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T.V.’s Cosmetic and Plastic Surgery Shows Staff Report
Medically reviewed by George W. Weston, M.D.

T.V.’s Cosmetic and Plastic Surgery Shows
Depending on where you sit, television programs about plastic and cosmetic surgery are either the worst bane ever to ever hit the airwaves or the most thrilling entertainment you can find anywhere on the dial. A pop culture professor says the appeal of The Swan, Extreme Makeover, Dr. 90210, the soapy Nip/Tuck and others is due to Americans’ fascination with reinventing ourselves. Another expert maintains the appeal is actually a modern, high-tech retelling of Cinderella.

Daily, cosmetic and plastic surgeons face patients who have seen a particular operation on television and must sort out some commonly held myths about rejuvenation surgery.

According to several plastic surgeons, the first consultation usually goes something like this: “Yes, we do that procedure. No, it is not completed in twenty minutes. No, you will not spend two weeks in bed recuperating with a nurse at your beck and call. No, cosmetic surgery will not make your life a dream. No, we can’t make you look like Brad Pitt or Angela Jolie. No, we can’t do five different procedures in one session.”

A Quick Fix

But who can blame Jane and John Q. Public for being mislead? Reality shows often portray cosmetic surgery as a quick fix so more Americans than ever are taking the message to heart and going to see about that nip and tuck they’ve had in the back of their minds. Somewhere between 9.2 million and 11.4 cosmetic plastic T.V.’s Cosmetic and Plastic Surgery Shows surgery procedures were done in 2004, the most recent year for which statistics are available, according to the leading plastic surgery professional groups.

But much more than vanity, ego and narcissism are at work behind the appeal of the shows, say human behavior experts. “Americans are, and have always been, fascinated with reinvention,” Robert Thompson, professor of media and culture at Syracuse University in New York told “Settlers left the Old World for the new while waves of poor immigrants in the 19th and 20th centuries also reinvented themselves. We again reinvented ourselves by moving West. In essence, the history of the United States has been one, big makeover show.”

Meredith Jones, lecturer at the University of Western Sydney and Ph.D. candidate, interviewed plastic surgery patients and their surgeons before and after their surgeries to find the appeal of the shows. It’s all in her Ph.D. thesis, “Makeover Culture: Landscapes of Cosmetic Surgery.”

A “Magical” Transformation

“Often, cosmetic surgery is seen as a ‘reward’ for hard work and for suffering in some way,” Jones says. “The lives of contestants and subjects on “The Swan” and “Extreme Makeover” are often presented like the Cinderella story wherein a woman has been selfless and hardworking. We then see them as the meritorious poor who are rewarded with a ‘magical’ transformation.”

And that, says Jones, removes cosmetic surgery from notions of vanity and frivolity in the minds of many viewers while linking it with labor, progress and merit.

Adds Sander Gilman, an Emory University professor who has studied the history of plastic surgery and written two books about the field: “By the year 2020, nobody will ask if you’ve had aesthetic surgery, they will ask why you have not had plastic surgery.”

Today, he says, it has become normal to be around people who opt to change their looks. But soon, the question will become, “Why are you walking around bald, fat or flat chested?

If you follow the scientific press or even the comments of plastic surgeons in magazines and newspapers, it’s no secret what most think. Surgeons see the shows as a distortion that plants in the minds of viewers that the field provides unrealistic quick fixes.

Crazy Circumstances

“The average person today getting cosmetic surgery is not a bored, rich lady but a working mom who just wants a single procedure to improve her appearance somewhat,” says Valeria J. Ablaza, M.D., F.A.C.S., a plastic surgeon at the Plastic Surgery Group in Montclair, New Jersey. “But many programs show patients having months of surgery and winding up no longer resembling their former selves. Plus, the crazier the circumstances of the person’s life before surgery, the better it is for television.”

In response, Dr. Ablaza and her partner, Allen Rosen, M.D. have penned “Beauty in Balance,” a tome written to counter the effects of “Extreme Makeover” and “The Swan.”

Yet another plastic surgeon reacted -- and took to the airways -- when he first saw the plastic surgery drama, “Nip/Tuck.”

“I could not believe that show was portraying plastic surgeons as immoral, unethical, hypersexual beings,” says Robert Rey, M.D., one of the reality surgeon-stars seen on “Dr. 90210.” “I was highly offended and decided right then and there I would go on television to show what life is like for 99.99 percent of plastic surgeons who are honest, moral and monogamous.” Dr. Rey has been on “Dr. 90210” since July, 2004.

Adds Dr. Ablaza: “’Nip/Tuck’ is a black comedy that satirizes plastic surgery, the surgeons and the patients.”

Unqualified medicos

According to Robert Kotler, M.D., another plastic surgeon featured on “Dr. 90210,” the effect of the programs is to drive more people to make appointments at plastic surgery offices. Consequently, more unqualified medicos enter the booming surgical rejuvenation marketplace, Dr. Kotler says.

“As a result, I’ve seen the number of people needing corrective surgical procedures increase markedly,” Dr. Kotler says. “Correcting shoddily done cosmetic surgery is far more difficult and expensive than getting it right the first time.”

Another burden: the shows attract the attention of “eternal” plastic surgery patients who are rarely satisfied with any outcome at all. Consequently, surgeons are trained to screen for people who suffer from what is known as “body dysmorphic disorder,” an obsession with an imagined or slight defect on their bodies. Professional plastic surgery societies reckon anywhere from seven to 15 percent of people seeking a retooled body part are afflicted with the disorder. Surgeons try to steer them to psychiatrists and psychologists. Opposed to that are the best candidates for surgery who only want more self-confidence with one procedure or perhaps a repair on a loathsome body part like a crooked nose or sagging eyelids.

Saints from Sinners

To help sort saints from sinners, Dr. Kotler wrote “The Essential Cosmetic Surgery Companion,” a patient workbook filled with tips on finding the best possible surgeon to do a procedure correctly, the first time. Dr. Kotler’s book has sketches of various body parts; the patient hands the book to the surgeon and asks him or her to mark where scars will be made.

“Too many people are buying into the hype of reality TV shows which underplay the serious medical risks of choosing the wrong cosmetic surgeon,” says Dr. Kotler.

Adds Leo McCafferty, M.D., a Pittsburg plastic surgeon: “We do much more than just stretch skin. Television audiences generally don’t equate us with all the burn or accident victims we repair. Plastic surgery is actually a medical specialty that deals with both fixing the abnormal and the unhappy normal.”

“One program, ‘I Want a Famous Face,’ asks teenagers to undergo facial plastic surgery that supposedly will make them look like some celebrity,” says James Wells, M.D., F.A.C.S., a past president of the American Society of Plastic Surgeons. “It is nothing more than taking advantage of a vulnerable youngster by hinting he or she will also have a famous career only because of the change in appearance.”

Meredith Jones’ research Down Under revealed that the flood of patients is creating some changes on the way plastic surgery is done. Some surgeons told Jones they felt obliged to buy certain office equipment patients had seen on television; they also expected to see the gear in the office of top surgeons, even it was not used.

“But more importantly, television shows have created a consumer who will shop around for another surgeon if she’s not happy with the first,” Jones says. “She also has clear ideas of what she wants done – not what the surgeon wants done – and will perhaps litigate if the results are not what she expected. The modern patient sees herself in an equal partnership with the surgeon and thinks of cosmetic surgery as a commodity for which one shops. Moreover, the subjects I studied are so well informed because they do not rely only on the shows for information; they spend countless hours on the Internet and in chat rooms.”

Confident before Juries

Adding to the fray are the authors of “Facelift Diaries,” a book written by two university psychology professors so that the public would better understand how a facelift is major surgery with physical, emotional and social challenges.

Because so many unrealistic high expectations are brought crashing to earth after a cosmetic procedure, two psychologists formed Extreme Communicator, a company that helps plastic surgery patients change their behavior to complement their new looks.

For instance, an East Coast attorney, 39, was often criticized as being so aggressive and harsh, nobody would work with her. She thought she would appear more feminine after facial plastic surgery, a breast augmentation and Botox. After the procedures, she did indeed become more confident before juries, thanks to her enhanced appearance. However, her harsh personal communication style had received no makeover.

“We found her aggression was a mask for insecurity and, over a course of six months, showed her how to soften her personal style to match her new look,” says Larina Kase, Psy.D., a partner in Performance and Success Coaching in Philadelphia.

“Eventually, she made partner in her firm because she became so much more effective.”

And where might the fascination with plastic surgery lead? T.V.’s Cosmetic and Plastic Surgery Shows

“The basic appeal and drama in plastic surgery is found in the before and after pictures,” says Professor Thompson. “Already, we are seeing other things – like houses in Extreme Makeover, Home Edition – that can also be shown in before and after shots. The technique can also be done with cars.”

Who knows? The day might be coming – with much of New Orleans still in shambles – when we can find, “Extreme Makeover, City Edition” in the TV listings.

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