New US drama outrages plastic surgeons

Imagine that you are a hotshot Miami plastic surgeon and you've just had an unfortunate—well, fatal—incident performing liposuction on a South American drug dealer who paid you cash upfront. Why the disaster? You were dumb enough to let the guy's brother into the operating room (for even more cash), where he went berserk. Would you dump the corpse into a Florida swamp? Furthermore, would you know enough to tie hams to the victim, because alligators love pork?

Consider that you refuse to do free work on a kid who needs skin grafts for burns. Or that your partner picks up a gorgeous woman in a bar, has throbbing sex with her, and then persuades her in the clear light of morning that she needs work on her forehead, her eyelids, her cheekbones, her breasts, and her tummy.

No wonder America's plastic surgeons are annoyed. These scenarios come straight from Nip/Tuck, a new US television programme featuring two plastic surgeon partners that was first broadcast on the FX cable channel last week. The programme was developed by Ryan Murphy, who interviewed a plastic surgeon as a newspaper reporter and was surprised to find that the doctor suggested plastic improvements for him.

One of the show's characters is a sleazy charmer and a terrific salesman; the other is slightly less sleazy and a more talented surgeon (he knows when his partner put the buttock implant in upside down). They work in Miami, a centre of plastic surgery for an elderly population and stylish young people and also a city connected to Latin American crime. One reviewer headlined the programme “Miami Slice.”

US broadcasters try out episodes of new TV series during the summer to gauge viewer response and decide whether the series will run in the autumn. Nip/Tuck attracted 3.7 million viewers and is the top-rated new series premiere.

Its debut on 22 July came at a bad time for the image of US medicine. Less than a week later (27 July) the widely watched investigative programme 60 Minutes described a problem at Tenet Healthcare systems in Redding, California, where a cardiologist is said to have recommended unneeded coronary bypass surgery, bringing income to the hospital and misery to patients.

The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery which represent most board-certified plastic surgeons in the US, both posted press releases on their websites condemning Nip/Tuck. However, the groups didn't want too much publicity, on the grounds that it would only attract more viewers to a show that they feel does not represent the way plastic surgeons work.

Dr James Wells, president of the American Society of Plastic Surgeons, told me that the programme “reached to the bottom of the barrel. It was salacious, done grotesquely. It gave little consideration to tissue care. It was speeded up, slapdash... slambang, the worst example of stereotyping.”

He said that about 11% of the group's members did only cosmetic surgery and about 8% did only reconstructive surgery. The rest did a mixture. His own practice in Long Beach, California, was about 60% cosmetic surgery, 40% reconstructive surgery, he said, and he and many plastic surgeons did work for free in the community and in overseas missions.

Dr Robert Bernard, president of the American Society for Aesthetic Plastic Surgery (ASAPS), who does cosmetic surgery and reconstruction after mastectomy, said, “Doctors educate patients. They disabuse patients of unrealistic expectations. The programme sends a subliminal message that plastic surgery is harmful... Most patients are happy with their outcomes.” He added that doing work for free was part of the norm.

Plastic surgery is a growth industry in the United States, as ageing baby boomers try to remain youthful, or at least youthful looking. Figures from ASAPS show that cosmetic procedures have increased 228% since 1997. There were nearly 6.9 million cosmetic surgical and non-surgical procedures in the US last year. Botox injection was the most popular, with more than 1.6 million procedures last year, up an astonishing 2400% since 1997. The leading surgical procedure is liposuction.

Nip/Tuck is not the only US programme to play upon Americans' drive for self improvement and ageing baby boomers' attempts to stave off physical decline. There is also a show called Extreme Makeover, which turns mousy nobodies into sexy beauties. It usually involves bigger boobs and a nose job.

It seems that plastic surgeons are an easy target. A medical journalist colleague told me that plastic surgeons were the only doctors who “walk the edge.” How many doctors have their own press agents and send out their own press releases, she asked—only some plastic surgeons, plus a few dermatologists and a few cosmetic dentists. I and other medical journalists often get press releases from doctors who do cosmetic improvement, while news about other doctors comes from their academic institutions or their papers in a medical journal.

Nip/Tuck was promoted in a full page, four colour advertisement in newspapers showing a woman's eye peeking through surgical wraps, with stitches—not eyeshadow or eyeliner—above and below the eye. The headline said, “Truth is only skin deep.”

Maybe we should look further.