Ethics in Plastic Surgery: When Results Go Beyond What Exists in Nature

My friend group and I were having a genuinely interesting discussion recently about colleagues who do things way outside of normal. I want to talk about it, because it sits uncomfortably with me and I don't think we discuss it enough.

Let me be clear about my starting position. I completely recognize that most of what I do is elective surgery. We are making desired changes to people's bodies, whether cosmetic or reconstructive. And there is no right or wrong in what someone wants for their own body.

Some people want smaller noses. Some want larger ones. Larger lips. Larger breasts. Smaller breasts. There's an enormous amount of personal opinion and aesthetic preference in these choices, and that's completely legitimate. I'm not here to police anyone's taste.

But here's the thing: for the most part, all of that falls within the range of what you actually see in real human beings.

What about when it goes past that? What about:

• The extreme little upturned noses
• Gigantic BBLs, and I mean gigantic
• Gigantic implants
• Results that genuinely don't exist in nature

You do not see real people who naturally look that way. Not anywhere.

And yes, the patients are signing on for this and asking for it. I understand that. But the question that keeps nagging at me is: why are we doing it?

Here's what really bothers me about it, and it goes beyond any individual case.

Society already holds women to essentially unreachable beauty standards. Even the bodies that do occur naturally, the ones we're all supposedly striving for, are rare and difficult to achieve. We're already chasing something uncommon.

If the beauty standard evolves into something impossible to have without surgery, that's awful. It's already bad enough that so many of us don't feel good about our bodies.

And yes, I get the irony, I'm a plastic surgeon. I'm aware. But I can still think critically about this, because I'm also a woman subject to those same beauty standards, and because I have a little girl. I think about what she'll be measuring herself against.

When people question these surgeons on social media, the response is almost always some version of: "It's not about me, I'm helping her achieve her dreams." As though they're some kind of hero for it.

I'd put it differently:

Framing yourself as a selfless facilitator doesn't hold up when you're the one with the medical license, the training, and the ability to say no. The person who understands the risks is the one responsible for weighing them. That responsibility doesn't transfer to the patient just because they asked. It's the same reasoning behind surgeons who refuse to say no to stacked, dangerous procedures.

This isn't hypothetical. I have seen patients who did very, very extreme things and were very regretful later.

I'm sure some of them aren't. But I'd imagine a lot of them are. And here's the part that makes it so much worse: the damage done by these types of procedures is extremely difficult to fix.

This is not like a haircut you grow out. Tissue that's been massively over-expanded, over-resected, or repeatedly operated on doesn't simply return to baseline. In many cases we cannot put someone back the way they were, and being the surgeon on the other end of that is genuinely hard.

This is the part I feel most strongly about. In my opinion, many of these patients have mental health struggles, and those should be addressed before we do something permanent to their bodies.

A patient asking for something extreme deserves a real evaluation, not an enthusiastic yes. A good surgeon should be willing to tell you no when what you're asking for isn't in your interest, and should be honest with you about it rather than taking the booking.

I don't know what the solution is. I don't know who would step in and stop this. There isn't an obvious regulatory body for "this result doesn't exist in nature and probably shouldn't."

But here's where I land:

• What people want for their bodies is their business, and most of it is well within normal human variation.
• It becomes an ethical problem when we start manufacturing a beauty standard that is physically impossible without surgery.
• "I'm just helping her achieve her dreams" is not a defense when you're the one holding the scalpel and the training.
• Regret is real, and this kind of damage is extremely difficult to fix.
• Mental health struggles should be addressed before permanent surgical changes, not after.

It all just feels uncomfortable to me. And I think more of us in this field should be willing to say so out loud.