Safety and beauty go together

Undergoing plastic surgery is a unique decision. What makes one feel beautiful might vary from person to person.

Although body satisfaction is truly individual, everyone deserves a plastic surgeon who understands your intentions and also puts your safety first.

Board-certified plastic surgeon and host of the podcast “The Holistic Plastic Surgery Show,” Dr. Anthony Youn, MD, considers his work as enhancements and not answers to deeper issues. “[If they think a facelift will make them happy], then I stop them there because really you can enhance your life with these types of changes, but you can’t take a life that is unhappy and make it happy by getting a cosmetic procedure.”

That’s why he always suggests getting a second opinion from another plastic surgeon before getting cosmetic surgery done.

“You’re dealing with invasive procedures and just because [a doctor will perform a surgery] doesn’t mean it’s safe,” he points out. And Youn does have a point.

Evidence of malpractice in this field is often a result of an individual doctor who’s either negligent, doesn’t inform their patients properly, or fails to diagnose an injury.

So how do you know a doctor is right for you?

Fact is, search hard enough and anyone can find a doctor who’s willing to do the most skeptical or difficult of surgeries. What you should look for is a doctor who’s willing to say no.

Youn believes in having his own do-not-do list, which he calls his Beauty Blacklist. Here are 13 procedures he cautions against:

While tummy tucks are one of the most common operations performed, Youn says many doctors will claim that they have a new or “better” version, or create a ‘branded’ tummy tuck. (Tummy tucks do continue to evolve in ways to reduce complications and hide scars, but this isn’t a “new” procedure.)

Some doctors may make up variations of a tummy tuck, particularly those that include liposuction, which Youn says many surgeons abandoned years ago. “If you look up these branded tummy tucks in a scientific journal, there’s nothing on them,” he adds.

“There are standard ways of doing many of these procedures. [And] there are doctors who try to separate themselves by making variations of operations that aren’t necessarily better,” says Youn. “But if the patient doesn’t have anything unusual, I’m not going to tell you that I’m going to do this very different than the doctor down the street from me.”

During this procedure, fat from the inside of the mouth is removed to reduce the fullness of the cheeks. While Youn has been performing this procedure for about 15 years, he says he’s seen it recently become trendy on social media with influencers and other surgeons.

As a result, many doctors perform it on people whose faces are already thin.

Dr. David Shafer, board-certified plastic surgeon in New York City, agrees. When cheek fat removal is performed by an experienced surgeon on the right candidate, the procedure is not dangerous, and can have effective results.

However, “if someone is already thin in that area, it will give them a hollow look,” Shafer tells Healthline.

Removing fat in the cheeks is often a premature decision, given that as we age, we may lose the fat naturally and wish our cheeks were full again.

Thread lifts were a popular procedure between 2005 and 2010, and are now making a comeback.

The point of thread lifts is to insert temporary sutures to subtly “lift up” skin. Youn says the skin may look better right after the procedure but the effects only last about a year.

“We realized that they didn’t work [because patients] would have these permanent sutures sticking out of their skin years later,” Youn says. “Unfortunately, they’re back. At least the sutures today aren’t permanent so you don’t have to pull them out of people’s faces, but there is still the question of whether the procedure will last.”

Shafer agrees, noting that people often think thread lifts can create similar results as a surgical facelift.

“There is a lot of confusion because there is the word lift in it,” Shafer says. “But you’re putting a barbed thread underneath the skin, which will pull and give you a little bit of a lift, but it’s very temporary. When you do a facelift, you are lifting up all the skin and moving it as a unit.”

Still, Shafer says thread lifts do have a place.

“We offer them for someone who has a big event in the next few days and wants more definition to their jaw line, so we might put in a few threads to get them that, but this is not for someone who has been saving up for years and thinks it will be equivalent to a facelift with less down time and less risk,” says Shafer.

After Botox, Youn says filler injections are the second most popular cosmetic procedure. When injected into the skin, fillers work by pumping up areas of the face, such as the lips or those with wrinkles.

However, fillers are made of different substances, and Youn suggests only using ones that contain hyaluronic acid, such as Juvéderm and Restylane.

“These are [the] safest fillers because we have an antidote to them, so we can inject a substance that can melt [the filler] away if you don’t like it,” Youn points out.

If a filler that can’t be reversed is accidentally injected into a blood vessel, people can get permanent scarring or lose parts of their nose or lips.

Shafer notes that because the body naturally makes hyaluronic acid, the chance of compatibility issues or reactions to hyaluronic acid fillers is low.

“Permanent fillers are risky too because you can’t go back,” adds Shafer.

Youn avoids lip implants because he says they look stiff and unnatural, and don’t move like a natural lip.

“The only thing that looks natural in a person’s lips is their own fat. A good procedure should pass the kiss test, where when kissed, your lips feel like lips — not a spare tire,” he says.

Shafer says a lip implant can cause a skin reaction around the lips because it’s a foreign object.

Both doctors agree that fillers are a better choice.

“We start out with plump lips and as we age, we get dehydrated, so we can use filler to fill up the lips for a natural look,” explains Shafer.

Youn says the Brazilian Butt Lift (BBL) is one of the fastest growing operations because of celebrities like Kim Kardashian.

“The problem is that this operation has the highest mortality rate of any cosmetic surgery by far,” Youn says. “There was a study that showed that the mortality rate could be upwards of 1 in 3,000 when performed by a board-certified plastic surgeon, and that doesn’t include doctors who aren’t plastic surgeons who are performing this.”

For perspective, he says mortality rates for other cosmetic surgeries is 1 in 50,000 to 1 in 100,000.

The cause of death from the surgery is most often from fat emboli, which occurs when the fat that’s injected into the buttock is accidently injected too deep and close to the large veins in the buttock.

“The fat will go through those veins and clog up the vessels around the lungs,” Youn explains.

Shafer acknowledges that the surgery is high risk, but also says the BBL can be safe if performed by a qualified plastic surgeon on the right candidate. He also points out that BBL is a better alternative than a butt implant.

Youn says butt implants have a high risk of infection and that they can move around and become displaced.

Shafer agrees. “I tell patients to think about having a thick wallet in your back pocket and sitting on it,” he said. “Then imagine having two and they shift around. That’s not comfortable.”

This surgery requires swallowing balloons filled with saline solution. The intention is that the balloons take up space in your stomach, making you feel full and less hungry.

“There are reports of [the balloons] eroding through the stomach in some patients,” Youn says.

Shafer adds that the only way to remove the balloons is by having an endoscopy, a procedure that involves inserting a long, flexible tube with a camera on the end, into your mouth.

Mesotherapy is the injection of substances into fat to melt the fat. The FDA approved a version of mesotherapy called Kybella, which is used to reduce double chin fat.

Both doctors agree that Kybella is safe when used for the chin. Youn emphasizes Kybella should only be used for this purpose.

“There are doctors who cook up their own concoction which can have multiple substances in it and they might inject into different parts of the body to melt the fat away. There’s no standardization to it. So whatever the doctor decides to put into their concoction that day, they may inject into you,” he explains.

“I have seen infections, scarring, [and] weeping wounds from this.”

While hydroquinone is used to lighten age spots and sun spots, research has shown that it can cause cancer in laboratory animals. However, there’s currently no evidence it can cause cancer in humans.

“I don’t say never use it, but recommend using it very sparingly,” says Youn.

Shafer notes that better alternatives exist, such as Lytera and Dermal Repair Cream. “These have skin lightening and brightening properties without the harmful chemicals in them so there’s no need to use hydroquinone anymore.”

Injectable skin lightening products containing various ingredients are available, but the Food and Drug Administration (FDA) do not recommend them. There is not enough evidence that they work, and there may be health risks.

During this operation, excess skin is cut out by lifting the nipple up so it doesn’t appear to be dropping. This leaves a scar around the areola only.

“I think many women get duped thinking they’ll only have a scar around the areola, and initially, this is true, but a few months later because there was so much tension around the areola, things start stretching and the areola ends up looking super wide,” Youn explains.

Shafer points out that this procedure also gives the breast a flattening appearance instead of lifting it up.

“To do a lift or reduction, you [want to] do a traditional vertical, or vertical and horizontal lift, as well as the incision around the areola to hold the tension properly,” he says.

There are different types of breast implants. Textured and smooth implants are the main categories. However, textured breast implants, which are covered by a grained outer shell, have been recently linked by the FDA to anaplastic large-cell lymphoma, a rare form of cancer.

They were used because they were believed to move less than smooth breast implants. Further research is currently being conducted on the link between cancer and textured implants.

For the sake of caution, both Shafer and Youn no longer use these and only use soft implants instead.

Some doctors believe that inserting stem cells into breast cancer survivors who’ve had a mastectomy could help recreate the breasts. This is based on the science that stem cells can turn into a cell for that body part.

“The problem is there are doctors who are advertising breast enhancements using stem cells and people think, ‘Oh that’s great because it’s my own tissues,’ but it’s never been truly studied or proven to be safe, and you’re dealing with an organ that is a leading cause of death for women,” warns Youn.

Shafer tells us breast implants give a surer result.

“When you put a 300 cc implant in each breast, you know that 10 years from now there will still be 300 ccs of augmentation, but when you put 300 cc of fat or stem cells, you don’t know how many of those cells will survive, so you could have one side with more than the other and now you have asymmetry,” he said.

Implants also remain the same size whether a woman gains or loses weight, he adds.

Behind every intent is a philosophy, and when it comes to cosmetic procedures, making sure the doctor’s philosophy aligns with yours is equally important.

Asking your doctor about their blacklist could be one way of doing this. For example, if one doctor will do anything without hesitation or questions, it’s also fair to wonder what else they’ll do without double checking.

So just as Youn screens his patients, it’s also a good idea to ask yourself why a particular surgery feels important or of interest to you.

“I look at why someone is considering going under and possibly putting their life on the line,” Youn says. Before moving forward with the surgery, he suggests figuring out if the procedure is truly right for them or if they’re being coerced by an outside perspective.

Getting a second opinion doesn’t just mean talking to another surgeon. It can mean talking to another therapist, a professional, or even a friend who has your best interest at heart.

Cathy Cassata is a freelance writer who specializes in stories around health, mental health, and human behavior. She has a knack for writing with emotion and connecting with readers in an insightful and engaging way. Read more of her work here.