**4. Preoperative evaluation**

Although it is well established that liposuction is not a treatment for obesity, more often than desired, the obese patient is programed for this type of procedure, and there are usually other associated comorbidities such as high blood pressure, diabetes mellitus, metabolic syndrome, ischemic heart disease, DVT, and obstructive sleep apnea. If despite recognizing that liposuction is not a reasonable treatment for obesity, if in any case it is decided to do this procedure, the minimum required is that, in the case of hypertension and diabetes, these conditions should be well controlled (it is advisable to postpone patients who have recently changed medications or doses in order to avoid unpleasant outcomes). If the risk of DVT, consider pharmacological thromboprophylaxis apart from mechanical prophylactic measures.

It is common that this type of patients is using recognized or unrecognized (natural remedies) medications and "herbal aids" to lose weight. This type of drugs ranges from amphetamines, thyroid hormones and ephedrine and a fairly large list of herbs and teas that if we take the care to inquire about it (identify them and look for their pharmacological effects), we will find that at least they alter the coagulation system or facilitate the interactions with epinephrine (see Chapter 1). Therefore, the patient should be instructed to suspend all this type of medications and naturopathic remedies at least 2 weeks before surgery. Needless to say, it is a contraindicated procedure in cocaine addicts.

With regard to laboratory tests, in our work center, it seems that it is exaggerated, but the type of patients and the procedures that are carried out have led us to request complete blood chemistry, basic metabolic panel, quantification of glycosylated hemoglobin (if the patient is diabetic), thyroid profile, coagulation times, liver function tests, pregnancy detection, serological detection of hepatitis A, B, and C, as well as detection of antibodies against HIV. If the patient presents some suspicious data, antidoping is added. All patients, regardless of their age, undergo ECG [6].
