You raise many different scenarios
For patients that are open about plastic surgery:
These are patients that are comfortable knowing that the surgery has been performed and are not ashamed to tell others as well. For this group, they want to hear that they "look good". After the compliment, they will often tell the complimenter that they have had surgery.
Note: As a plastic surgeon, I take it as an insult if people say "you had plastic surgery"' , if you look better and natural then it is fine but if a patient actually looks like they have been surgically altered then I need to improve my craft.
For patients that do not want anyone to know that they have had plastic surgery:
Less is more in this group. Dramatic changes are a no-no. If they hear a compliment like " you look rested" they will be happy, but once again "did you have surgery?" is not good.
As for the question at hand, the proper etiquette to discussing plastic surgery is to say "you look good". Never let someone know that you think that they have had plastic surgery. Firstly, because if they did not have any then you are accusing them of looking unnatural. Secondly, if they want you to know about their surgery, then they will spill the beans after you compliment them on looking better.
My personal aesthetic sensibility is this: a good aesthetic cosmetic surgery result is a result that looks natural, not 'done'. I always delight in the patient who reports that their friends or their colleagues at work say "You look fantastic!", but that they can't quite put their finger on why.
I have had many patients report that they have receiveed compliments on their clothing, hair , weight loss lipstick etc. following surgery. Some patients elect to share the details of surgery, others do not. Great surgery should make people look great. it should not make them look like they've had surgey
If they look great, say so.
If you think they look great, say that you think they look great. It should also be OK to ask them "what are you doing to look so good?" That opens up the opportunity for them to tell you if they want to. If they don't want to tell you, they may just make up a little white lie. If they do let you know that they've had work done, the biggest compliment is to ask for the doctor's phone number! That makes them feel good that you believe in their judgement.
Most all patients don't want someone to notice that they have had cosmetic surgery. That would mean that they didn't look "natural." Even at 2 weeks, my facelift patients typically can go back into the world incognito despite a huge difference from their preop appearance.
It is a rare patient who would be disappointed and say after surgery "nobody said anything!"
Tell them they look great! Dont let them know you think they had plactic surgery.
Patients are very disappointed if friends and family dont see an improvement after plastic surgery.
However, most patients also tell me they dont want people to know they have had plastic surgery.
Therefore it is best to compliment them by saying" you look great!"-leave it at that-if they want to share the fact they have had surgery it is up to them.
But by all means compliment them-it is very disappointing to go through sugery and have no one think you look good.
In this situation, everyone is different. My advice would be to just tell them that they look great. If they bring up the surgery, then it is okay to talk about it. If they do not bring it up, then I would just let it go. That said, most people after surgery are usually fairly open about their procedure. They are sometimes just worried about people being critical. If they do talk to you about their surgery, be encouraging. They just underwent a big procedure and expense and the worst thing to do would be to start criticizing them - especially since there is no turning back after surgery.
David Shafer, MD
Wait for an Opening, or MYOB
Proper etiquette regarding comments about a friend's appearance, in most circumstances, would depend on the depth of the friendship, and the risk of offending the other party. It would be rude to comment on the changed appearance of a casual friend or business acquaintance, while often there may be "no holds barred" policy of comments or criticism towards your life-long best friend, who most likely would tell you before considering or having cosmetic surgery anyway.
The more important question revolves around whether a person "wants to be noticed for their plastic surgery". I would make the argument that good plastic surgery should not be obvious, in inverse proportion to the level of one's friendship with the patient. Even the best cosmetic surgery (e.g., a rejuvenated facial appearance or new nasal profile) will be impossible to hide from your best friend, while a brow lift, eyelid surgery, or a facelift shouldn't necessarily be so obvious on a casual friend (or stranger) so as to draw a comment. Of course, BAD plastic surgery of the face, or disproportionate breast enhancement, is almost impossible NOT to notice. In this circumstance, regardless of the depth of your friendship, it is better not to comment unless invited to do so.
If you really must know if a friend has had plastic surgery, a nice compliment about their looks is always a good place to start. From there, be subtle with a few follow-up probing questions, and if the subject of plastic surgery doesn't come up voluntarily in short order, Mind Your Own Business!
Be sensitive and courteous by maintaining their privacy.
After being in practice for 23 years, I must admit that every cosmetic patient is unique. I have had some patients fly in from out-of-state and stay in a nearby hotel for three or more weeks until almost all the signs of surgery are resolved before venturing out into the public. Others could care less…they put on sunglasses, don a scarf, or put on a hat and go about their usual business, not missing a beat. And, everyone else seems to be in between.
So how do you handle someone that you strongly suspect has had a plastic surgery procedure? I would recommend that you be sensitive to that person and assume that they want their privacy until proven otherwise. I think it pays to be courteous. You might drop a subtle hint telling them that they look great, but do not push it. If they want you to know, they certainly will tell you.
Probably the nicest answer would be just to say they look great. If they are comfortable with people knowing they had surgery, they may "spill the beans."
Plastic surgery is an immensely private affair for some patients. Many husbands have no idea their wives have had surgery before, and the wives make sure that I know this beforehand when I am talking to both of them together.
For celebrities and people in the public eye, their beautiful persona may rely on the illusion that they are naturally gifted or beautiful and have never "had work done", although people are far more open than ever about having had surgery.
As a plastic surgeon, I have had patients look at me in public and suddenly look away, as though knowing me would be evidence that they have had work done.
The surest way not to be embarrassed as a patient is to be honest, often in degrees. I give the advice that, if asked, patients may want to admit to having their eyes done, a truthful reply, and just not mention the facelift, LiveFill, cheeklift, browlift etc. That way they are truthful but haven't given out their entire medical records to a nosy stranger.
Everyone likes to know they look good...
Don't over think this too much. If you think someone looks good, tell them they look good. You don't have to say "wow, that tummy tuck sure looks good!" Just compliment them naturally. Think about what you would like someone to say to you after a nice refreshing vacation, a great tan, or some weight loss after a lot of rigorous exercise. If you do, you'll come up with the right answer.