Reality Cuts

That shift in zeitgeist could explain the reality shows' popularity in the first place. Whether you call it an obsession with the superficial or a commendable drive to be your best, there's no doubt that many Americans feel more pressure to look perfect. "There's certainly an emphasis on youth [in our culture]," says Singer. "And certainly the public is more self-indulgent than in the past. … There's an emphasis on self-improvement. For some people that's a new suit or makeup. Plastic surgery is just an extension of that. It's one more option." And those options are more varied than ever, including relatively low-risk and low-impact procedures, like laser skin resurfacing or injectable wrinkle fillers. The industry also promotes the idea that these procedures are just one step above face —reams-an easy fix for an age-old problem.

The "I Want a Famous Face" show notwithstanding, patients who opt for the heavy procedures don't necessarily want to look like Jennifer Lopez. "The way patients come into the office these days is very different than they did 20 years ago. They don't want to look 'diff—rent'-they just want to look better," says Dr. Robert Bernard, a plastic surgeon in White Plains, N.Y., and a past president of the ASAPS. "It's no longer about having that cute little button nose with the ski slope. You mention that to a patient these days and she will run out the door."

Would-be patients also have more access to information about plastic surgery than ever —efore-and the more information they have, the less foreign, and more acceptable, the concept seems. The reality shows are part of that. But so are celebrity and beauty magazines and, perhaps more importantly, the Internet. "A lot of patients come in with stacks of papers off the Web now, and there's often a lot of good stuff in there," says Bernard. Of course, he adds, there's also a lot of bad stuff: "I spend a lot of time disabusing them of misinformation."

That's the problem with the reality shows. They can be used as educational tools, says John Persing, a plastic surgeon at Yale University and the coauthor of the new study. "When [viewers] see an operation and there's a discussion with a patient and their family beforehand, I think that's a good thing," he says. But many of the shows, he notes, are instead "focused largely on entertainment." Some of the shows don't even focus on the surgery or the patients, but on "the personal aspects of the surgeons' lives," he adds. After all, they're prime-time programming, not public-service announcements; entertainment is why they're on the air in the first place.

When the shows sacrifice realism in the name of fun, they can be dangerous, critics say. Patients in the recent study who watched the shows had some skewed ideas; compared to people who didn't watch regularly, they believed the shows were realistic. These viewers may develop unfulfillable expectations, assuming that surgery alone will change their lives completely for the better. Some of the shows provide their stars with, well, extreme mak—overs-haircuts, makeup consultations, wardrobe overhauls, personal trainer sessions, time on a psychologist's couch. "These aren't patients who have only had cosmetic surgery," says Bernard. "It would be interesting to take the patients [in Persing's study] and six months later give them a questionnaire to see if their expectations of the surgery were actually met."

The shows may also suggest to viewers that plastic surgery can be had on demand. In fact, most plastic surgeons try to screen out patients who come in demanding procedures that might not be right for them. "The shows don't illustrate the process that good, ethical, board-certified plastic surgeons go through to select patients," says Singer. "Just because somebody wants something doesn't mean they should have it." The bottom line is, the decision to have plastic surgery should be made together by a patient and a doctor. And that means a doctor in the sam— room-not one in a television studio on the other side of the country.

© 2007