Plastic Surgeons Frown on Reality TV Shows

Let''s face it, you don''t need a pretty face to get on television anymore; nowadays it helps to have an ugly one.

And if you come with crooked teeth, small breasts and cellulite to boot, that''s even better. These qualities will make you a perfect candidate for one of the various reality "makeover" plastic surgery shows proliferating across the tube these days.

And while the viewers and participants may be riveted by the results, plastic surgeons who don''t appear on shows such as The Swan (Fox), I Want a Famous Face (MTV) and Extreme Makeover (ABC) find that while the programs have given visibility to the field, generally the negatives outweigh the positives.

"It exposes people to what potentially can be done by plastic surgeons, that it''s not just frivolous, it''s not just ridiculous, so in that sense it''s very helpful," said Dr. Nolan Karp, an associate professor of plastic surgery at New York University School of Medicine in New York City.

On the other hand, Karp continued, "a lot of the result is not related to the surgery. A lot of the results in many cases are related to the dental work, to the grooming. Some of these shows sequester people for two months and give them a special diet and get them trainers and buy them new clothes."

It comes down to portraying the procedure and the patient in the best possible light, something television can do very well.

"These shows basically select patients from a large number of candidates so they pick the people who are the best candidates to have an extreme makeover because they have the kind of features that lend themselves to a home run," explained Dr. Peter B. Fodor, president of the American Society for Aesthetic Plastic Surgery, who was asked to be a surgeon on one of the shows. (He declined.)

For example, removing a "big nasal hump" is going to have the kind of instant, dramatic effect broadcasting executives love. Similarly, the smart producer is only going to perform on-camera liposuction on someone with "good, elastic skin."

Many patients are also shown in the worst possible light for their "before" pictures (no makeup, etc.), and in the best possible light after.

"Reality television shows really promote unrealistic expectations, and to get patients to have realistic expectations is one of the hardest things we do in our practice," Fodor said.

Dr. Terry Dubrow, the board-certified plastic surgeon who is one of two plastic surgeons making up the Dream Team of The Swan conceded that what you see on TV is quite different from what you will encounter in "real life."

"It is unusual that a person can come in with a laundry list of things they want done and be able to afford them," he said. "On the show, just as long as they were significant issues and realistic expectations and because they didn''t have to pay for them and because they would be monitored closely, we could go ahead and do all of those things."