Popular television shows such as Extreme Makeover, The Swan, and I Want a Famous Face, where participants/patients undergo drastic, life-altering cosmetic surgery on camera, are no doubt the guilty pleasures of the year -- if not the decade.
On The Swan, plain-Jane contestants go through a cosmetic boot camp and ultimately compete in a beauty pageant. On I Want a Famous Face, starstruck patients go under the knife to look like, say, actor Brad Pitt or another mega-star.
And on Extreme Makeover, compelling contestants undergo multiple surgeries and fashion makeovers that turn them from the dumpy to the divine and from the mousy to the magnificent. What's so bad about that? The answer depends largely on who you ask.
While their spins are decidedly different, many plastic surgeons say these types of shows have several alarming things in common -- namely, they trivialize plastic surgery; minimizing its very real risks and set unrealistic expectations for viewers. Others, however, say that these shows can be positive and empowering to viewers.
Risks, Options Largely Ignored
"These shows trivialize cosmetic plastic surgery, and that does such a disservice for the patients," says Laurie A. Casas, MD, an associate professor of surgery at Northwestern University Medical School in Chicago and the communications chairwoman of American Society for Aesthetic Plastic Surgery (ASAPS).
"There is no discussion of options, no discussion of risks and benefits, no sense of the length of surgery or the postoperative course," she says. "That is all glossed over."
As a result, "the public walks away with the impression that cosmetic surgery is no big deal," she tells WebMD. "If it were reality television, it would explain that as consumers, there are options in physicians, locations for surgery, procedures, and the timing of procedures."
Moreover, "reality TV leaves you with unrealistic expectations," Casas says. "There is no way you walk away with realistic impression of what any of this means or costs."
Peter B. Fodor, MD, a Los Angeles-based plastic surgeon and ASAPS president, agrees. "Patients expect a transformation, and that is not realistic, and that is the biggest shortcoming of these shows."
When it is a contest environment like on FOX's The Swan, he says, "there is a tendency to do more longer procedures, and any time a surgery lasts longer than six hours, the risks of complications increase dramatically," he says.
"I can understand how these shows are entertaining to a segment of the population, and claims have been made that plastic surgery has become more popular as a result, but historically increases in cosmetic plastic surgery are more economy-related," he says.
Randall Flanery, PhD, associate professor of community and family medicine at St. Louis University in Missouri, says, "The more we learn about [these shows], the more staged and manipulated they look, but the visual image is very compelling, so we are willing to believe that it's true. I am sure the surgeries are real, but they occur in such contrived situations."
The message is faulty as well, he says. "They are saying is that the only way to really make yourself acceptable is by undergoing a drastic transformation of appearance and if you do that, everything will be all wonderful and changed."
Not true at all, Flanery says. And any viewer who undergoes a radical makeover and expects to wake up with a fairy tale life will be extremely disappointed.
Teens may be especially vulnerable to these shows, he says.
"The people I worry about the most are teenagers who worry about who they are and whether they fit in, and these shows give a false impression of a blueprint on how to be popular and accepted," Flannery says.
When it comes to trying to emulate a celebrity, buying a pair of the sunglasses or jeans they sport is one thing, but undergoing surgery is a different animal. "The current popular image, whether Brad Pitt or whoever, just changes so quickly that to try and closely imitate their appearance is even more extreme than other things," he says.
His advice: Turn off the TV.
Not Such an Ugly Duckling
These shows often end with a dramatic reveal of the new "you." Viewers are left with the impression that the participant's life has overwhelmingly changed for the better in every aspect.
But a more typical scenario is "a patient comes in that has had a large nose on her face that has driven them crazy all their life, and they take two weeks off for a [nose job] and it does change their life in the sense that they don't worry about the nose anymore," Paul S. Nassif, MD, a facial plastic and reconstructive surgeon in Beverly Hills, Calif.
The changes are not often as extreme as those seen on the television, he tells WebMD. "That part is glamorized.
"You do feel a heck of a lot better, but it's not a complete life-altering event in general, although I am sure that there could be exceptions," he says.
Stiff Psychological Auditions
"Candidates go through an extremely, extremely thorough psychological evaluation including a state-of-the-art battery of tests that takes four to five hours to complete and one to 1.5 hour interviews," says Catherine Selden, PhD, a clinical and forensic psychologist in Beverly Hills. And Selden should know. She is the Extreme Makeover psychologist and has personally assessed every candidate who has been on the show since its inception.
In fact, she just evaluated a new set of applicants. "We do turn down a lot of people if they are not appropriate candidates," she says. When doing an assessment, we also discuss expectations and warn candidates about possible pitfalls.
So why is this never seen on camera?
"It's too confidential," she says.
Selden is planning on conducting a follow-up study of Extreme Makeover participants to see how they fare once the cameras are turned off and their real life begins anew.
While it is too early to tell, so far "people may not be totally satisfied, but I don't know of any serious psychological difficulty," she says.
During evaluations, "I make it very clear that plastic surgery is not an answer to psychological problems, and I also discuss the adjustments that it will take and the reactions that they may get from people in their life that may not be all good," she says.
Any change, good or bad, leads to stress, she points out.
"I have seen incredible, positive changes in people's lives because they have had plastic surgery," she says. "More and more people in general public do want plastic surgery, and they don't go through evaluations to see if they are good candidates," she says.
And they should. This is one way that plastic surgery reality television surpasses real plastic surgery, she says.
"[Evaluations] should become a norm," she says.
The Case for Extreme Makeovers
Not everyone is anti-plastic surgery reality television -- including, of course, some of the doctors who appear on these shows, such as periodontist Jeff Ganeles, DMD, of Boca Raton, Fla.
"There are a number of pluses," he tells WebMD. "These shows raise the awareness of the public as to what's available, and in general, that's good."
Ganeles has done a few dental makeovers on Extreme Makeover. Whether bleaching or implants, "it's important for people to know that these things are possible," he says.
On balance, these shows are much more positive then negative, he says. However, "viewers must realize they are watching television, not a documentary, and if they recognize this, they can really pull a lot of useful information from the shows."
Remember, he says, "they are put together for entertainment; they are not science and they are not medicine, they are an entertainment medium and are dramatized in order to emphasize the particular focus."
The knowledge imparted by these shows is "empowering and terrific," says Shervin Erfani, DMD, a cosmetic dentist in San Diego, Calif.
"They show a lot of people what the capabilities are these days in terms of cosmetic dentistry," he says. "About 70% of people do not seek regular dental care, so these shows open the door to the possibilities."
Published May 17, 2004.