Think of Sandra Perez Gonzalez, who allegedly injected her patients with a variety of unregulated chemicals at a beauty salon in Long Beach, California, killed one of them by accident, and now faces manslaughter charges. Or Oneal Morris, the Miami woman who, after injecting her clients' butts with industrial tire sealant, was sentenced to one year in a Broward County jail for practicing medicine without a license. Manslaughter charges were later added to Morris’s case after one of her clients died of "massive systemic silicone migration”—which, as The Atlantic's James Hamblin writes, means “that the silicone-ish products under her skin migrated throughout her system in massive quantities to the arteries in her lungs, where it clogged them or caused them to burst.”
As the stories around disreputable back-alley procedures proliferate, it’s easy to blame the patient for soliciting services from an unlicensed cosmetician in a strip mall. That’s what Dubrow and Nassif are doing when they chide patients on Botched. But even though the show’s surgeons are less than charitable when talking about their clients’ past decisions, Botched stands out from its cosmetic-surgery show predecessors by treating it not as a frivolous indulgence but rather as a serious medical procedure—administered by an industry with a reputation for predation and sloppiness.
Unlike The Swan, which positioned cosmetic surgery as a prize that women could strive for, Botched—its schadenfreude aside—reminds us of the seriousness associated with undergoing cosmetic procedures. An operation by a board-certified surgeon is safer than getting your butt cheeks plumped with a cocktail of unknown chemicals, and yet more and more patients are getting work done at legally ambiguous centers.
Since 2002, medical spas—a sort of hybrid between doctors’ offices and beauty parlors—have increased tenfold in the U.S. And since these medical spas face different regulations in every state, many patients are unfamiliar with the spas’ uneven safety records. For example, some states don’t specify who is allowed to own or operate a medical spa, and other states don’t define whether or not a licensed medical doctor even needs to be on scene at the clinic when a cosmetic procedure takes place. This regulatory ambiguity, tied with aggressive advertising sets cosmetic surgery apart from other established medical fields. Plus there’s the fact that cosmetic surgeons rarely, if ever, deal with insurance companies.
The Supreme Court in 1982 backed the Federal Trade Commission in a case that allowed medical doctors to advertise their services for the first time in the media—a ruling that allowed cosmetic-surgery clinics to flex their strongest PR muscles by showcasing their services in magazines and daytime television slots.
Since then, the pushback has been hard. In the UK, activists like Kat Banyard, a British author and feminist, have campaigned since 2012 to ban cosmetic surgery advertising in the country. She wrote in The Independent at the time that cosmetic surgery ads “frame surgery as quick and easy, trivialising the risks, like blood clots, post-operative infection and, in rare cases, death.”
“Cosmetic surgery occupies this really paradoxical place,” Pitts-Taylor added, “where it operates with many of the benefits of being part of medical services, and yet, it also is aggressively commercial in a way that other fields of medicine are not supposed to be.”
As law enforcement officials hustle to keep up with the growing black-market presence of illegal cosmetic procedures, and states try to even out the regulatory field for medical spas, Botched prompts viewers to think of cosmetic procedures as real and often irreversible investments—a lesson this show's characters learned the hard way.