When Do Plastic Surgeons Draw the Line?

In light of the recent media coverage concerning the numerous plastic surgeries done on a particular young actress, I am curious to know how most plastic surgeons feel about this.

When does a patient cross the line? How do you tell a patient, enough is enough?

Doctor Answers 7

When to not operate on a plastic surgery patient

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There are times not to operate on a patient at all if their expectations are unrealistic or if their medical or psychological health isn't optimal. These are times when the wise and ethical surgeon just won't proceed with surgery.

That is also why the doctor MUST be primarily involved in the initial consultation process with a patient. If you go where a "cosmetic consultatant" sees you and tells you that you can have whatever you want, it is time to move on to the place where the doctor takes the role of consultant. Sometimes you just can't have what you want and you need to know that.

As to how much surgery is too much in one day, the actress crossed that line in my opinion. Surgery has been shown to be increasilgly risky if it lasts over 6 hours in one day or takes on too many body areas or involves areas that increase the risk of operating on other areas. Better to stage the procedures for safety. None of this is worth risking your life for what might seem to be convenient.

Celebrity plastic surgery and multiple cosmetic procedures.

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To some degree, all surgery involves risk and a prediction of the future. As a skilled professional, it is our responsibility to guide and advise patients. We review patient's expectations, medical history, physical examination and then assess the risks of undergoing the proposed procedures.

Heidi Montag's 10 combined procedures at one setting may have appeared excessive but many were minor injections (botulinum toxin and fat). Furthermore, she is an individual very close to her ideal body weight. Liposuction in someone who is 5 foot 8 inches and weighs 250 pounds is completely different than in in individual that weighs 135 pounds and has slight fullness to the outer thighs. Every situation is different and must be treated on a case by case basis.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Crossing the line with multiple surgeries

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Sometimes determining when a patient is crossing a line is more obvious when doing multiple surgeries than when doing fewer surgeries since there may be fewer constraints on single procedures but that might be still inappropriate for an individual patient. There are no hard and fast rules except as sometimes determined by law that might restrict the length of surgery, the amount of fat removed in liposuction, or the type of anesthesia administered in particular settings.

Crossing the line can involve psycho-emotionally inappropriate situations and also medical or physiological guidelines. One test is to ask what would happen if something went wrong. Of course if everything goes wll, no one will criticize, no problems will have occurred and everyone is happy. The problems comes when something goes wrong. Can both the patient and the surgeon justify the decisions and course of actions? If there is a sense that regret might result, you might what to rethink the decision.

A doctor must spend enough time with the patient to explore the "why's" of the request and not just accept the "what's" that should be done. Is the patient looking for improvement or running away from imperfection? How secure or insecure is the patient? An insecure patient who has a complication can end up a disaster emotionally.

Physiologically, we look at time under anesthesia since complications increase the longer one is under anesthesia, the total surface area of the surgeries since swelling and bruising over a wide area is often more physiologically taxing than surgery concentrated in a smaller region, and whether one procedure is additive in complication risks to another such as can be the case when liposuctioning an area that one is also lifting and tightening.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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Responsible plastic surgery, the surgeon's role

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A responsible plastic surgeon will only perform surgeries that will benefit the patient. If multiple procedures are contemplated, the question is for each individual procedure will it help the patient.

In patients with body dysmorphia,the standards are even more rigorous. Why is the patient doing surgery?

The safety of all procedures together must be within acceptable safety standards.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
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How to Draw the Line in Plastic Surgery?

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As I was told in my training, "you  should never regret the cases you didn't do, but you will regret some of those you did". I try to take this teaching pearl very seriously, as do many of my colleagues.  With experience, I have found it to ring true.  There is absolutely no question that cosmetic surgery is not for everyone.  Exclusionary criteria for surgery can be for physiologic reasons, for social reasons, and for psychological reasons.  The most common reason I refuse to take on a patient is for the latter, including unrealistic expectations, and expression of body dysmorphia.  Unfortunately, if an individual such as a young actress wants, "something done", there will invariably be a Surgeon willing to accommodate.  An ethical Surgeon will address a patient's aesthetic concerns with reasonable approaches, and consider surgery only in psychologically and physically healthy patients.  There are times when a Surgeon is unwilling or even unable to read the warning signs of a poor candidate for surgery based on psychological criteria.  This scenario rarely leads to a happy patient, let alone a happy Surgeon.

Stephen Prendiville, MD
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When a Patient has had Enough Plastic Surgery

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Most experienced plastic surgeons or even those with a modicum of common sense know when a patient is asking for unnecessary surgery. When the defect is so mild that only the patient and surgeon can see it then it's likely that surgery will fix the problem.

You see patients like these blame whatever is happening in their lives on their looks. "If my nose was straighter I would have gotten the part." Good and ethical plastic surgeons know when to tell a patient that perhaps surgery isn't the answer. It's different for every surgery and unfortunately there are some surgeons who like the "fame" associated with operating on "celebrities."

I am very conservative and believe that an educated patient is the best patient. Those surgeons that choose the wrong route will eventually pay the cost.

It is the responsiility of both the surgeon and the patient to have reasonable expectations

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There are many times when having more than one elective cosmetic procedure at the same sitting makes sense. The issues that limit that choice involve:

1. general health of the patient

2. expected blood loss

3. expected operative time

In general, it is more prudent to stage procedures than to try to pack in as many as possible at one sitting. Patients sometimes pressure doctors as they can't take time off from work for multiple procedures. It is our job to look beyond the pressure and make a decision that is in the best interest of the patient (even if it means losing that patient to another surgeon)

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.