Did Heidi Montag's Plastic Surgery Go Too Far?

Deborah Kotz

Was reality TV star Heidi Montag's decision to have 10 cosmetic procedures in one day a sign, as some tabloids claim, of her low self-esteem and addiction to plastic surgery? Or was it a brilliant PR move to land her on the cover of People and launch her singing career?

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Perhaps, we'll never know, but she has certainly ignited a heated debate about whether, why, and how much women should elect to have themselves surgically altered for the sake of "beauty."

In an interview with ABC's Good Morning America, Montag's plastic surgeon, Frank Ryan, defended his decision to perform 10 hours of surgery on the 23-year-old. "I disagree that it's too much," he said. "Many of these were little tweaks." (See the interview with Montag and her surgeon.) The operations Ryan performed on Montag in November were a minilift of the brow, Botox in the forehead, nose job revision, fat injections in cheeks and lips, chin reduction, neck liposuction, ears pinned back, breast augmentation revision, liposuction on waist and thighs, and a buttocks augmentation. Notice the word revision after two of the procedures. Montag had a nose job and breast implants three years ago.

Plastic surgeon Richard Chaffoo, however, tells me that Montag's surgeries were excessive. As chief of plastic surgery at Scripps Memorial Hospital in Encinitas, Calif., he has had plenty of Los Angeles celebrities come to him for touch-ups. But he says he always looks for red flags—signs that a prospective patient has a psychological problem such as a fixation on invisible flaws (known as body dysmorphic disorder) creating the urge to make unnecessary changes.

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"I prefer to do the least amount of surgery needed to give someone a natural, nonenhanced appearance," Chaffoo says. "It's hard for me to believe that a 23-year-old would need so many procedures" since she hasn't yet experienced the ravages of pregnancy or aging. He says he also limits his surgeries to a maximum of four or five hours because being under a general anesthetic for longer increases the risk of rare but serious complications, including blood clots in the lungs.

"I'm in a different industry," Montag told GMA, saying she was expected to go under the knife to advance her aspirations to be a singing idol. (I guess she's not thinking of Barbra Streisand, who passed up a nose job to keep her voice intact.) Chaffoo says his alarm bells go off when a patient expects her surgery to create a certain look to help her land a reality show gig, get her a pay raise, or rejuvenate a personal relationship. "These are the wrong reasons because they're unrealistic," he explains. "Your marriage won't be saved because your cup size is a little larger."

Women with these expectations should go for counseling, Chaffoo says, not surgery. The right reasons to have a little work done? "If you have something that's been bothering you for a long time and have a realistic vision of how you'll look and feel after the surgery," he says. Many of Chaffoo's patients are looking for "mommy makeovers" like a tummy tuck or breast lift to reduce sagging after breast-feeding. Women in their late 40s and 50s may opt for facial rejuvenation (injection with fillers or Botox), a brow lift, or eyelid surgery to erase a few years.

If you're considering having plastic surgery -- not as much as Montag, I hope -- Chaffoo says it's crucial to use a board-certified plastic surgeon who will do the requisite psychological screening as well as medical screening to make sure you don't have any medical conditions that make surgery particularly risky. Rapper Kanye West's mother died two years ago after liposuction and a breast reduction, with her death attributed to pre-existing coronary artery disease. "She never should have been operated on," says Chaffoo. It's also important to go to an accredited hospital or surgical facility.

All in all, women need to realize that there's no such thing as minor surgery. "Every surgery has its risks, even if they're small, and every procedure has recuperation time," Chaffoo says. (Montag said she still hasn't completely recovered, and when asked to demonstrate her vocal abilities, she couldn't open her mouth fully to sing.) "If you sit down and explain the pros and cons, most patients will make the right decision," Chaffoo adds. "Plastic surgeons need to realize that knowing when to say no is just as important as their surgical skill."

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