The Upside of Bad Plastic Surgery

E!'s reality series Botched! is ghastly, mean, and important.

The "Human Ken Doll" featured on E!'s new show, Botched. (E!)

If television was, for a moment there, getting too highbrow for you—with Louie confronting Nietzschean crises and Orange is the New Black continuing its meta-commentary on the prison-industrial complex—worry not: You now have the husbands of the Real Housewives franchise.

Paul Nassif and Terry Dubrow, world-renowned cosmetic surgeons and spouses of Adrienne Maloof (now ex; Beverly Hills) and Heather Dubrow (still together; Orange County), star in a new reality show that has them correcting the plastic surgery disasters of too-vain, if not just unlucky, clients. Botched, which premiered last month on E! and airs Sunday nights, is the latest in a series of body-image exploitation shows, but tries to distinguish itself by showing some of the shadier practices of the cosmetic surgery industry.

In many ways, Botched continues the tradition of older plastic surgery shows like Extreme Makeover and The Swan, which debuted in 2004 and promised the show’s winner—determined by beauty pageant-like tasks—a chance to score the cosmetic procedure of a lifetime. But Botched does something arguably more sinister than simply exploit insecurities using the classic ugly-duckling trope: It feeds off society's dark tendency to root for other people’s failures—in this case, the gruesome failures of patients desperate for new bodies.

In the first episodes, famed supermodel-turned-reality star Janice Dickinson comes in to replace her 30-year-old breast implants, which had become so worn out that they started forming wave-like ripples on her chest. Dubrow and Nassif gave her fresh implants, but only after scolding her for not getting them swapped out with newer ones sooner.

“These implants being from the ‘70s,” scoffs Dubrow. “Who knows, we may take them out, put ‘em on there, and there might be streaks of cocaine left.”

Then, in the second episode, a Chinese woman named Cheryl comes to see Dubrow and Nassif after a failed “eye westernization” operation left her hardly able to blink—a quandary made worse by her enormous cheeks, which she filled herself with illegally obtained silicone.

“Uh, I bought some black market, you know, fillers from China—they were really cheap. So I just stuck it in there, and, you know,” Cheryl tells the surgeons as she mimes a syringe in her cheek.

“You practiced medicine on yourself?” yells a dumbfounded Dubrow.

These sort of blame games and accusations towards victims of botched work are common from the plastic-surgery establishment, says Victoria Pitts-Taylor, a sociologist at Wesleyan University and specialist in body image and feminist studies. And they expose a larger question of who gets held accountable when a surgeon’s over-eagerness for profit results in a surgery disaster, or when patients, so distraught over their body image, find poorly regulated fillers to fix themselves up or demand the impossible and the risky from their own doctors.

“Who is blamed in the narrative for the situation that they're in?” Pitts-Taylor asked when I spoke with her. "I think we're all being a little bit too willing to accept these narratives of blame of individual patients for being too crazy, or being too careless, and there's certainly not enough critique of the industry as a whole."

The industry’s alleged ethical issues and the high risks surrounding cosmetic surgery—even the kind conducted by board-certified physicians like Botched’s Dubrow and Nassif—are well-reported and illustrated by a number of famous cases.

For example: Kanye West’s mother, Donda, died in 2007 after receiving a radical breast reduction and tummy tuck. She had reportedly consulted with a number of surgeons who’d refused to perform the operations due to her pre-existing—and potentially fatal—cardiac condition. But then Donda West found Dr. Jan Adams, a Beverly Hills surgeon and regular guest on The Oprah Winfrey Show, who performed both operations. West died the next day.

While her death no doubt resulted in part from the seriousness and risk level of her operation, a sizable portion of the total number of plastic surgery deaths happen from something as small as a needle. Minimally invasive cosmetic procedures—such as fillers or injections—have increased in popularity by more than 140 percent in the past decade, according to the American Society of Plastic Surgeons, and because of their pervasiveness and varying sets of regulations, fillers are also some of the easiest to sell on the black market.

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.