Surgical marathons: is marketing hype dictating practice standards?

Are You Hot?, Bachelorettes in Alaska, Celebrity Boot Camp, Dog Eat Dog, Love Cruise, Meet My Folks, My Life Is a Sitcom, Race to the Altar, Temptation Island, Trading Spaces —these are just a few of the more than 80 reality shows available to American television viewers today. At what point is enough enough? We have watched reality-based television in the form of game shows, talk shows, tabloid news shows, and crime shows for years. However, producers behind the new crop of reality programs are pushing the envelope further than anyone—except, perhaps, Jerry Springer— has done in the past. The premise of most of these shows is simple: People are placed not in real but, rather, surreal situations. They are then encouraged to act in unusual or outrageous ways, often for money but sometimes simply for notoriety. In such circumstances, seemingly ordinary people have shown an astounding willingness to humiliate themselves, even betray their families and friends, in exchange for their proverbial 15 minutes of fame. The program probably most familiar to us, as aesthetic surgeons, is Extreme Makeover. Among the throng of reality shows, this one is unique and, literally, a cut above the rest. Most plastic surgeons with whom I have discussed the program have mixed feelings. On one hand, they recognize the potential benefits of a program that exposes the public to the positive impact of cosmetic surgery on ordinary people’s lives. At the same time, however, many plastic surgeons are concerned that the show encourages unrealistic expectations—and they are probably right. “Extreme” as defined by Webster’s dictionary is, “going to great or exaggerated lengths radically exceeding the ordinary, usual, or expected.” Is this the message we want to convey to our residents and colleagues practicing aesthetic surgery while at the same time attempting to teach safe and predictable elective surgery? Many ASAPS members have told me that they are seeing increasing numbers of patients in their offices who want to be “made over” from head to toe and believe this can be accomplished virtually overnight. Aesthetic surgeons can feel pressured by patient demands, even unrealistic ones. First there is the desire to please, but there are also economic incentives. After all, what surgeon isn’t eager to add additional surgeries to his or her schedule? When patients start requesting 6 cosmetic procedures instead of 2, busy surgeons suddenly become busier, and that’s good for the bottom line. But is it good for patients? We know that longer surgeries inevitably carry greater risk. Data also suggest that certain combinations of surgeries involving multiple areas of the body increase the risk of serious complications or death. Plastic surgeons are trained to recognize the variables involved in assessing risk to patients and to use appropriate judgment to minimize the risks as much as possible. Is there danger that a new wave of patients responding to the marketing hype of Extreme Makeover and copycat promotions will cause otherwise prudent surgeons to lose sight of appropriate standards of care in elective cosmetic surgery? Responsible plastic surgeons who exercise reasonable judgment may face a difficult challenge in educating prospective patients about the pros and cons of multiple, simultaneous procedures—when they can be safely performed and when they cannot. These surgeons undoubtedly will lose a certain group of patients to more aggressive practitioners who have embraced the concept of “extreme” surgery and believe they can compensate Stanley A. Klatsky, MD, is Editor in Chief of Aesthetic Surgery Journal. Editorial