Celebrities and Plastic Surgery

Donn M. Hickman, M.D.

     It has been said of plastic surgery and hair transplants that you will never see a really good result because when done well and gives balance to the appearance, you don’t see any signs or perceptible scars.  Celebrities and those with great public persona always have to project youth and vitality, resisting the forces of age, or else the public will find  suitable replacements for the images so imagined. There is always a more appealing messenger.  This is human nature which brands public perception as the way we view the world.  Everything we do is marketing ourselves- our look, our speech, our message, our delivery, our meaning, and quite frankly our first impression.  We would hope the scrutinizing consumer  when choosing a plastic surgeon, understands the character behind the face, the professional versus the novice, and the expert from the charlatan. 

     The change in  the American health insurance payment system has caused a surge of non-core physicians and surgeons to move out of their designated areas of interest and enter the highly unregulated, modestly disciplined, and highly lucrative field of aesthetic medicine. This includes skin care, injectables, and actual plastic surgery.   Individuals in the public spotlight seek the latest advancements for looking and feeling their best.  They are subject to the same marketing pressure as everyone else.  They may seek a cosmetic specialist and  not really know if  the doctor is properly prepared to perform the task.  It is plain that everyone in Hollywood  should look good..  To have a particular look such as a popular pop star, actor, or any name-sake celebrity is very desperately felt in Southern California and Los Angeles.  Many celebrity icons have insecurities about their appearance. They may search for a particular set of eyes, a nasal profile, neck line, lip size, bust line, or body contour, and jump at the first slick advertisement or personable doctor at hand.   They may often be guided by the doctor’s office location, flashy ads or infomercials where he or she is featured, and a persuasive and comforting affability.   It is only the probing astute consumer doing the necessary homework on the doctor,  the credentials, specialty core training, actual medical board status, and a study of the doctor’s work, that  he or she will be properly informed of the qualifications the doctor brings to the table.

     Having stated the obvious, all consumers must think before buying,  and particularly when considering plastic surgery. The poorly screened patient with unrealistic goals or pursuing an endless stream of procedures does not alter the root of the patient’s self-esteem problems.   Instead, surgery may reinforce other elements including a destructive lifestyle.  A person may be trying to be something they can’t,  fit a role or position that can’t, or attempt to restore the perfect image of their younger self that they can’t.   The surgeon then becomes part of the problem when giving in to these false hopes.  Sometimes  a surgeon may offer to try something but only after considerable consultation with the patient.  Attempting to correct a problem by causing another set of problems is what we warn as “do no harm”,  “put off until tomorrow what cannot honorably be done today” and “that  your aptitude should determine your specialization”.  If  the plastic surgeon can within reason achieve something or make corrections, and knows the limitations of his or her aptitude, then a patient may be  reasonably confident that a procedure is indicated.

   The only cure for wrinkles is to not get old. We fight aging with every breath we take.  Often our genes influence the journey through life and some of us reach the final destination looking a little more robust than others.  Extraordinary new technologies and innovations plus conventional and well tested procedures offer the consumer seeking plastic surgery many choices.   It is up to the individual to balance a healthy lifestyle, diet, exercise, and any special care by the primary doctor to insure the journey into maturity is looking forward. This is reinforced by carefully examining any fads, slick promotions, or any beauty surgery fixes.

    Often movie celebrities must completely change their mindset, character, emotion, and physical state to secure the special roles we enjoy on the silver and small screen.  It is extraordinary to see an actor get  into a complex character by gaining or losing large amounts of weight.  In the stress of  this action,  they perhaps consume too much tobacco or alcohol,  engage in flirtations with controlled substances and physical-enhancement substances, and  yes, also, quick and aggressive plastic surgery.  Often people in the public limelight will come to the office and want the latest and greatest laser or chemical peel treatment to erase wrinkles and restore glowing skin, and do not expect any risk or downtime, nor personal compliance required for healing.  They believe the best doctor will get them through it.  Furthermore, the person who has been making  poor life choices,  and for things introduced to their bodies, do not make the best immediate candidates for plastic surgery.  They may often rush into surgery and demand the brightest eyes, the smoothest brow, the largest lips, and the tightest face, and with some persuasion, the doctor satisfies the person’s wishes.  The result and that doctor’s stamp are now on the patient for all to see.  The mature individual, who has not aged gracefully may, after plastic surgery take on an unnatural appearance. Without surgery they may just look old.  Some consumers may like a slightly artificial look, because their natural appearance does not fit the way they feel nor does it help them reach the public.   These consumers may wish to be bold and go for broke, requesting the most aggressive and the most number of procedures.  Bold may suit them but for the observer, this bold look may look in fact odd. 

    Celebrities are not that different from the general public, since consumers and their doctors can make bad choices, on what is operated upon and to what extent. What may please one patient may quite profoundly displease another.  When celebrities look strange from obvious plastic surgery, it does put a blemish on all of us, but we cannot make a true judgment, since the doctor and the celebrity have a confidential pact. The extent of the informed discussion is not known.  Actors in the very competitive  action hero roles may prepare physically, but also may resort to quick and large doses of anabolic steroids plus growth hormone  to optimize their physical look.  These steroids are controlled unlawful substances.  These patients may experience changes in face size, thus are not going to look as good after an eye lift or facelift, even when performed well.  A Woman with a face injected full of silicone, bloated lips, or having too many facial implants, may seek a well-trained authentic plastic surgeon for a facelift. The facelift results may be less pleasing because of all the prior ghastly procedures.   It is often best not to select such patients since the surgeon is then credited for the entire result.  Michael Jackson had a great Rhinoplasty at the time he produced his Thriller album and it was done by a great plastic surgeon.  This icon could not stop his quest for some perfect view of his nose and self, and somehow convinced the next surgeon or surgeons to go far beyond anything recognizable.  Plastic surgeon greed was implied here since Michael Jackson could afford these measures.  He pushed the limits of reality to the point of developing a ghostly facial deformity.  As a board certified plastic surgeon also boarded in general surgery, my office is  frequently confronted by the previously-operated patient who presents with a  complex surgical problem and may not reveal the true state of their health or nature of prior surgery.  They more often than not fully expect some correction of their problem in one single stage and for everything to be right.   We are, truly the build, fix, and repair specialty of surgery.  We take care of mistakes of nature, trauma and disease, as well as other surgical misadventures. We also correct, revise, and make enhancements on procedures we have performed.  We are trained to deal with problems that can result from procedures we perform. 

    A practice in plastic surgery is not without the occasional complication that distresses the patient as well as the surgeon.  No matter how hard you plan, how rested you are, or how precise your execution is on the day of surgery, even experienced plastic surgeons can have complications, or a result that is less than ideal.  It is hard enough for those of us with many years of surgical training and even additional boards of certification to perform perfect plastic surgery.   That is why it is difficult to see how a celebrity  or any consumer can fail to research a doctor carefully before signing up to have plastic surgery.  A real plastic surgeon with 7-8 years of formal surgical residency and fellowship may be compared to a cosmetic surgeon who may have never had any surgery training whatsoever in a residency program after medical school.  

    There are vast numbers of cosmetic surgeons who never had more than a month or two of core formal surgical education after medical school, involving operating itself, or caring for the sick surgical or burn patient.  Yet we are aware of family doctors, dentists,  dermatologists, and emergency room doctors performing face lifts and body surgeries.   Some have gone through unsponsered and unofficial  fellowships where they simply observe another doctor perform surgery for 3 months to two years.  What the public needs to understand is that bad results make great press and create a lot of emotion, but public responsibility is fundamental. 

 This final comment is a famous passage of five centuries ago.  It is from the father of plastic surgery and defines the role of the plastic surgeon directed to the individuals who have serious physical afflictions.  Sometimes the patient seeking plastic surgery will be delighted at what their eye fancies and what boosts their spirit, but others may not see it that way when the look is overdone.

"We restore and make whole those parts which nature or ill fortune has taken away, not so much to delight the eye but to buoy up the spirit of the afflicted."

Gaspare Tagliacozzi  1597