Dr. Vip Dev, a board-eligible surgeon in Bakersfield, California, offers these guidelines for gauging whether a patient is a candidate for cosmetic surgery. Dev also offers his candid opinion on the safety and ethics of performing multiple surgeries simultaneously.
Is cosmetic surgery a viable option for a woman under the age of 25?
Dr. Dev: An emotionally mature adult under 25 who wants a physical change to improve self-esteem is an appropriate candidate. Someone who has body issues stemming from emotional/psychological disorders is not. It’s imperative that the surgeon understand the difference. There are many surgeons who find genetic/hereditary issues in both men and women that deserve attention, such as huge or crooked noses, or those with humps; breasts that are asymmetric, tiny, huge or tuberous; weight loss patients whose skin sags (and this can happen at that young age), drooping upper lids due to heredity; ears that stick out; and, obviously, reconstructive surgeries.
| Ethically, the surgeon should know when to say “no” to a patient, regardless of the amount of money that could be earned or the fame or persuasion of the patient. |
Was it responsible for a surgeon to perform so many procedures on Heidi Montag?
Dr. Dev: Absolutely not.
Do you think Ms. Montag might have a problem?
Dr. Dev: Without question.
Are there any procedures that naturally go together and are, in fact, more successful when done in tandem?
Dr. Dev: There are none that are “more successful when done in tandem,” although there are some that seem to go together, such as a chin augmentation with a nose job, as most unbalanced noses come with receding chins, for some reason. Also, of course, a little liposuction goes naturally with a tummy tuck to finish things up neatly, even though liposuction can surely be done alone. Most facelift procedures include eye work and a neck lift, along with the face lift, as one’s face tends to age evenly — i.e., if your neck has gotten to the “turkey neck” stage, it’s undoubtedly true that your jowls and mid-face are likely drooping, as well.
What are the physical considerations cosmetic surgeons should take into account when performing multiple procedures?
Dr. Dev: Physically, each surgery comes with its own requirements for time — the length of time required for the patient to be under anesthesia, the risks for blood loss, the exposure of the body during the procedure to the air and potential airborne contaminants, such as bacteria, etc. It’s something of a rule that one wishes to keep the total anesthesia time under four hours whenever possible. [If it’s] more than that, you have to worry about things going awry. Of course, it goes without saying that cosmetic enhancements are best performed on healthy people who can withstand the rigors of anesthesia and the discomfort of recovery. As both age and weight increase, concerns increase about the patient’s ability to withstand a procedure.
Are there any ethical considerations that cosmetic surgeons should take into account with their patients?
Dr. Dev: Ethically, a surgeon should avoid any patient who is clearly expecting miracles in his or her life after a plastic surgery, unless that surgery is geared toward correcting a trauma-based problem, such as rebuilding breasts ravaged by cancer or rebuilding a face damaged in an accident. Then, the patient might truly be correct that the surgery could change his or her life.
However, ethically speaking, when a surgeon meets a patient who expects an incredible change in his or her life based on a nose job or a bigger set of breasts, that surgeon should tread carefully. Patients with body dysmorphic disorder abound, and it’s a wise surgeon who avoids them, as they will never be satisfied with their body image, no matter how much surgery is performed (Michael Jackson’s name comes to mind). Ethically, the surgeon should know when to say “no” to a patient, regardless of the amount of money that could be earned or the fame or persuasion of the patient.
What do patients need to understand most when it comes to cosmetic surgeries?
Dr. Dev: It’s imperative that patients have realistic expectations from plastic surgery. It is, after all, surgery, and comes with risks and scars from the procedure(s). It’s important that the patient understands the limitations of the craft. A 50-year-old woman will not look like a 20-year-old woman, no matter how skilled her plastic surgeon. Therefore, it is wise for the person undergoing plastic surgery to know that the goal is an improved appearance, not a perfect one.
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