Where Do Plastic Surgeons Need to Draw the Line?

Plastic surgery has been in the news a lot recently. First, we learned about calf-reductions. It's a procedure that's been gaining popularity among women who, for the sole purpose of fitting into knee-high boots, are willing to undergo elective surgery. 

Then for a few days in late September, we couldn't stop talking about the allegedly "three-breasted woman." As it turned out, Alisha Hessler's claims of getting a surgically implanted third breast in order to be "less appealing to men" were false "” it was just a prosthetic. 

Oh happy day, Carolco Pictures

But would it really have been far-fetched to believe that somewhere a plastic surgeon was actually willing to perform such an operation? The face of plastic surgery is changing as fast as the faces (and bodies) of those who turn to it. As new and sometimes bizarre procedures emerge, the ethics of plastic surgeons themselves must adapt with the times. It's no longer a question of what doctors are capable of doing, but where they draw the line.

For instance, the growing acceptance of `transgender' as a legitimate medical and physiological condition has made formally taboo procedures routine, like breast implants for men. Such operations are now justifiable for many plastic surgeons to perform. In some cases, cosmetic enhancement will even be covered by the patient's medical insurance as part of the gender reassignment process. 

The new normal, LabourTV.Blogspot.com

But does the changing attitude towards transgender also make it more difficult to tell whether a patient truly needs the operation? Has it created wiggle room in a plastic surgeon's diagnostic method? After all, we've ushered in a new age of body acceptance and self-realization. So what's to stop a patient from arguing that plastic surgery is necessary because all of her life she's felt as though she was always meant to have dog ears?

To find out whether there really has been a shift in plastic surgery ethics, I reached out to the current President-Elect of the American Society of Plastic Surgeons, Dr. Scot Glasberg. He's an avid proponent of quality regulation, safety, and ethical standards in the field. 

As it turns out, even though plastic surgery procedures are constantly changing, the field's ethical guidelines actually aren't. "Cosmetic surgery is real surgery. It has real risks so we have to be mindful that everything we do benefits the patient," says Dr. Glasberg. This means that any procedure must meet the following criteria:

  • Enhance the patient's quality of life
  • Improve the patient's self-esteem 
  • Be done for reconstructive purposes. 

"I am first and foremost a physician. I adhere to the Hippocratic oath, which says to do no harm. So I spend a good deal of time figuring out why a patient wants to get any given procedure. If it's for the wrong reason, I will say no." 

According to Dr. Glasberg, a few examples of red flags are: 

  • Thinking that a particular procedure will directly result in landing a certain job. 
  • Thinking that a particular procedure will directly result in finding love or improve an existing relationship. 
  • Someone who is overweight thinking lipo-suction will make them thin (it is actually a contouring procedure, which isn't intended for weight loss). 
  • Anyone who wants plastic surgery just to look like a certain celebrity. 
Basically, turning to plastic surgery in order to fix something that's been bothering you for a long time, made you self-conscious, and has affected your self-esteem is pretty much the only valid reason to go under the knife. 

But another cardinal rule of plastic surgery is this: It is meant to enhance the norm and not go beyond it. And what practitioners consider "normal" hasn't changed over time either. 

For instance, even if gender reassignment procedures weren't as socially accepted in the past, they were never actually outside the realm of a plastic surgeon's code of ethics. 

"Let's take a man 30 years ago who wants to undergo genital reconstruction. Plastic surgery would take him from one norm to another norm "” from a normal male to a normal female," explained Dr. Glasberg, "So it's still helping people enhance their quality of life." 

Any woman wanting triple fun bags on the other hand, would never pass the requisite psychological screening patients are asked to submit prior to major aesthetic surgery. Such a request is objectively not a normal body type and, therefore, would be an unethical procedure. This standard is not expected to change any time soon. 

But other procedures on the market, despite technically being enhancements of the norm, still have people asking if plastic surgery is starting to cause more harm than good. 

Xurxo Lobato / Getty Images

One highly debated procedure is genital rejuvenation. Procedures such as labiaplasty and G-spot enhancement are now being performed on women who, unlike transgender folks, were born with properly formed organs, but want to simply make them . . . prettier. 

For one, critics say that advertising cosmetic surgery for a woman's nether regions promotes false insecurities and that surgeons are capitalizing on this new female complex. What's worse: The surgeons may have artificially created this situation themselves. Its existence has forced women to question whether they are aesthetically pleasing by comparison with the arbitrary standard of beauty that has been set. Before, this really wasn't something women even thought about. 

But ASPS doesn't see a moral issue with the existence of such procedures. 

"Times change and as times change we look at ourselves differently, we look at society differently and patients are willing to look at themselves differently," he says. "That's a perfect example of the maturation of the healthcare field," says Dr. Glasberg (though he himself doesn't specialize in such procedures). 

He does take issue with other trends in the field. For instance, the plastic surgery "makeover" show, The Swan, is one he considers unethical. "It's a classic example of where we don't want to be. If you watch the psychological profile of those women "” it's clearly off." 

But it seems that the biggest problem with the present standard of plastic surgery ethics isn't the kinds of procedures being performed or negligent psychological assessments. Instead, it's the amount of surgeons willing to perform operations with which they have little experience or proficiency. 

This has resulted in countless botched procedures at the hands of practitioners who aren't properly trained in every operation they advertise despite their official titles. In recent years, plastic surgeons have seen increasing patients looking to correct their previous doctor's work who may have lured them in with bargain prices at the expense of quality. 

When it comes to plastic surgery, it really is a case of getting what you pay for. 

As cosmetic operations become more popular every year, more under-qualified surgeons are willing to capitalize on the trend by peddling hack jobs to the desperate, thrifty, and uninformed. However, the types of procedures doctors are willing to perform remain, for the most part, unchanged by today's growing number of fame-seekers "” no matter what the self-proclaimed 'tri-breast-a-saurus' briefly led us to believe. 

Not gonna happen, Stylebistro.com

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