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Article-'Must be' TV

Key iconKeypoints:

  • A recent study suggests that reality TV influences potential cosmetic surgery patient expectations and choices
  • The study was conducted over four months in the Yale Plastic Surgery Clinic
  • Results were published in Plastic and Reconstructive Surgery

Television shows that feature patients undergoing cosmetic surgery have a definite impact on viewers who are considering such procedures for themselves, according to a recent study. As part of the "reality television" craze that erupted onto the airwaves over the past few years, cameras follow patients who seek cosmetic procedures from the pre-operative consultation into the operating room and through the post-operative visit. Using a documentary-style format, patients discuss their reasons for seeking surgery, their thoughts about the process, and, eventually, their feelings about their outcomes.

Critics have expressed concern that these television shows misrepresent the complexity and risks of the surgeries, raise viewer expectations to an unrealistic level and, at the same time, encourage them to undergo surgical procedures they might not normally have considered. "Despite widespread unease about the effects that reality television shows have on patient decision making and expectations, no data existed on how these shows affected potential patients," says John Persing, M.D., F.A.C.S., professor and chief of plastic surgery at Yale University School of Medicine in New Haven, Conn.

Dr. Persing is part of a team that included Richard J. Crockett, M.D., currently a resident in plastic surgery at Mount Sinai Medical Center, New York, and Thomas Pruzinsky, Ph.D., of the Department of Psychology at Quinnipiac University in Hamden, Conn. The team attempted to discover if first-time patients seeking cosmetic surgery were influenced by reality television and, if so, to what degree. The study was conducted over a four-month period in the Yale Plastic Surgery Clinic at the Yale University School of Medicine. The results were published in a recent issue of Plastic and Reconstructive Surgery.

REALITY VS REALITY TV The study included 42 first-time cosmetic surgery patients over 18 years of age with no history of previous cosmetic procedures or consultations. Patients seeking revision or reconstructive surgery were excluded. As part of the assessment, patients were asked to rate their familiarity with several reality television shows. Fifty-seven percent of the patients were identified as high-intensity viewers and placed in a study category apart from the remaining casual or "not familiar" viewers.

Seventy-nine percent, or four out of five patients, reported that they were influenced in their decision to seek cosmetic surgery by television or the media, and 31 percent described being very much or moderately influenced. In this group reporting this degree of influence, 85 percent were high-intensity viewers.

"Although a causal relationship cannot be stated using a survey form of research methodology, the results lend strong support to the idea that plastic surgery reality television shows influence both the expectations and choice of potential cosmetic surgery patients," Dr. Persing tells Cosmetic Surgery Times . "I don't think it initiates interest, but it might enhance the interest of something they're already thinking about."

ALIGNING EXPECTATIONS Against this background, physicians must take special care to assess their patients and the procedures they request to weed out those who, because of the influence of reality television, may have an unrealistic expectation of what surgery may do for them. This may be especially true with procedures usually associated with cosmetic repair or reconstruction such as surgical modification of the feet or toes, umbilicoplasty, vaginal rejuvenation or labiaplasty, which are now being presented more openly in the media and requested more frequently by patients for aesthetic reasons.

"Choosing a good patient is not a perfect science," says James Wells, M.D., past president of the American Society of Plastic Surgeons. "Are they a cosmetic surgery junkie? What are their goals, worries and aspirations? Are they doing this for a realistic reason? You have to talk to people and tell them what they can realistically expect."

Dr. Persing agrees that refusing the patient's request is sometimes the best option, "If the person isn't able to maturely assess the risks or benefits of the procedure, then it's appropriate." But he cautions against refusing a patient's request based solely on the procedure being requested. "We can't refuse off the cuff. In the 50s and 60s, breast augmentation was thought of as being unusual, but as time went by and the techniques improved the quality of the procedure, the outcomes also improved," Dr. Persing says. "The question is, is the patient emotionally stable enough to accept the results of these unusual procedures?"

JUST SAY NO? Both Dr. Wells and Dr. Persing acknowledge that magazines, newspapers and television are filled with images of patients, especially celebrities, whose doctors definitely did not say "no." "When I see those bad cases on the news at 11, I cringe or get a chill," Dr. Wells says. "Sometimes the surgeon has an obligation to say 'no' as much as he has an obligation to say, 'yes, let's start this journey together.'" He adds, "I've called patients the night before surgery and said, 'I don't think I can give you what you're looking for, let's refund your money.' I've never been unhappy that I did that — I've been unhappy that I didn't do it."


Crockett RJ, Pruzinsky T, Persing JA. The influence of plastic surgery "reality TV" on cosmetic surgery patient expectations and decision making. Plast Reconstr Surg. 2007;120: 216.

For more information

John Persing, M.D., F.A.C.S.; [email protected]

James Wells, M.D.; [email protected]

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