Is extreme makeover surgery too great a risk for too little reason? Or is it a medical achievement?

Many of us have watched at least one episode of one of the latest reality TV shows about extreme cosmetic makeovers. Admit it; it's mesmerizing to watch someone with significant physical flaws be transformed into a younger, more attractive version of themselves. Many people seem to undergo a personality makeover as well, gaining confidence and discovering a more gregarious and outgoing nature than before. Having indulged our curiosity or stoked our own thoughts of how we'd like to be made over, people seem to come away with either of two vastly different points of view...

Either: What a gift! It’s so exciting that this person has the opportunity to overcome appearance issues that have hampered their quality of life. Inspiring to see their dream of a new image come true. Good for them or maybe…wish it were me.”

Or: What are these people thinking? How can they subject themselves to the pain and surgical risk over image concerns? Extreme makeover just feeds into our society’s increasingly impossible standards for personal appearance.”

These polar opposite positions raise serious questions. Is extreme makeover surgery too great a risk for too little reason? Or is it a medical achievement that offers people who suffer with physical problems a new lease on life? As you might expect, the answers to these questions are not simple.

Cosmetic procedures are growing at a staggering rate worldwide. Even though most cosmetic surgeries and non-surgical procedures are not covered by insurance, more and more people are taking advantage of the growing range of treatments for appearance flaws, especially related to aging. 9.2 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2011. Only 18% were surgical but comprised 63% of total expenditures.

The top five cosmetic and minimally-invasive procedures were: ¹

Prices for cosmetic procedures range from $130 for microdermabrasion to $8,043 for lower body lift (physician fees only; does not include anesthesia, hospital or office fees, supplies, medication).

Cosmetic procedures are one thing; extreme makeovers are really a special subset of the cosmetic surgery field.

An extreme makeover is defined as undergoing more than one cosmetic surgical procedure at the same time. In a recent study, almost 60% of those surveyed would consider plastic surgery. Of that group, almost 50% would consider having an extreme makeover, i.e., undergoing two or more procedures at the same time. Those surveyed noted the following number of features they would want corrected:

Number of procedures:
One physical feature 35%
Two physical features 26%
Three physical features 12%
Four or more physical features 9%

The popularity of extreme cosmetic makeover reality TV shows is another overwhelming indicator of Americans’ desire for a physical overhaul. Ten thousand applicants tried for a spot on Extreme Makeover's second season.²

And, according to a study published in the July 2008 issue of the Journal of Plastic and Reconstructive Surgery, reality shows directly influence first-time patients who decide to have cosmetic surgery. The study interviewed first time cosmetic surgery patients and discovered that many were inspired to have surgery based on makeover programs they had watched. All of the available information suggests that extreme makeovers will become increasingly more common.³

The controversy over extreme makeovers was brought into focus over the tragic death of Donda West, the 58 year old mother of rap singer Kanye West, who died November 10, 2007 after a five and a half hour extreme makeover surgery performed by reality TV show host, Dr. Jan Adams.  Ms. West was 5 feet 2 inches tall, weighed 188 pounds and had a history of high blood pressure, high blood sugar and cardiac artery blockage. The procedures performed on Ms. West included liposuction, partial breast reduction, two breast implants, belt lipectomy (removal of fat around the waist and skin tightening), and abdominal muscle tightening.

An autopsy performed on Ms. West determined that there was no evidence of surgical or anesthesia mistakes but that she died from pre-existing coronary artery disease and multiple postoperative factors following surgery. While Dr. Adams has denied any wrongdoing, other plastic surgeons have spoken out, saying that Ms. West was an unsuitable candidate who should never have been operated on. Many in the medical field believe that this total body assault should not be undertaken lightly.

So, are extreme makovers safe?

Anesthesia Risk in Prolonged Surgeries

Anesthesia has a strong effect on the cardiovascular system. Prolonged anesthesia can create a greater risk of complications such as pulmonary thrombosis, where blood clots form in the veins and enter the lungs and the prolonged anesthesia usually means a longer recovery period. Although there have been few studies done on the effects of long periods of anesthesia, physicians generally agree that more than six hours of anesthesia should be avoided if possible. Extreme makeovers can last well over six hours, depending on the number of procedures being done.

However, plastic surgeons who perform extreme makeover surgery suggest that it is preferable for the patient to undergo one episode of anesthesia than three or more separate episodes and that the recovery period for one session of extended anesthesia is much shorter than the combined recovery periods from multiple surgeries performed at different times.

Surgical Complications

Cosmetic surgery, like any surgery, includes some risk of complications. In particular, cosmetic surgery risks include asymmetries, dimpling, loss of sensation, tingling caused by nerve damage, fluid collection under the skin (seroma), infection leading to skin death. When multiple surgeries are performed at once, the risk of complications multiplies at the same time that the body’s immune system is assaulted by the invasive procedures.

A study conducted by Dr. Grant Stevens found no difference in rates of complications based on number of completed procedures. This study, however, was conducted only on Dr. Stevens’ patients, making it difficult to generalize these results to the larger field of extreme cosmetic surgery. Plus, Dr. Stevens is a board-certified plastic surgeon.⁴

Many physicians performing cosmetic surgery are not board-certified and may not be able to achieve the same results. However, overall plastic surgery risks are relatively small. The risk of serious complications is less than half of one percent. Mortality plastic surgery risks affect only one in 57,000 patients. Plastic surgery risks are the lowest when the procedure is performed in an appropriate environment (hospital or surgery medical office) by a surgeon certified by the American Board of Plastic Surgery.⁵

Moreover, Dr. Stevens points out that his patients have a higher degree of satisfaction because they see results sooner, take less time away from work and in many cases, spend less money than it would cost to pursue multiple, individual procedures. Other physicians suggest, however, that there is value in performing one procedure at a time, evaluating the results and making adjustments in subsequent procedures. Plus, multiple procedures multiplies the risks while reducing the body’s ability to fight.

Even if one excludes the safety aspects, extreme makeovers continue to be controversial.

Quick Fix versus Better Choices

Some people worry that extreme makeover surgery, especially surgeries including liposuction and other procedures for fat removal and body tightening, provide an unrealistic quick fix that not only exposes people to unnecessary surgical risks but does not address the underlying issues of need for weight control and exercise.

Others argue that most physicians recommend appropriate lifestyle changes to support these types of surgeries and that some people need to begin with the success of the procedure to develop the motivation to truly adopt a different lifestyle.

Promotion of Unrealistic Ideals of Beauty

In an article about teenage girls, Susan Carney writes that, “The concept of “normal” has become so skewed that it is difficult for most girls, and often for the rest of us, to see things in their proper perspective. Healthy bodies come in a wide range of shapes and sizes. However, we have been conditioned to accept only a very narrow definition of attractive and to consider abnormal almost everything that does not meet those impossible standards".⁶

She echoes others’ view that the emergence of the extreme cosmetic makeover reinforces the idea that a person must be thin and beautiful to be worthwhile, notions that lead to conditions such as anorexia and bulimia. Moreover, there is a psychiatric disorder, body dysmorphic disorder (BDD), that causes people to believe that they have physical flaws which must be corrected, whether that is realistic or not. People suffering from BDD can become cosmetic surgery addicts.

On the other hand, proponents argue that extreme makeover surgery gives people a new lease on life, allowing them to be the best that they can be, encouraging self-confidence and in some cases, leading to better diets and more exercise. They further argue that plastic surgeons are well aware of BDD and know how to screen patients for signs of this disorder.

Cosmetic surgery gifts and prizes remove selection safeguards

While plastic surgery professional groups have been positive about some reality extreme cosmetic makeover programs because they raise awareness and provide education, the same groups are opposed to contests where a person receives the opportunity for a makeover as prize.⁷ Physicians say that it is critical that a qualified specialist determine whether or not a patient should undergo a procedure; faced with a patient who has won a makeover prize, a physician may be hesitant to reject the person as a candidate even if that’s the right decision. The same situation exists when a person receives a gift certificate for a procedure that may not be suitable for their situation.

The cons and pros in a nutshell:

Whether you agree about the worth of extreme cosmetic makeover or not, the combined procedures approach does increase the risks of complications due to anesthesia or surgery but there is no clear evidence at this point that those risks are too great to consider going forward.

However, differing opinions about the value of and the need for extreme makeovers aside, there is one underlying theme that runs through all of the discussion on this topic.

It is absolutely critical that the doctor who performs any procedure be qualified to do so. The data shows that a skilled experienced physician must:

• Evaluate the patient’s current medical condition to confirm that they are a candidate for an episode of extended surgeries.
• Evaluate the patient’s requests to be sure that they are reasonable, that expectations are not unrealistic and that the patient is not suffering from a mental disorder that should be treated by a therapist rather than a plastic surgeon.
• Educate the patient about risks and benefits for informed decision making.
• Guide the patient through the steps that are necessary to maintain the makeover results.

One of the best ways to evaluate a physician’s competence is to be certain that he or she is certified by the American Board of Plastic Surgery, the only plastic surgery board recognized by the American Medical Association. Check your physician’s certifications at the American Board of Specialties website.

Even if your procedure will be done outside the hospital setting, check to be certain that your doctor has some type of hospital privileges, often courtesy privileges. Hospitals have stringent credentialing processes; their approval is an excellent safeguard.

If your procedure will be performed in non-hospital setting, ask if the facility is accredited by the Joint Commission on the Accreditation of Healthcare Facilities (JCAHO) or the American Association for the Accreditation of Ambulatory Surgery (AAAASF). And ask if an anesthesiologist will be available for any complications.

The Bottom Line

Extreme cosmetic makeovers remain popular but somewhat controversial. If you decide to consider it, follow good consumer decision making practices to be sure that your experience is as safe as possible.

Published June 16, 2009, updated May 18, 2012

References

1. Statistics 2011, American Society for Aesthetic Plastic Surgery
2. Extreme Attention To Cosmetic Surgery Makeover, LocateaDoc.com, August 23, 2008
3. Crockett Richard J, The Influence of Plastic Surgery “Reality TV” on Cosmetic Surgery, Journal of Plastic and Reconstructive Surgery, July 2007 - Volume 120 - Issue 1
4. Stevens G, Extreme Cosmetic Surgery: A Retrospective Study of Morbidity in Patients Undergoing Combined Procedures, Aesthetic Surgery Journal, July/August 2004
5. FAQ, American Board of Plastic Surgery
6. Carney S, Extreme Dieting and Plastic Surgery, Youth [email protected], February 11, 2007
7. Surveying the Impact of Extreme Makeovers, LocateaDoc.com, August 23, 2008