Extreme Plastic Surgery Makeover Show Panned in New Documentary

— Old show is "not an accurate representation" of plastic surgery today, expert says

Welcome to Culture Clinic, MedPage Today's collaboration with Northwell Health to offer a healthcare professional's take on the latest viral medical topics.

Two decades ago, makeover shows dominated reality TV, but one show took it further than the rest. Now, in a new documentary, "The Swan: Behind the Mirroropens in a new tab or window," former contestants and doctors are sounding the alarm about ethical issues bulldozed over for the sake of "good TV."

"The Swan" ran for two seasons on Fox, in 2004 and 2005. Female contestants with low self esteem who desired to drastically change their bodies were selected for a months-long "glow up" involving extensive plastic surgery, exercise, and life coaching.

After months of not being allowed to look at themselves in a mirror, the women saw their "new" faces and bodies in a dramatic reveal, and were subsequently pitted against each other in a beauty pageant.

Kelly Killeen, MD, a member of the American Society of Plastic Surgeons who practices in Beverly Hills, California, told MedPage Today that "The Swan" is not well regarded in the plastic surgery community.

"That's just not how plastic surgery should ever be ... it's demoralizing," Killeen said. "And to have it all broadcast on television is awful."

Plastic and oral surgeons performed as many cosmetic procedures as they could within the 10 hours the "swans" were under anesthesia. Most got veneers, breast augmentation, and liposuction. Some also got abdominoplasty, rhinoplasty, face lifts, eyelid surgery, and more.

Killeen noted that long surgeries carry increased risk of complications, so it's standard to break up multiple elective surgeries, especially if they will be on different areas of the body.

"Patients just don't heal well when you're operating all over somebody's body," she said.

On top of that, the contestants were put on calorie deficit diets, which Killeen cautioned is never appropriate during recovery.

While healing from surgery and dieting, these women also exercised for hours each day with trainers.

Lyle Leipziger, MD, chief of plastic surgery at Northwell Health's North Shore University Hospital in Manhasset, New York and Long Island Jewish Medical Center in New Hyde Park, New York, told MedPage Today that it's important not to physically overdo it following surgery. For most procedures, it's advised that patients abstain from exercise other than gentle walking for at least 6 weeks because of increased risk of elevated blood pressure, bleeding, and popped sutures.

"The idea is to never push the envelope, to make sure everyone heals at their own best rate, and that they're monitored carefully during that time," he said.

The documentary also raised concerns about the quality of post-operative care; several described changing each others' dressings and not knowing that their surgeries would require upkeep for life, which Killeen said reflects a lack of informed consent.

The experiences of the women varied, with some feeling extremely victimized by the show and revolted by the language surgeons and producers used to manipulate them into getting more work done, and to have the emotional outbursts at the core of reality TV. Others felt grateful to get so much plastic surgery done for free and for the lifelong friendships they gained with fellow contestants.

The two plastic surgeons on the show are Terry Dubrow, MD, and Randal Haworth, MD, who are both based in southern California. Dubrow, now best known for his work on the reality series "Botched," did not grant an interview for the documentary. Haworth did, however, and his flippant comments have been met with pushback.

For instance, Haworth told the interviewer that he sees the "The Swan" differently now than he did back then.

"I've become more empathetic because I have a dog," Haworth said.

Neither Dubrow nor Haworth responded to MedPage Today's questions.

In footage from the show, clinicians described the contestants' features as not "ideal" and needing to be "fixed" by plastic surgery. Killeen takes issue with this languageopens in a new tab or window and said that women with non-white ethnic backgrounds are most subjected to it.

"When women come in, I don't look at their whole body and go, 'what can I make better?' Because there's so many different types of beautiful," she said. "I think it's very dangerous when we start telling people they're not ideal."

She added that it's important not to call patients' features "difficult" even if a particular surgery is technically challenging to perform.

While hindsight is 20/20, Killeen said a lesson doctors can glean from "The Swan" is to remember that "patients are not promotional material."

Leipziger added that plastic surgery is now more mainstreamopens in a new tab or window and visible, so conversations between doctors and patients are all the more crucial.

"This show," he said, "is really not an accurate representation of responsible modern plastic surgery."