5 Things I would Not Do As A Plastic Surgeon

One of the latest social media trends is hearing directly from Plastic Surgeons “5 things I would never do as a plastic surgeon”. Here are my 5 top “don’ts” as a plastic surgeon.

1. OPERATE OUTSIDE MY AREA OF EXPERTISE

Most people think of plastic surgeons as the premium cosmetic surgeons and that is definitely true. However, we are also well trained in hand surgery, reconstruction surgery, skin and soft tissue tumors etc. I would not take a weekend course and do your brain surgery or your cardiac bypass. Board certified plastic surgeons are constantly astounded by the number of non-plastic surgeons who feel that if they take an online course or a weekend course, they are now qualified to perform surgical procedures and simply “learns as they go” with patients. Plastic surgery training is at least 6 years after medical school and frequently more. In my case, I did 9 years of surgical training after medical school (I did a full general surgery residency though I have never worked as a general surgeon and would not feel comfortable doing general surgery now – again staying with what you know well) 

2. OPERATE ON PEOPLE WITH UNREALISTIC EXPECTATIONS 

It is sad and frustrating that filters and apps are so inexpensive and readily available on every computer and cell phone. They can make people look extremely different from how they appear in real life. This is creating very unrealistic expectations in patients because they see before and after photos posted either on patients or friends, social media, or even worse, on a surgeon’s website that have been “enhanced” by filters or apps. I do my best to give my patients realistic expectations of what can be achieved. Just because someone wants a particular result does not mean it can be achieved with surgery alone. 

I often will have a patient in their mid 50’s say, “I want to look like I am 20.” I like to think this is said as more of a general expression but I hope they realize even with unlimited money, someone in their 50’s will never look like someone in their 20’s. Surgery and other tools such as laser, will improve or enhance certain features but aging changes everything about us! This does not mean we cannot take years off and make most people look much better. It is all about realistic expectations. 

3. I WILL NOT MAKE SOMEONE LOOK EXTREMELY UNNATURAL

There is a trend that has been going on for years and seems to be particularly prevalent in Hollywood, where if 1 or 2 fillers would be very helpful for someone’s facial appearance then 5-6 will be even better. This is NOT the case – it gives a a very unnatural look and in my opinion, it’s awful. I realize that taste is individual and I am certainly willing to do things like put in a somewhat smaller or larger breast implants than what I think is ideal because I believe I am here to serve my clients. However, when someone wants something that is far outside of what I consider “reasonable” (and this is subjective), I will not do it. I have had a few patients over the years, who wanted what I felt was a very unnatural amount of filler put in their faces and lips. I put more than I would ideally like but I also told them that I thought putting any more filler would be extremely unnatural and told them that was all I was willing to put in. Most of the time, my patients appreciate my honest feedback but I have had a few patients who were not understanding. 

4. UNREALISTIC GOALS

This is somewhat similar to #1 but it is different. In the first discussion, I am referring to simply physical things. For example someone extremely overweight thinks that by doing liposuction alone, they are going to look thin and trim. If you are overweight – liposuction and tummy tucks can improve your appearance but they are not a substitute for losing weight. In this section, I am referring to “unstated” sometimes unconscious goals. Plastic surgery and especially the cosmetic surgery aspect are very closely tied into our self image. 2 quick examples of what I am referring to. Many years ago, I saw a woman who came to me requesting a breast augmentation. It became clear, after I talked more with her about her life, that she was upset because her husband was having an affair with a younger woman who also had larger breasts than she had. With further discussion, it became clear that she was hoping if she did a breast augmentation, she would get her husband back. Instead of operating on her, I suggested she consider marriage counseling or at least reflection about her marriage etc. Had she proceeded with surgery, she would not have been satisfied with her breast augmentation since it was not a change in breast size or shape that she wanted but rather, an improvement in her marriage. 

Another example, I had a young woman come to me requesting eyelid surgery. After some careful questioning, it was clear she did not like herself and she was hoping if she changed the appearance of her eyelids, then she would somehow come to like herself. I suggested that she look into therapy but she would be disappointed with the surgery since it would not ultimately change how she felt about herself. 

5. I WOULD BE WARY OF SOMEONE WHO HAS MULTIPLE SURGERIES FOR THE SAME THING

This again will tie into realistic expectations. I certainly have operated on people who have had surgery with others and not been satisfied. These are complicated situations. It is important that I can feel confident that there is a good chance that I can approach the problem and improve it. There have definitely been times when I have operated on someone who has had prior surgery for the same reason with a very nice improvement. There are other times, when I have told the patient, that I believe the previous surgeon did everything correctly and just redoing it or doing a different operation on the same area will not likely change anything, and I have turned down the opportunity to operate on them.