Do “reality” television shows about people undergoing cosmetic plastic surgery accurately represent what the average patient can expect from surgery?   According to the American Society for Aesthetic Plastic Surgery (ASAPS), recognized throughout the world as the authoritative source for cosmetic surgery education, the answer in many instances is “No.” 

Viewers may not be able to distinguish results achieved by plastic surgery from those obtained through changes in hair styling, make-up, wardrobe and cosmetic dentistry, and this can be misleading.   In addition, viewers may be encouraged to regard “extreme” changes as the goal of cosmetic plastic surgery, when in fact most cosmetic surgery is geared toward enhancing a person’s appearance while preserving their individuality.

Patients come in looking for the most natural results possible.   They often want reassurance that they won’t end up looking like a different person.   They don’t want to go into work a couple of weeks later and have people not recognize them.   They’d much rather have everyone talking about how great they look, not about how much plastic surgery they’ve had.

That doesn’t mean people can’t have multiple procedures, and still look very natural.   In facial rejuvenation, having your face lifted but doing nothing about the puffy bags under your eyes may create a disharmonious facial appearance.   Fixing both requires two procedures, a facelift and eyelid surgery; that are often performed at the same time. The key is in the right technique and the surgeon’s artistic touch.

However, combining certain types of procedures may be contraindicated in specific instances. That’s why people need to keep in mind that what is good for a patient appearing on television may not be good for them.

ASAP warns that patients who base their expectations on another person’s surgical results may be in for disappointment.  That’s because every individual has unique physical characteristics; bone structure, condition of tissues and muscles, and even unique healing abilities that help determine the final results of cosmetic surgery.

ASAPS gives credit to at least one of the current “reality” TV shows for selecting only surgeons who are certified by the American Board of Plastic Surgery. This certification, particularly when a doctor also is a member of the American Society for Aesthetic Plastic Surgery, ensures that the doctor has appropriate training and experience in cosmetic plastic surgery. But even when doctors are well qualified and have engaged in appropriate patient evaluation, counselling and informed consent, ASAPS is concerned that viewers may still see patients as “contest winners.”   To emphasize the importance of proper patient selection for cosmetic plastic surgery, ASAPS recommends that explicit statements about surgeon credentials, methods of patient selection and patient informed consent should be included in all such programming.

For many people, undergoing aesthetic cosmetic surgery has a profoundly positive impact on self confidence; this, in turn, can enhance the way they relate to other people and even how they perform their jobs.   However, having plastic surgery is never a guarantee of happiness or success. A suitable candidate for cosmetic plastic surgery is someone who is in generally good health, has a strong personal desire for self-improvement, and is able to identify specific, realistic goals for his or her appearance. Those who have unrealistic expectations are routinely informed by their plastic surgeon about what is possible and what is not possible through surgery.   According to an ASAPS survey of its member surgeons, people with unrealistic expectations frequently are refused surgery.

ASAPS recognizes the challenge television producers face as they try to balance all of the factors that go into creating “entertainment.”   When it comes to important health issues presented on television, entertainment and public education ideally should go hand-in-hand.   And when it comes to plastic surgery on “reality” TV programs, what you see may not be all there is to the story.