Extreme Cosmetic Makeovers - Good or Bad Idea? - By: Katt Mollar

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...

"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 and in the U.S. 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. In 2007, over 11.7 million cosmetic procedures were done, a 446% increase over 1997!

The top cosmetic surgical procedures in 2008 were breast augmentation, nose reshaping, liposuction, eyelid surgery and tummy tuck whereas the top 5 non invasive procedures were botox, hyaluronic acid, chemical peel, laser hair removal and microdermabrasion.

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. 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.

However, the controversy over extreme makeovers was brought into focus over the tragic death of Donda West. 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.

Despite information suggesting that extreme makeovers will become increasingly more common, there are many controversial issues under discussion regarding extreme makeover surgery.

(1) 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.

(2) 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.

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.

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.

(3) 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.

(4) 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".

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.

(5) 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. 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.

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 show 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 and educate the patient about risks and benefits for informed decision making.

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. 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). Ask if an anesthesiologist will be available for any complications.

Extreme cosmetic makeover remains 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.

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