Top ten plastic surgery procedures to avoid in 2009

I am a plastic surgeon and as such benefit very much from the recent “craze” of plastic surgery both in celebrities and the general public. There are a number of procedures that have an excellent track record of safety, effectiveness, and patient satisfaction. In my opinion procedures like breast augmentationabdominoplastyface lift,blepharoplasty, and liposuction would fit into this criteria.

I think there are other procedures that are being done on a routine basis that are in principle at the least silly and possibly even dangerous. Mind you, these are not procedures that I perform. Of course, my negative comments regarding these procedures are not because I do not do these procedures. I do not do these procedures because I feel they are either dangerous, not effective, or a better alternative is out there. This is my current top ten list:

1. Lipodissolve and mesotherapy –See my previous post
2. Buttock augmentation – I am not talking about correcting irregularities with fat grafts. I am talking about implants used to add buttock fullness. High risk of infection and implant complications. I think the fad will end quicker than the pain from sitting on implants.
3. Permanent Fillers – Never, ever let anyone inject silicone into your face. Temporary fillers (Radiesse, Restylane …) or natural fat injection is O.K.
4. Injection for Breast Augmentation – Injection of soft tissue fillers to increase the breast volume. The procedure is expensive and only lasts several months. Risks include breast lumps that can be difficult to rule out breast cancer.
5. Transumbilical breast augmentation – The scar for breast augmentation is almost never an issue after surgery. The scar aroundthe belly button is visible in a bra or bikini. The revision rate is very high and the implants tend to sit too wide and move unnaturally with exercise. If a revision is required, a much longer incision on the breast is needed. In my opinion, this is marketing hype and has no place in breast augmentation.
6. Cosmetic Leg Lengthening Surgery – The bones in the leg are broken and lengthened over time. I actually do not know of anyone who does this procedure but it must be done somewhere.
7. Pectoral implants – Similar to buttock implants.
8. Laser lipo or smartlipo – In my opinion, no advantage to tumescent liposuction. Disadvantages are the cost of the technology and the generally poorly trained physicians currently using this technology. See my previous post. My opinion may change in the future if studies can demonstrate improved safety, efficacy or both as compared to traditional techniques. I doubt they will.
9. Phenol peels – Very deep chemical peel that can make a patient look like a pale burn victim. There are much better alternatives including laser therapy and moderate peels such as TCA peels.
10. Physicians without proper training – This is truly most important. Pick a board certified plastic surgeon and you are on the right step. To become board certified by the American Board of Plastic Surgery, a plastic surgeon must first complete intensive training in an accredited training program. Thereafter, the surgeon must pass rigorous written and oral examinations given by the board. The American Board of Plastic Surgery is one of only 24 accredited specialty boards recognized by the American Board of Medical Specialties (ABMS) and is the only board recognized by the ABMS to certify a surgeon in plastic surgery. There are a number of other boarding organizations that include “facial”, “aesthetic” or “cosmetic” in the title. These are not recognized by the ABMS and do not have the same training requirements.

To verify a physician’s board status, contact the American Board of Plastic Surgery at  (215) 587-9322. You may also contact the American Board of Medical Specialties at  1(800) 776-2378 or

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