Plastic Surgeon Lists Six Procedures She Would Never Undergo

Beverly Hills plastic surgeon Dr. Sheila Nazarian has spoken out about six aesthetic procedures she would never undergo herself. She warns that the little-known risks behind these popular surgeries are often horrifying. As a board-certified specialist in facial, breast, and body work, her career has taught her one hard truth: just because an operation is possible does not mean it is the right choice for a patient.

When weighing any surgical intervention, she looks at four specific factors. She asks herself if the results are predictable and reversible. She considers potential complications. She evaluates how long the outcomes will last. And finally, she decides whether she would recommend the procedure to someone in her own family.

Here is her ranking of six procedures she rarely or never suggests, starting with those she might consider for select patients down to the one she avoids entirely.

Cheek implants sit at the top of this list as something she may occasionally consider. In this operation, solid devices are placed over the cheekbones to permanently increase projection and contour. These can create beautiful results in the right candidates, so she does not consider them a 'bad' procedure on their own merits. Her worry lies with the aftereffects. Facial aging will continue its course while the implant remains a fixed size and shape for many years. This mismatch can result in a very unnatural appearance. Implants can also shift, become visible, or even get infected, demanding revision or removal. Today, doctors have other ways to restore facial volume that allow more nuance and individualized treatment. She generally prefers an approach that lets the surgeon sculpt the face rather than committing every patient to a permanent implant.

Chin implants are next on her list of reservations. For properly selected patients with a recessed, under-projected or 'weak' chin, they can be a great solution. However, they are not the answer to every case. The surgeon must determine why the chin appears deficient. Is it purely aesthetic or is there a medical issue that needs addressing? Some patients have a skeletal or bite issue that an implant cannot correct because an implant rests on the outer surface of the lower jaw. Depending on the anatomy and desired degree of correction, the patient may require invasive surgery that cuts and repositions the actual jawbone. Potential chin implant issues include malposition, asymmetry, infection, numbness, and over time, pressure-related changes to the underlying bone if the implant settles in the wrong spot.

Lip implants come third. These are permanent synthetic devices inserted through the lip to create lasting volume. The word 'permanent' may sound attractive, but lips are dynamic structures that move constantly when we speak, smile, eat and kiss. A permanent implant can sometimes feel too firm, become palpable, migrate, get infected or simply look unnatural as the face changes with age. If a patient dislikes the size or shape of their lips, correction requires another procedure. She much prefers creating subtle lip enhancement with temporary hyaluronic acid filler because it can be adjusted over time and, importantly, can often be dissolved if necessary.

Buttock implants sit lower on her list of concerns. Unlike breast implants, solid silicone buttock implants are positioned in an area subjected to significant pressure and muscular forces from sitting, walking and exercising. Recovery can be very difficult because patients cannot simply stop using their gluteal region during everyday life.

Complications from these procedures can include wound separation where stitched incisions reopen, infection, fluid collection, implant malposition, and the need for revision surgery. When patients seek gluteal enhancement, I would rather evaluate whether a safer, anatomically appropriate alternative exists before placing a large permanent implant in an area exposed to so much mechanical stress from surgical fat transfer or good old-fashioned exercise.

Transumbilical breast augmentation places implants through an incision hidden inside the belly button and advances them through a tunnel up to the breasts. Typically, empty saline implants are inserted into the body first and then filled with salt water, as opposed to silicone gel implants which arrive from the manufacturer already filled to a fixed volume. The obvious selling point is no incision on the breast itself, but I do not believe hiding a small scar justifies sacrificing surgical control. This technique limits a surgeon's ability to visualize placement of the implant during the operation. For me, breast augmentation is about precision: controlling the pocket, position, symmetry and the implant relationship to the patient's anatomy. I prefer an incision that gives direct access and maximum control rather than choosing a technique simply because the incision sounds more appealing.

Injectable silicone belongs in a completely different category from an FDA-approved silicone breast implant. In this procedure, silicone is injected directly into tissues to enlarge areas such as the buttocks, breasts, face or lips. I would never recommend cosmetic free-silicone injections. Silicone can migrate from where it was injected and trigger chronic inflammation, granulomas, tissue destruction, infection and other serious complications that may appear years later. Once injected, it can be extraordinarily difficult, or impossible, to remove completely because it becomes incorporated throughout the tissues. Some complications require multiple operations and can cause permanent deformity. For me, the risk-benefit equation simply does not make sense.

The common thread is that aesthetic medicine should never be about doing a procedure simply because it exists or because it is trending. My job as a plastic surgeon is as much to operate as it is to know when to say no. The best procedure is the one that gives the individual patient the safest, most predictable, most natural-looking result, with risks that are justified by the potential benefit.