Cosmetic Surgery

In This Article:

Not knowing key facts about plastic surgery (namely, the pros and cons and all your options) can hurt you—not just your appearance, but also your health and your budget. Relying on published research, we've created an overview of what is available, along with what you need to know about the risks and benefits of the most common procedures.
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Cutting & Pasting

Sometimes money is the root of expensive mistakes. Just because celebrities are doing something doesn't mean you should jump in and do it, too. Yes, lots of celebrities have had their looks altered by cosmetic surgery, but often you can tell at a glance who got a bad face-lift because their faces have been cut and pulled so tight they look constantly surprised or incessantly half-smiling.

Michael Jackson, may he rest in peace, was a classic example of facial cosmetic surgery gone amok, but we've all seen others who seem shockingly unattractive, or strangely altered as a result of having had skin pulled too tight, or overfilled with dermal implants, or Botoxed into an expressionless zombie. A number of famous women have had their chests augmented and enlarged to the point that their breasts seem to enter the room a full minute before they do, or stand out like rocks from the chest, but that doesn't mean you should, too...or that this look is the new normal.

In short, what you don't know about plastic surgery can hurt you—not just your appearance, but also your health and your budget. To help you think about this, we've prepared overview of what is available, along with what you need to know about the risks and benefits of different procedures. It all begins with finding the best doctor for the job!

Choosing a Surgeon

Before we get to the details involving the various corrective medical procedures available, we need to address the most important consumer challenge of all: Who should do your surgery, regardless of what you decide to have done. Given the growing number of doctors with cosmetic or plastic surgery practices (and if you live in Southern California or Florida, their advertisements are about as prevalent and insufferable as those for car dealerships), it is very difficult to know where to go, whom to consult, and how to get started.

Most women use one of four methods to select a cosmetic surgeon: articles in fashion magazines, finding out where celebrities went (everybody loves knowing where the "stars" are going for anything and everything, regardless of how they look), getting a referral from a friend or a friend of a friend, and, last but not least, researching the doctors who advertise their services.

Though we wouldn't call these the worst plans of action, they should just be the beginning of the process. You need to know more before you can make an informed final decision. Take the time to gather detailed consumer information. Jot down a comprehensive list of questions to ask so you'll know what all your options are, which procedures will meet your needs, what the risks or disadvantages are, and which doctors are performing the safest and most reliable current procedures. The latest method doesn't necessarily mean the best when it comes to surgery—you don't want to be someone's test case.

Shockingly, many physicians downplay any risks. A quick review of several cosmetic surgery Internet sites reveals a scarcity of information regarding what can go wrong during or after a procedure. Yet each and every medical or cosmetic corrective procedure has risks. Yes, the risks are few and far between, but an average of about 1% to 4% (depending on whose statistic you use) of all patients have some sort of problem or negative outcome. When you consider that almost 10 million procedures were performed in the United States in 2010, that would mean there were at least 100,000 patients with problems. It is wise for you to decide if you want to chance being one of those who may fall in that statistic.

Being proactive about any surgery is incredibly important, but we must reiterate that it is even more vital with cosmetic surgery. After all, this surgery is usually elective and completely up to you; there is (or ought to be) nothing life-or-death about these procedures. Furthermore, cosmetic surgery is a very lucrative business—most surgeons get paid up front before you go under the knife or laser. So, before you hand over your hard-earned money, your very appearance, and your well-being, you have to be knowledgeable about every (and we mean EVERY) detail.

Cosmetic Surgery vs. Plastic Surgery

What is the difference between a cosmetic or plastic surgeon and a board-certified plastic surgeon? A lot! Training and credentials in surgery are the issues in contention. Although a doctor may offer cosmetic, plastic, or aesthetic surgery, he or she may not be board-certified to perform that surgery. The person could literally be a gynecologist, pediatrician or dermatologist with no training in cosmetic surgery whatsoever. Board-certified means the doctor has gone through very specific and extensive training in a specialized field and passed a difficult examination by a board of experts in that field. A non-board-certified cosmetic or plastic surgeon may be self-taught and may lack formal training in that field. Board-certified plastic surgeons consider this an issue of public safety, which we think is an understatement. They suggest that going to anyone but a board-certified plastic surgeon is a huge mistake, asking, "Would you want your plastic surgery performed by someone who has never had any formal plastic surgery training?" Good question, and we bet we know what your answer will be!

According to the American Society of Plastic and Reconstructive Surgeons (a professional association), many physicians who practice plastic or cosmetic surgery today received their formal training in another specialty—often a nonsurgical specialty—or had surgical training for another area of the body. One clear distinction with board-certified plastic surgeons is that they will have privileges to perform plastic surgery at an accredited hospital. Though most cosmetic surgery procedures are done in a doctor's office, you want to be assured that your surgeon has the level of skill accepted by an accredited hospital. It is completely fair to ask any doctor you see for cosmetic surgery whether he or she is board-certified and which hospitals he or she is affiliated with. Then check to be sure the hospital is accredited and the doctor's certification is current and recognized by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Board of Medical Specialties (ABMS) to certify physicians for the full range of plastic and reconstructive procedures. To verify a surgeon's certification status, contact the American Board of Plastic Surgery at (215) 587-9322 or visit the board's Web site at or the American Board of Medical Specialties at or by phoning 1-800-776-2378 (Source: American Society of Plastic Surgeons, online at

Of course, there are great dermatologists and lousy board-certified plastic surgeons practicing plastic surgery. But the odds of getting someone who is inexperienced are greatly reduced when you take the time to find out if that person is board-certified. To be certified by the ABPS, a physician must have at least five to six years of approved surgical training, including a two- to three-year residency in plastic surgery. He or she must also have been in practice for at least two years and pass comprehensive written and oral exams in plastic surgery.

For more information about a physician in your area who provides these kinds of services, visit the American Society for Dermatologic Surgery Web site at or call the American Society of Plastic Surgeons 1-888-475-2784.

What to Ask

Once you've dealt with the issue of board certification, ask lots of questions, and listen for answers that make you feel comfortable and make the most sense to you in light of the research you have done. Not all cosmetic surgeons will come up with the same game plan for your face. Each surgeon has techniques he or she prefers, sometimes regardless of whether they represent the best or most current technology. That's not necessarily bad. Some surgeons use the latest technology not because it is better or has proven more effective but due to pressure from their "elite" clients, who expect what's new regardless of the risks.

One of the most important questions you can ask the surgeons you interview is how often per month they perform the specific procedure or procedures you are considering. It is best (but not essential) to get a doctor who specializes, as opposed to a doctor who tries to do it all.

Likewise, it is also imperative to ask how many surgeries the doctor performs in a day. If the doctor schedules more than three procedures a day, most likely another doctor or nurse will do the prep work and/or the finishing work. That may not mean poor results, but it does mean the doctor is not giving you his or her full attention. Make sure the doctor you are consulting will be the only doctor working on your face or body, and that he or she will never leave the operating room during your procedure.

It is also valid to ask if the doctor charges for redos and touchups. Though it isn't something doctors like to admit, going back in for fine-tuning or to correct mistakes is common, and you don't want to be charged to have the doctor repair what you don't like.

Be insistent about understanding every nuance of your postoperative care. Many complications can occur when the patient doesn't realize his or her part in the healing process. For example, scar tissue can cause problems for a breast implant. One of the ways to minimize that risk is to keep your breasts tightly bound and your arms firmly at your side, with little to no movement and no lifting for four to seven days.

What Can Go Wrong

Negative outcomes are another complex issue. Both patients and physicians have a tendency to ignore the downside of cosmetic surgery. Paying attention to the risks of cosmetic surgery takes the glamour out of the process, so dangers are often downplayed to the point of being entirely ignored. Even when a doctor does discuss the perils of cosmetic surgery, they are often mentioned in an offhand style or glossed over completely in a vague and patronizing manner. Do not turn your face or any part of your body over to a surgeon who doesn't discuss, at length, all the risks involved with the cosmetic procedure you are interested in! Here is a partial list of what can go wrong with cosmetic surgical procedures:

  • Anesthesia, which is used for most surgeries, comes with several risks, including airway obstruction, blood clots, and even brain damage
  • Blood loss or clots
  • Infection at or around the incision site
  • Internal bleeding once the incision is closed
  • Asymmetry (uneven results)
  • Numbness or tingling
  • Fluid buildup and prolonged swelling
  • Skin irregularities such as puckering, dimpling, or divots

Cosmetic corrective or plastic surgery procedures can produce amazing results and literally erase years off your face or create the appearance you've always wanted, but do not assume there aren't risks, because there are. What you don't know means you can end up unhappy and, in plastic surgery, you won't get your money back.

When to Do It

The options for changing your body and face are almost limitless, and the results can be stunning. Traditional surgical procedures that cut off leathery, thick, lined, and sagging skin long abused by the sun can subtract years from a person's appearance. Laser resurfacing can create smooth skin and remove skin discolorations. Dermal fillers can plump up wrinkles and acne scarring. Endoscopic face-lifts can rejuvenate the face using tiny incisions without any cutting and pasting of the skin.

In the past, most people waited until they were well into their late 50s and 60s, with noticeably aged skin, before they seriously considered cosmetic surgery. All that has changed with the advent of relatively noninvasive, low-cost procedures such as laser resurfacing, Botox, and dermal fillers. Indeed, having some procedures done at a younger age, before you "need it" means having healthier-looking skin for years as opposed to an abrupt change when you finally decide you can't take it any more and search out a plastic surgeon. Besisdes, why wait until your skin is drooping and leathery before doing something about it (which should also consist of a daily anti-aging skin-care routine).

Women in their early 40s and 50s may want to undergo cosmetic surgery to deal with sagging corners of the mouth, slight pouching or sagging of the chin and jawline, and folds along the forehead. Though hardly aging by some standards, these irksome signs of middle age are easy to modify. Plus, having cosmetic surgery at this relatively young age slows the way skin will continue to age. Statistically, the most common age range for cosmetic surgery is 35-50, followed by ages 19-34. People over age 65 account for the fewest amount of cosmetic surgical procedures.

There are also endless options for cosmetic procedures that are just about maintenance or reshaping the face. Whether it is acne scarring, excess fat or skin, surfaced face veins, skin discolorations, hair removal, or changing the appearance of your nose or lips, facial enhancement has a plethora of options to offer.

Some cosmetic surgeons suggest that when you are younger, laser resurfacing (such as Fraxel), endoscopic face-lifts, and mini-tucks (doing a section of the face as opposed to an overall face-lift) are the best ways to put off the need for a full face-lift or eye tuck until you're much further down the road. They claim that if you do things as they crop up there's less trauma, better healing, and, because younger people generally have more elasticity and fat in their skin, the results should last longer. Whether or not less-invasive procedures or minor procedures decrease the need for eventual major surgery is not yet known, but there is something to be said for having the face you want now as opposed to later.

We are in a new era of accessibility to cosmetic surgery. Some people are pleased to know their face doesn't have to look as old as they really are, and that they can have a choice about what to do about it. As long as the results are impressive (and they often are), people will want to stay young-looking via any procedure that is relatively non-risky and permanent (although all cosmetic surgery has duration limitations meaning your skin won't stay age-free forever). That's not bad or good, it is just a legitimate option for creating the look you want. Plus, it beats wasting money on creams and lotions that do nothing for the wrinkles or saggging that bother you the most. Skin care can do a lot to help prevent and repair signs of aging, but any cosmetic surgeon worth getting to know would agree that when it comes to correcting signs of aging, the combination of a brilliant skin-care routine with the right cosmetic surgical (or non-surgical) procedures is the smartest way to go.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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