Plastic Surgery Interactive Resource

My Problem With Extreme Makeover

By John Di Saia, M.D.

This piece was originally written for the local press. It was published in
Beach Cities Style in the July 2004 issue. It may be
helpful for those trying to assess reality versus hype in cosmetic surgery.

What could a plastic surgeon possibly have against "Extreme Makeover?" After all, the show has certainly increased the awareness of the average American to cosmetic surgery in general. Doesn’t this translate into more business? The surgeons on the show have very likely enjoyed some degree of market advantage from their involvement. Isn’t this true for cosmetic surgery in general?

If the show didn’t seem to affect the average patient coming into my office for cosmetic surgery, I wouldn’t have a problem. I notice in my patients that have seen the show however, impressions that confound successful encounters with cosmetic surgery. These impressions revolve around the concept of "unrealistic expectations."

In training plastic surgery residents in cosmetic surgery, one of our prime points of instruction is the development of "realistic expectations." Too much hype runs at odds with this basic concept. "Extreme Makeover" viewers often require debriefing at consultation and pre-op appointments to "bring them back to earth."

Looking at the "Extreme Makeover" show, we see featured plastic surgeons working alongside makeup artists, wardrobe consultants and cosmetic dentists. Show participants receive services from all of these individuals free of charge. In the "real world," there are few patients that come to the office with such unlimited funds as to allow the involvement of all these specialists. The results achieved in a procedure without the added improvements from such ancillary personnel may not be as striking as those seen on the show. Indeed the appearance of problem areas in a surgical result may be camouflaged by changes in makeup or clothing. Patients expecting an "Extreme Makeover" type outcome in a regular private plastic surgeon’s practice are setup in this regard to be unhappy. No smart surgeon wants an unhappy patient. Targeting the patient’s expectation toward improvement and more often than not providing much better have worked well in my practice.

An additional sore point has been seen in the patient desiring multiple procedures in one operation. Some participants in the "Extreme Makeover" show have had three or more large scale procedures in one operation. Some "Extreme Makeover" viewers expect that anything they may want addressed can occur during one operation. There is a point at which a patient can receive too much surgery. In the late 90’s, a plastic surgeon in Irvine came "face to face" with this concept when a patient after such an operation had a disastrous outcome. Most responsible plastic surgeons in private practice split up long procedure lists into a number of shorter operations to optimize patient safety.

So do I watch "Extreme Makeover?" No. That would be like a plumber watching a television show hyping plumbing. I view it as entertainment that has occasional aspects applicable to the cosmetic surgery experience. In that light, the show’s producers have done a good job in producing a topical entertaining television experience. As long as the average patient doesn’t look at the show as more of a documentary, we are OK.

John Di Saia MD is a board certified plastic and cosmetic surgeon practicing in San Clemente. He can be contacted via his office (949) 369-5932 or his web site


Note: This piece is written for the general information of those seeking Plastic Surgery. It is presented freely in this format for this purpose. No other rights are granted. It has as a matter of fact already been printed in the July 2004 issue of Beach Cities Style. It may not be duplicated, cited or otherwise copied in any form without the written consent of the author and magazine.