If surgery takes place later in the day, it’s like not eating breakfast. The low and decreasing blood sugar levels cause fainting, weakness and headaches, in addition to adding extra physical stress to the body.

3. Hydration

Having an early surgery means there is less chance for your body to become dehydrated. Not drinking water is part of the fasting process. Dehydration has obvious physical consequences and sets off its own series of stress responses that are not good for cosmetic surgery patients.


Non-medical reasons


1. Cosmetic plastic surgeons

Starting early in the day with cosmetic surgery allows the cosmetic plastic surgeon to have some time to see post-operative and pre-operative patients in the afternoon. Some plastic surgeons will operate all day long on certain days, but in general I like to break my days up and not operate for more than five hours a day.

Also, surgery is unpredictable in terms of timing. Though most plastic surgeons know how long their surgery takes, unforeseen circumstances like extra bleeding can occur and cause delays. This can have a domino effect and cause a string of delays extending into the evening.


2. Hospital staff

The workday at hospitals also starts early for nurses and staff. Hospitals are busy places, and the full day is needed to get all the work done; much medical care continues straight into the night! However, as in any workplace, hospitals are not fully staffed at night. The minimum number of staff required to take care of emergencies is usually what’s available. Most of the staff is at home, sleeping like normal humans! At 7:30 a.m., most hospital staff and nurses are at work.


3. Surgery complications

As with any other form of surgery, sometimes a complication arises after cosmetic plastic surgery. The complication of the surgery may require the patient to be taken back to the operating room.  Starting early in the morning means there is more time to deal with this possibility with the full complement of hospital nursing and support staff. It’s safer!

These are some of the reasons why cosmetic plastic surgery is started early in the morning. It’s  better for the cosmetic patient, better for the plastic surgeon and better for all the nurses and hospital staff.



Morad Tavallali, M.D., FACS

Plastic Surgery on the Body Affects the Mind for the Better

Botox, cosmetic plastic surgery and body language


I have written in the past about plastic surgery and how muscle action affects our mood. Early experiments of this type involved measuring brain endorphins (happy-feeling brain hormones) after patients were asked to hold a pencil in their mouths to simulate grinning. We know that then we are happy, our mouths turn into a grin. The experiment showed that when we force a grin by using the same muscles, we become happy!


Botox (botulinum toxin) useful against depression and headaches

Last year, a study showed that Botox, a medication that blocks muscle action, has beneficial effects in patients who suffer from migraines. Patients with migraine headaches suffer a tightening of the muscles of the scalp as one of the sequels to migraine attacks. Injecting Botox or any other Botulinum toxin effectively knocks out the muscles, relaxing them and improving migraine symptoms.


tummy tucks for men photo

Body positioning affects body hormones




Recent research has shown that body position affects our hormonal levels within two minutes! Specifically, taking on a dominant or “powerful” stance for two minutes,  such as placing your hands on your hips with your legs apart or holding your arms up in a “victory” stance, such as that of Rocky Balboa above, will decrease your cortisol (stress) hormone levels and increase your testosterone levels, which are associated with feeling in control, being more outgoing and being more self-confident. In contrast, sitting quietly in a chair with hunched over shoulders and crossed arms and legs will increase your stress levels and decrease your testosterone levels.  Here is a link to a TED talk by the researcher who discovered this fact: http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are.html


Plastic surgery affects mood?

The study that begs to be performed next concerns whether patients who have had plastic surgery also benefit from an increase in self-confidence and empowerment and whether they have decreased stress hormone levels and an increase in testosterone.

Any cosmetic plastic surgeon will tell you that they have seen a change in their patients’ body posture after surgery, be it a breast augmentation or a facelift. Plastic surgery patients hold themselves straighter, walk more confidently and even dress in a more extravagant way after cosmetic surgery. They typically also smile more.

In fact, one of the main reasons patients go to a plastic surgeon seeking cosmetic surgery is to “feel” better about themselves, and they will often voice that.  If you think about it, all of us have the same feelings on a daily basis when we look at ourselves in the mirror. On good days, when you wake up looking better, you will tend to enhance that by dressing up and thereby reinforcing your “on top of the world” look—which makes you feel even better! On a bad hair day or when you get up on the “wrong side of the bed,” you will look less attractive and may even dress down, thereby reinforcing the image of the “depressed and less attractive” you.

Why does all this matter, anyway?

Simply put, more attractive people have been shown in multiple studies to make more money. That’s one reason. See how I said attractive people and not beautiful people. There is a difference, as few of us are beautiful but many are attractive. The French even have a saying for “attractive ugly women”: une jolie laide!

Tall people tend to dominate us shorter folk, and it seems we pay them more for it. Thin people feel more confident than chubbier ones, and we also pay them more. This means that physical shape will affect financial earning potential. Some of our physical shape is determined by our genes, and there is little we can about that other than having plastic surgery to enlarge breasts, reduce nose size or remove excess skin and fat. The other part of our physical appearance is determined by aspects of posture, which you can control much more easily by keeping  your head held up high and standing tall! Plastic Surgery on the Body Affects the Mind!

Morad Tavallali, M.D., FACS