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Heidi Montag part 2

March 9, 2010
So, Ms. Montag's surgical escapades bring up interesting questions for doctors and patients. Her plastic surgeon went on TV after the negative media stories started coming out in force and said that people get multiple plastic surgeries at once all the time and this is nothing extraordinary. I agree with that. He also said that she had a rational understanding of what she wanted him to do and that she felt that these procedures would help her career. He characterized it as a business decision on her part. He said that he did extensive psychological testing on her and she does not have body dysmorphic disorder or an addiction to plastic surgery. Anyway, these are all elective procedures and people do it because they want to, not because they have to.

I do have a bit of a problem with this line of reasoning.

He is absolving the surgeon of responsibility in the plastic surgery decision making process. As long as the patient is not floridly crazy, the plastic surgeon is ethically OK to do anything the patient wants and can afford. Plastic surgeons and all aesthetic physicians are already walking on the edge between doctor and luxury salesman. If we are just technicians providing a specialized service to any who are willing to pay (assuming they are not foaming at the mouth lunatics), then we should be willing to abandon the title of physician.

And that is fine for those willing to do that.

The consequences of that kind of attitude would, of course, be disastrous for public relations. Plastic surgeons are already seen as remorseless vultures preying on the insecurities of their patients.

As an aesthetic physician, I can sleep with an unwrinkled brow only if I feel that I am in no way harming my patients. I realize that I am not saving lives, relieving pain (except for migraines and teeth grinding - to be precise) or bringing new lives into this world. But if I am helping people feel good about themselves in small ways without significant risk, I am happy with what I do.

And this is what is missing in Dr. Ryan's argument. It's not that he did 10 procedures at once. It's that he did them on a 23 year old girl who is under the delusion that these procedures will make her a star. Everything we do in medicine involves a risk to benefit calculation. Life threatening cancer warrants the considerable risk of a 10 hour surgery. This clearly does not. Aside from the anesthesia risk of a lengthly operation, doing these procedures so early exposes her to complications many years later as her features change with time. For example, doing a second rhinoplasty for what this surgeon admits to be a very minor cosmetic defect means that the tissues of her nose are much more scarred than before. Scar tissue behaves unpredictably over time. As she ages, her nose will probably start to look more and more bizarre as the scar tissue deforms the natural aging changes of her tissues. As her skin thins with time (and I mean when she is 40, not 70), the scar tissue will become more visible and the contours of her nose will become more asymmetric and irregular. I see this in my clinic on a daily basis. Sometimes I can help by filling in the irregularities, and sometimes I can't.

to be continued

2 thoughts on “Heidi Montag part 2”

  1. Jules says:

    I googled you after watching a video of you on the Tyra Banks show. Speaking of celebrity plastic surgeries..one of the most talked about in the tabloids lately is Megan Fox. Since they are only speculations, what do you think she has had done? After seeing her before and after photos, it’s undeniable that she has something done. Personally, I think she looks great before and after, but I think her nose now fits her face better. If Megan Fox came to you, could the 15min nose job tweek her nose to give her the same “after” results?

    What are your thoughts on her after “work”?

    1. Dr. Rivkin says:

      Well, I am asked about celebrities often, but I really hate to comment on that kind of stuff. My consultation process is very individual, i.e. if Ms. Fox came in and asked me to do this or that with her nose, I would have to evaluate her specifically in light of what she would like to accomplish. I can’t see anything wrong with any part of her – she is absolutely stunning, so I can’t imagine her wanting to do anything. I have not looked at pictures of her from the past, so I don’t really know how her nose has changed.

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