What does a plastic surgeon need from a pre-op clearance letter?

A useful pre-op clearance letter for plastic surgery is more than a one-line 'cleared for surgery' from the PCP. It needs: current medication list with hold instructions (especially GLP-1s, anticoagulants, NSAIDs, supplements), labs (CBC, BMP, urinalysis if implant case), EKG if patient ≥50 or has cardiac history, ASA classification with rationale, explicit statement on infections (active UTI, dental abscess, URI), and a date — clearances older than 30 days for any patient with comorbidities should be repeated. A one-line letter does not protect the surgeon, the patient, or the anesthesia provider.

Should the surgeon or the coordinator review the clearance letter?

Both, but the clinical judgment call belongs to a clinician. Coordinators should do the administrative review (confirm the document arrived, confirm it's current, confirm signatures), but the actual clinical content — whether the patient is safe, whether GLP-1 was held, whether the urinalysis is clean before an implant case, whether the ASA classification matches the chart — requires a clinician's eye. Asking a coordinator to make those calls is the single biggest source of preventable same-day cancellations in private-practice cosmetic surgery.

How far in advance should pre-op clearance be done?

For elective plastic surgery, clearance should be obtained 2-4 weeks before the case. Two weeks gives time to address common issues (anemia, uncontrolled HTN, dental abscess, urinalysis result). Four weeks is better for cases with known optimization needs (iron deficiency, smoking cessation, GLP-1 hold). Same-week or same-day clearance gives no time to fix the things that the clearance was supposed to catch — which means the clearance functions only as a checkbox, not as a safety net.

What are the most common reasons cosmetic surgery gets cancelled day-of?

Across private-practice cosmetic surgery, the top day-of cancellation triggers are: active URI within 2 weeks of surgery, uncontrolled hypertension on the day of surgery, positive pregnancy test, positive drug or alcohol screen, GLP-1 medication not held the full hold period, active UTI discovered on day-of UA before an implant case, and hemoglobin below threshold on day-of CBC. Five of these seven are preventable with a properly-run clearance 2-4 weeks out.

Pre-Op Clearance for Plastic Surgery: A Surgeon's 2026 Workflow Guide

The PCP clearance letter that lands on your coordinator's desk is not a clearance. Here's the 5-step workflow that turns it into one.

Every plastic surgeon I've worked with has the same workflow problem. The PCP sends back a one-line letter — "cleared for surgery" — and the coordinator files it. The chart looks complete. The schedule stays full. And then at 0615 on the day of surgery, the patient's pregnancy test is positive, the urinalysis from three weeks ago that nobody read came back with nitrites and leukocyte esterase, or the BP on arrival is 178/102.

Same-day cancellations in private-practice cosmetic surgery cost $15,000-$30,000 per case. Most of them are preventable. Here's the workflow that actually prevents them.

The 5-step pre-op workflow

1. Set the clearance window

Require the PCP clearance 2-4 weeks before the case. Anything inside one week functions as a checkbox, not a safety net.

2. Define what 'cleared' means

Give the PCP a one-page template with required elements: current med list with hold instructions, labs (CBC, BMP, urinalysis if implant), EKG if ≥50, ASA class with rationale, explicit infection statement. A one-line letter is not a clearance.

3. Run the clinical pass

A clinician reads every clearance — not the coordinator. Looking specifically for the GLP-1 hold, the urinalysis result before implants, the BP on the most recent reading, the hemoglobin trend, and the patient's actual functional capacity.

4. Trigger the fixes early

When the clearance flags something (anemia, A1C high, occult UTI, BP not controlled), the patient gets called the same day. Workup and re-check happens before the OR slot is at risk.

5. Verify day-of

Morning of surgery: BP, urine HCG if applicable, urine drug screen if practice protocol, day-of EKG if cardiac history, last-time-eaten check. New finding = case delayed, not pushed through.

Where coordinators get it wrong (not their fault)

Asking a non-clinical coordinator to flag clinical issues from a PCP letter is the riskiest part of most private-practice pre-op workflows. The misses I see weekly:

BP "well-controlled on lisinopril"— doesn't tell you the day-of pressure
The three G's— ginkgo, ginseng, garlic. Patients never list these as medications. Coordinator never asks. They're bleeding risks.
GLP-1 hold not verified — the patient said they held it, the coordinator wrote it down, but the actual last dose was 9 days ago, not 14
Occult UTI before implants — the UA showed nitrites, nobody read the actual lab, the breast aug went forward, the implant got infected
Smoking on a tummy tuck— the patient told the coordinator they quit. They didn't.

None of these are coordinator failures. They're clinical judgment calls that should never have been delegated to a non-clinical person.

Where MyPreOp.ai fits

The reason MyPreOp.ai exists: take the clinical pass off the surgeon and off the coordinator, and put it on an AI that's been trained on the ASA, ACC/AHA, and ASRA guidelines and validated on real cases. Coordinator uploads the PCP letter + labs + med list. In 30 seconds, a two-section PDF report comes back — plain-language summary for the coordinator, clinical detail for anesthesia. ASA class assigned. Flags noted. Verdict: cleared, cleared with conditions, or not cleared.

Built for private-practice surgeons who are tired of personally reviewing every clearance and tired of 6 a.m. surprises.