Less Really Is More

Tips From a Plastic Surgeon on How to Avoid an Overdose

During my 16 years as a plastic surgeon, I have seen countless lives improved by cosmetic procedures. I've also seen disasters--not medical ones, which are thankfully rare, but esthetic ones, which are increasingly common. Americans underwent 1.8 million plastic surgeries in 2003, up from 330,000 a decade ago. Surgical enhancement has grown so popular that many patients--even celebrities--are getting the equivalent of bad haircuts. How can you avoid that fate? My advice is simple: don't get carried away.

The patients I see in my Park Avenue practice range from exotic dancers to middle-aged businessmen, but their goals are surprisingly similar. Very few of them want extreme makeovers. Most want just to look refreshed. They emphatically do not want their friends to start whispering when they enter a room. Unfortunately, some of them have already suffered esthetic mistakes elsewhere. Inexperienced or overly aggressive surgeons often pull the skin too hard, or too far. They perform liposuction on women in their 40s and 50s, when their skin lacks the elasticity to adapt without puckering. Or they pander to patients by placing breast implants over the chest muscle instead of inserting them from underneath. The technique reduces scarring but can result in a dreaded "double bubble"--a breast and an implant lodged in two different spots on the chest.

Surgery will never make you look young, but it can help you look better. If you can't recapture your 25-year-old self, what can you get? And how can you improve your chances of finding it?

The first step is to find a surgeon who is certified by the American Board of Plastic Surgery. But getting the look you want is not as simple as checking a surgeon's license. You need to understand the person's values and techniques. So talk to friends who have had surgery. Look at their faces to see if they really look better. Gather recommendations, then make appointments to visit three or four surgeons--and show up with a list of questions in hand. Which celebrities look good to you, and which ones don't? What methods will you use? Who will do the anesthesia? What exactly will I look like? Sometimes a patient will say to me, "If you could do anything to my face, what would you do?" They may not share all my preferences, but they always get a sense of how I see things.

One thing you shouldn't rely on is a collection of before-and-after photographs. Surgeons love to share them, but it's often hard to distinguish surgical enhancement from digital enhancement. When you find a surgeon you're comfortable with, ask to meet some of his or her other patients. There is no substitute for seeing someone in person.

Finally, be realistic. Don't expect to lose 20 years off your face. Lift your forehead gently. Then pull back the skin from your cheekbones, gently. Then smooth out that little lump under your chin. That is what a face-lift will do. You want to make your breasts larger? Go to a small C, and make sure your surgeon knows what that is. Don't leave any doubt about what size you'll be when you wake up. That happened to a woman I know, and she was devastated. Her new breasts were so big they embarrassed her.

I'm more conservative than some surgeons. I figure that I can always go back and do more. Unfortunately, no one can go back and do less.

Lorenc is a clinical professor of plastic surgery at the NYU Medical School. Hall is an editor at The New York Times. Their book, "A Little Work: Behind the Doors of a Park Avenue Plastic Surgeon," was published by St. Martin's in October.