Heidi Montag: Sometimes you just have to say “No”

Much has been written recently about Heidi Montag and her “10 plastic surgery procedures in one day.”  I would like to give my thoughts about the many issues that pertain to this “story.”

First, let me dispel the myth that ten plastic surgery procedures cannot be performed in one operation. While I will admit that this is a lot, you must keep in mind the complexity of each procedure. 

From what I understand, her procedures included things like a revision of her nasal tip, fat injections to her cheeks, breast implant exchange, liposuction, etc.  These may seem like complicated procedures to the general public, but as a board certified plastic surgeon I know that these are relatively small, quick procedures.  Each procedures carries minimal anesthetic risk or risk of major port-operative complications – especially when performed on a young and healthy person.  While the media likes to focus on the seemingly large number of procedures, the complexity of each and the required anesthetic time is most important.

To give an example, facial rejuvenation surgery in my practice often includes a facelift, necklift, upper blepharoplasty, lower blepharoplasty, browlift, and chemical peel.  This is common combination of six procedures performed widely by qualified plastic surgeons.  The actual operating time of all these procedures may be less than performing one breast reconstruction.

The point is that the most important thing is the total length of the surgery, not the number of procedures. I have no personal knowledge about how long Heidi’s surgery lasted, and if it was an exceedingly long surgery (in excess of 6 hours), than one may argue that it was “too much” – but the fact that ten procedures were done should not be the sole reason for the uproar.

Many people also point out that Heidi is only 23 years old.  Her young age and good health make her a good surgical candidate for an elective surgery (or ten). She has an extremely low risk of complications.  Also the fact that she is so young does not place her at risk for future complications. Yes, as she ages, it is likely that some of her surgery will need to be redone as her body changes. Her surgeries only affect her appearance, not the function of her body or her overall health.

The real issue is whether or not these surgeries should have been performed at all.  The fact that she desires such radical changes in her appearance at such a young age does raise suspicion about her mental state. Body Dysmorphic Disorder (BDD) is a serious condition that involves a person’s intense dislike of the appearance of his or her own body.  In order to truly have BDD, the person must have the perception of a problem, in the absence of a real problem.

For example, if someone has a crooked nose with a large hump, it is understandable that they may be unhappy with their nose and desire surgery.  However, if a person has no obvious deformity, yet they cannot stand they way the nose looks in the mirror and perceive a crooked, humped nose that is not there, then this is a sign of possible BDD.  Plastic surgeons are always on the lookout for these patients because these patients will never be satisfied with the outcome of a surgery, no matter how successful the operation.  They will always perceive a deformity.

I do not mean to imply that Heidi Montag suffers from BDD.  In fact, it is more likely that she simply has a strong idea about how she wants to appear and happens to have the resources and connections to make it a reality.

My personal opinion is that her surgery was a bit excessive in that it dramatically changed her appearance to the point where she looks like a different person. But, as a plastic surgeon that routinely performs cosmetic surgery, I understand that cosmetic surgery is a matter of taste.  It is our job to perform surgery in a safe and ethical manner, without imposing our own sense of taste on our patients.

Sometimes, though, a surgeon needs to say “no” and not be affected by fame or money. Fortunately for my sense of well-being (and unfortunately for my wallet), I say “no” very often in my practice.  I just seem to sleep better at night.

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