Before any surgical procedure, hospitals require patients to remove makeup, nail polish, and sometimes jewelry. This protocol is not about appearance; it is a safety measure that allows the medical team to monitor a patient’s physiological state effectively throughout the operation. The presence of cosmetics can obscure subtle health changes and interfere with advanced medical equipment. Adhering to the request to be completely bare-faced and polish-free contributes directly to maintaining a safe surgical environment for the patient.
How Cosmetics Obscure Vital Sign Monitoring
Cosmetics, particularly on the face and nails, interfere directly with the technology and visual cues the anesthesia team relies on to track patient well-being. The pulse oximeter, a device that clips onto a finger, measures the percentage of oxygenated hemoglobin in the blood, known as oxygen saturation (SpO2). Dark nail polish, especially colors like blue, black, or green, can absorb or scatter the light wavelengths used by the sensor, preventing it from getting an accurate reading.
This interference can lead to falsely low or unreliable oxygen saturation values, delaying the team’s response to a real drop in blood oxygen. Similarly, thick foundation, concealers, or colored face makeup can mask underlying changes in skin tone that are looked for visually. The immediate signs of poor circulation or inadequate oxygenation include skin pallor (paleness) or cyanosis (a bluish tint), which the medical team needs to observe instantly on the face, lips, and nail beds.
If the skin color is hidden by cosmetics, this visual assessment becomes impossible, removing a rapid diagnostic tool from the team’s repertoire. The residue and oils present in makeup can also prevent medical tape or monitoring electrodes from adhering properly to the skin. If a monitoring patch fails to stick, it compromises the continuous, reliable flow of information needed for patient safety.
Surgical Site Sterility and Electrocautery Hazards
Wearing makeup introduces foreign, non-sterile material into the operating room environment, which raises the risk of a surgical site infection (SSI). Cosmetics, such as foundation, eyeliner, and mascara, harbor bacteria that are difficult to fully eliminate with the standard antiseptic skin prep solutions used before surgery. If these microscopic particles or bacteria enter the surgical incision, the patient’s risk of developing an SSI increases.
Eye makeup presents an additional localized hazard, as the blink reflex is lost when a patient is under general anesthesia. Flaking particles from mascara or glittery eyeshadow can fall into the eye, potentially causing corneal abrasions or severe irritation that the patient cannot feel or respond to during the procedure.
Beyond the risk of infection, certain cosmetics pose an electrical burn hazard during the use of electrosurgery devices. Electrocautery units use high-frequency electrical current to cut tissue and control bleeding. Some metallic or glitter-based cosmetics, such as metallic eyeshadows or body glitter, contain inorganic metal pigments.
These conductive particles can act as unintended pathways for the electrical current if they are located near the surgical field, concentrating the energy and leading to a burn on the patient’s skin.
Airway Management and Anesthesia Mask Integrity
Facial and lip cosmetics can significantly complicate the process of securing a patient’s airway, which is a primary concern for the anesthesia provider. If a patient needs to be manually ventilated using a face mask before the breathing tube is placed, a perfectly airtight seal is required to deliver oxygen effectively. Thick foundation, greasy moisturizers, or heavy lip products like lipstick and gloss, can prevent the anesthesia mask from forming this tight seal against the skin.
A poor seal results in gas leakage, which hinders the ability to ventilate the patient and maintain proper oxygen levels. Furthermore, the physical act of intubation—placing a tube into the trachea—involves instruments that pass through the mouth. Thick or loose lip product can be dislodged and transferred into the airway, creating a risk of aspiration or contamination of the delicate airway equipment. Removing these materials ensures the anesthesia team can establish and maintain a secure, unobstructed airway without mechanical interference.