05/16/2010 05:12 am ET | Updated May 25, 2011

Oh, You Beautiful Doll: Plastic Surgery Risks and Rewards

"I looked at a Barbie doll when I was six and said, 'This is what I want to look like.'"

-- Cindy Jackson, 54. Holder of the Guinness Book of World Records for having more cosmetic procedures than anyone else in the world.

After 31 operations, 14 years and $100,000 (not adjusted for inflation), this patient may or may not look exactly like Barbie, but having had laser surgery, an upper eye procedure, two lower eye procedures, cheek implants, two nose jobs, four facelifts, a chin reduction, several chemical peels, plus tattooed eyebrows, eyeliner, lip liner and lipstick, what is certain is that she's taken a lot of unnecessary health risks.

Granted, hers is an extreme case of what has been called The Barbie Syndrome, but the alarming truth is that she's becoming less of an exception. The cover of People Magazine just this past January was about 23-year-old reality star Heidi Montag's 10 plastic surgery procedures in one sitting. I mean, how bad could she have looked before? You do that number of surgeries on burn victims, on crash victims or to save someone's life. Surgery is serious business and all surgery, no matter how minor, has risks.

Plastic surgery is clearly indicated for individuals with birth defects or to reconstruct tissues that have been removed for treatment of an underlying disease, like breast reconstruction following a mastectomy for breast cancer. And, let's be clear, I am not against plastic surgery for cosmetic enhancement. A person who doesn't like the look of his or her nose should consider a rhinoplasty. A woman whose breasts significantly deflate after childbirth may reasonably consider breast augmentation, just as a woman who is stooped over and has back pain from large breasts may appropriately seek a reduction mammoplasty.

However, harboring a severe dissatisfaction with one's body image that results in an insatiable appetite for multiple cosmetic surgeries to achieve perfection is labeled the Body Dysmorphic Disorder in the Diagnostic and Statistical Manual of Mental Disorders. Dr. Eileen Bradbury, a consultant psychologist at The Alexandra Hospital in England, treats cosmetic procedure addicts. She notes that people can become addicted to the anticipation, the excitement and the attention they receive, but the feelings are short-lived. The post-procedure high fades and the mundane problems of life return, leaving people with the need to come back for more procedures.

One could argue that such cosmetic surgery-seeking individuals are not harming anyone other than themselves, and if it makes them happy, why should we care? I would posit that in these cases, the plastic surgeons are doing the patients a disservice by treating the symptoms and not the deep-seated cause of their patient's unhappiness.

Short of having a psychiatric syndrome, many people seek to get a little "nip and tuck" here and there in order to increase their attractiveness, since some (but not all) studies, as well as the popular media, have supported the message that more attractive people make more money, get better service at restaurants, get better jobs, are considered more intelligent (which, I assume, is why men date supermodels), and get more successful mates. We say we abhor anorexia, but some of the biggest fashion models look too famished to make it to the end of the runway (more about eating disorders in a subsequent blog).

Thus, it should be no surprise to learn that in 2009, almost 10 million cosmetic surgical procedures were performed, consisting of nearly 1.5 million major procedures, such as breast augmentation, liposuction, eyelid surgery and rhinoplasty, and 8.5 million minimally invasive procedures like Botox and hyaluronic acid injections, microdermabrasion, chemical peels and laser hair removal. Americans spent close to $10.5 billion on cosmetic procedures in 2009.

But since our societal schizophrenia about what constitutes attractiveness is not going to be fixed here, if you're going to pursue elective, cosmetic surgery, to whatever degree, at least know about the risks. The most common include: infection, hematoma (a collection of blood), hemorrhaging (excessive bleeding), necrosis (tissue death), seroma (a collection of watery body fluids, which requires a drain to be inserted), nerve damage and scarring. Infection is rare but when it does occur, it can spread quickly. Anesthesia also carries its own particular risks. The outcome might not be what you expected either. You could end up with asymmetry, contour irregularities or localized paralysis. And the risks increase with multiple procedures.

Optimizing the success of any cosmetic surgery procedure is simple: become an informed patient. Check your surgeon's credentials. Ideally, he or she should be board certified by the American Board of Plastic Surgery. It's also important to verify that your doctor has privileges to perform surgery in a hospital, whether or not your procedure will be performed in one. And since many cosmetic surgery procedures are performed in a surgical center or a space other than a hospital, make sure the facility is accredited by the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) or the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). There should also be a registered nurse and an anesthesiologist present.

You can't overestimate the importance of the consultation with your surgeon. Ask lots of questions, and request that they have a former patient with a similar procedure call you so you can hear about the experience and outcomes from a person who has been through it. Be open about what you want, and also be willing to listen to your doctor's point of view. He or she may recommend a different procedure if it can achieve a similar result. Doing the smallest surgery to get the desired results, with the least possible risk, should be the goal. The risk-to-benefit ratio should be balanced. And, finally, try to have realistic expectations--it is unlikely that cosmetic enhancement is going to drastically change your life--after all, you are human, and not a plastic doll.