by Maura Lynch
When Kate* arrived at the office — a light-filled, CB2-meets-clinical-chic space in midtown Manhattan — she had one thing on her mind: a crop top.
“I’m a pretty small person, but I’d always had these little pockets of fat on my stomach,” she says. So when a friend raved about a minimally invasive treatment designed to target so-called stubborn areas, she decided to give it a whirl as a birthday present to herself — a flatter belly and the confidence to bare her midriff with abandon. But the procedure left her covering up more than ever before. “Immediately after taking the bandage off, I noticed there was a problem,” says Kate. “There was this dent in a diagonal line across my stomach.”
Millions of people in the U.S. undergo a cosmetic procedure each year. In 2020, roughly 2.3 million plastic surgeries and 13.3 million minimally invasive, nonsurgical treatments, like Kate’s, were performed, according to data from the American Society of Plastic Surgeons.
Less common is Kate’s poor outcome. A 2018 retrospective published in Plastic and Reconstructive Surgery looked at over 26,000 outpatient plastic surgeries between 1995 and 2017, and found that complications occurred in less than 1 percent of cases. The most common issue? Hematomas, which are essentially very bad bruises. There still isn’t great data on minimally invasive treatments as a whole, which include injectables and lasers, but a 2013 review published in the Aesthetic Surgery Journal estimated that the incidence of severe complications after soft-tissue filler injections is .0001 percent, for example.
A Rise in Misleading Before and Afters
The 2022 procedure playbook, however, looks very different than it did 10 or even 5 years ago. And that’s making already complex cosmetic treatments more complicated for everyone involved, increasing the likelihood of disappointing results. “People used to come in with pictures of themselves when they were younger or a movie star’s [face],” says Melissa Doft, M.D., a plastic surgeon in New York City. Now, says Dr. Doft, they’re bringing in photos that have clearly been Facetuned, filtered, or otherwise edited. “But you can never really match that. Surgery is not Photoshop.”
Blurring the lines between beauty and reality has made it increasingly difficult for patients and providers to set expectations, an integral part of any consult, says Steven Williams, M.D., a plastic surgeon in Dublin, California. While that may not increase the likelihood of, say, an infected scar, it can result in a dissatisfied patient nonetheless. “Even the perfect surgery may not meet expectations,” says Dr. Williams, “and that can be a source of a lot of patient frustration and sadness.”
In some cases, though, it’s the providers who are living in an alternate aesthetic reality, skewing patient expectations. “I’ve had a lot of people come forward saying, ‘That’s me [on the provider’s social media], but that’s not what I look like,'” says Melinda Farina, a patient-safety advocate best
known by her Instagram handle @beautybrokerofficial. This is why she recommends a return to the old-school, leather-bound, before-and-after books at doctors’ offices for a lower-tech but more accurate depiction of their track record.