Nip, Tuck Boom: Cosmetic Surgeries Up 32 Percent in U.S.

Elkwood's practice specializes in both cosmetic and reconstructive surgery.

With the new crop of TV shows, it is particularly difficult to blend the entertainment goals with the needs of the patient and surgeon, said James Wells, a Long Beach, California-based plastic surgeon and former president of the ASPS.

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"The ASPS doesn't endorse The Swan or I Want A Famous Face, because patients are chosen for their story and entertainment value, and not because they are necessarily the best candidates for surgery," Wells said. "These shows are in very bad taste. They really tread on the insecurities of the patient."

ASPS green-lighted member participation in Extreme Makeover, in part because surgeons had the final say in patient choice, and because the TV program gave a more realistic impression of the plastic surgery process—from initial consultation to surgery to follow-up.

Coming Out Parties

Another problem, according to Wells, is that although many procedures can be performed in a single session, such operations require a strong, coordinated team of surgeons, anesthesiologists, and a conscientious recovery team. And multiple procedures won't work for everyone.

People have perhaps always been impatient about cosmetic surgery—they tend to want the results instantly and believe they can recover in a very short time. "The reality shows are probably reinforcing this misconception," Fleming said.

Nationwide, women accounted for 82 percent of cosmetic surgery procedures. But in places like Los Angeles, the ratio is a little more even. Fleming says that his practice receives roughly equal numbers of men and women seeking various procedures.

The patients tend to fall into distinct groups. Teenagers typically seek alterations of congenital "abnormalities" such as big noses and ears.

Middle-aged men and women are generally interested in body procedures such as liposuction, tummy tucks, and buttock and breast lifts.

For women, many of the procedures are related to childbirth. Then there are the baby boomers seeking rejuvenation—eye- and face-lifts.

Perhaps the greatest change triggered by reality TV is that these shows have removed the negative stigma from plastic surgery—the field itself has been given a face-lift. It used to be that women would only undergo and recover from their cosmetic operations in secret. Now both men and women enjoy coming out parties to celebrate their new look.

On TV: Beyond Plastic Surgery airs on the National Geographic Channel Wednesday, April 21, at 9 p.m. ET/PT in the United States. Also on TV: Body Perfect airs Wednesday, April 21, at 10 p.m. ET/PT. Both are available only on the National Geographic Channel.