In December 2002 Extreme Makeover premiered on ABC as a one-hour, prime time special. Two and half years later the explosion of plastic surgery reality T.V. has been vaunted a phenomenon, with millions of viewers tuning in weekly to a bevy of shows that range from the educational to the farcical. In England now, you can even tune in to watch from the operating room, as patients get scalpeled and sutured on Cosmetic Surgery Live.

But the recent cultural obsession with reality T.V. and the public's gasping attention given to anything biographical was not enough, in itself, to fuel a show after show onslaught that centered around appearance altering operations. It took willing participation from the medical world.

The Recent Past of Plastic Surgery in the Media

In the past, a doctor's reputation was brought into suspect with every venture into the popular media, be it in print or through the airwaves. Denver plastic surgeon John Grossman remembers a time in which he was black balled from membership in surgical societies following his appearance on the Phil Donahue Show. He remembers when Dr. James Walter Smith published his book Doctor, Make Me Beautiful in 1973, and was nearly stripped of his presidency of the ASAPS (American Society of Aesthetic Plastic Surgery).

Contrast those actions to that of James Wells in 2002. Then president of the American Society of Plastic Surgeons (ASPS), Dr. Wells offered ASPS endorsement of Extreme Makeover. In exchange, the show agreed to use only member doctors and grant them veto power of any show participant.

Has It Gone Too Far

Now, however, as plastic surgeons continue offering up their services on a regular basis for these shows, the surgical societies they belong to are becoming more vocal about their objections. The ASPS and ASAPS have spoken out against shows like The Swan, I Want A Famous Face, and others, claiming that they present unrealistic expectations, while in England the president of the British Association of Aesthetic Plastic Surgeons (BAAPS), Adam Searle, has declared Cosmetic Surgery Live a "voyeuristic and pornographic extravaganza."

"British surgeons should have been alarmed," commented Manhattan plastic surgeon Steve Fallek about the experimental procedures that are frequently showcased on Cosmetic Surgery Live. However, this feeling didn't stop Dr. Fallek from filming his own episode for the show. His goal was to educate and inform the public about their options in plastic surgery; hoping to offer up a bit of realism.

He would be featuring a technique he developed that produced dramatic results for patients seeking a shapelier lower torso. "I wanted to stress safety," said Dr. Fallek. "It's great to be able to tell patients that this [procedure] exists." So stands the genre of plastic surgery T.V. today: a double-edged sword that promotes recognition, even though the platform doesn't provide the comfort or explanation tools of the consultation room.

While most surgeons welcome the growth in business that these shows bring, they also realize that they have a responsibility to carefully screen every patient and turn down people that don't understand the full extent of the surgical process. This last part is the reason that Dr. George Orloff, Burbank plastic surgeon, believes that the surgical societies oppose these shows. While he finds them to be beneficial to plastic surgery across the board, he realizes that it is "the role of institutions to emphasize education, that this is real surgery with real risks."

A Passing Fad or Just the Beginning?

No doubt the "doctor, make me beautiful," and let my friends watch it on T.V. craze has made enough of an impact that the effects of this heightened exposure will linger for years to come. But what will it mean for the future of plastic surgery?

Sure a live face lift on cable seems a little over the top, and many surgeons don't see any benefit to giving potential patients such access to the operating table. "At a certain point it becomes pornographic," says New Port Beach Plastic Surgeon Boris M. Ackerman. "We have to ask: what is the value of the public seeing this on the public airwaves?"

Then again, many surgeons had similar questions when Extreme Makeover was in its infancy. Dr. Orloff remembers his initial reaction: fearful that typical or realistic scenarios weren't being shown. "I didn't think it would be beneficial," he says. So he started a survey of patients in his office. Of about 300 respondents, 98% thought the show to be a positive for the field: that helped change his opinion.

Can Live Surgery Be Beneficial?

Like the BAAPS, many surgeons feel that Cosmetic Surgery Live may have crossed a line and is not presenting a good image for plastic surgery as a medical discipline. Of course the same feelings arose more than three decades ago about appearances on the Phil Donahue Show, and now such appearances are widely viewed as educational. It seems that as long as patients are learning more about the field, more and more surgeons are willing to accept exposure that caused initial reluctance. "Everything that has come before has benefited everyone down the line," says Dr. Grossman. "Years down the road we'll be glad we promoted publicity."

Dr. Fallek has already received around 40 emails from folks in England wanting to know more about his procedure that aired on Cosmetic Surgery Live just a few weeks ago. Arguing benefits is a matter of judgment, granted, but the show appears, at the very least, effective. Besides, having the task of distinguishing a good patient from a bad one has always been the burden of the plastic surgeon.

So who knows? Maybe the whole fad will fade gently into the cultural background and be but a vague memory. Or maybe it will find a different fate: "In twenty years the shows now could be viewed as tame," says Dr. Grossman. "We could be selling tickets to an amphitheatre at $20 a pop to watch live surgery."

Originally Posted: 05/06/05