From ‘Nip/Tuck’ to ‘Botched’ to the BBC’s ‘Plastic Surgery Undressed’, we’ve always had a fascination with surgery on screen – but what does healthy representation look like?
Ask me how I would least like to spend my weekend, and up there with “having the bone cartilage in my face sawn off” is “watching other people have the bone cartilage in their face sawn off”. But apparently not everyone feels the same.
A recent show on BBC Three, Plastic Surgery Undressed, asks people who are planning to have plastic surgery to watch live video footage of a surgeon performing the same surgery on someone else, to see if that deters them. Each episode focuses on a different procedure; in the first season, the show looked at nose jobs, breast augmentation, and instant abs. The second season, which aired over the last few weeks, looked at tummy tucks, hair transplants, and breast reductions. As someone who is incredibly squeamish, five minutes of the show turned my stomach and I had to switch it off. Some of the people featured on the show exhibited similar reactions – part of the entertainment, undoubtedly, is meant to be watching them squirm.
The show justifies all its gruesomeness by supposedly posing the question: would people want to go “under the knife” if they knew what it really entailed? “By listening to the negative stories they rarely see on social media, as well as hearing from people whose surgery was a success, the people contemplating the procedure will be able to weigh up the benefits, risks and significant financial cost,’ say the BBC. It’s meant to be about getting behind the psychology of why we have cosmetic surgery, specifically in a time when research suggests that half of Brits aged 18-34 would consider it.
“When I found that it was a BBC programme I was interested because it gives both the pros and cons of plastic surgery,” says Amir Nakhdjevani, the surgeon who appears on the show. “The fact that it had the educational value for the viewers and patients was something that interested me.” Nakhdjevani says that he hopes it manages viewers’ expectations of surgery: “Some people think that you can just have a glass of champagne and then fly over to Turkey or Belgium to have a procedure, without meeting the surgeon beforehand, or without thinking about the results. They don’t know what to expect. They don’t know the risk. And far too often we see patients that say, ‘I never knew it was going to be like that!’ So this programme was very much about educating people, making sure that they’re prepared for the recovery and what might go wrong, and that they are not being taken advantage of.”
Plastic Surgery Undressed is not the first TV show to take plastic surgery as its focus. Most notably, there is Nip/Tuck, the famous American medical drama series that ran from 2003 to 2010. Growing up I remember shows like “worst plastic surgery” countdowns on late-night TV (mostly in America). It’s hard to imagine those making it onto the airwaves today, in a time when we’re more aware around people’s bodily autonomy to have surgery if they want to, and as such, to face the consequences, although E! still make videos that would suggest otherwise. There’s also Botched, following two American surgeons who specialise in fixing people’s plastic surgery gone wrong, it aired in 2014 and has had five seasons, still running, and Dr 90210, a reality TV series about a surgeon in Beverly Hills.
Recently, a show called The Surjury – ‘surgery’ meets ‘jury’ – was due to air on Channel 4 but was delayed, and will probably now never air due to the fact that it was hosted by presenter Caroline Flack, who recently and tragically took her own life. Based on an obscure US show of the same name, the concept asked contestants to come on the programme, make a case for why they want surgery and let a panel of judges (strangers who are members of the public) decide whether they can have it for free. The show was called “a new low for television” by some critics, and “tawdry and exploitative” by MPs.
Channel 4 said in a statement: “There is no update on the show currently and it remains unscheduled.” It also told Metro: “Cosmetic surgery has become an increasingly mainstream choice in Britain. The Surjury seeks to explore why so many people feel the need to change their bodies, and whether surgery actually makes them happier. All contributors featured in the series have actively been seeking surgery of their own accord. Contributors (...) will be independently assessed by the clinic who will carry out their procedure.”
While Plastic Surgery Undressed gives the people having the surgery the choice over whether to get it, The Surjury would have put the choice into others’ hands, which ultimately feels judgemental. Dr Esho, a 10-year practising surgeon who was asked to take part in the show, explains why he said no. “I said no purely on the premise. My main concern was that, whenever plastic surgery is being done, whether it’s surgical or non-surgical, it needs to be the decision of the individual – always.” Dr Esho agrees with Nakhdjevani that Plastic Surgery Undressed is a better representation because “it shows you the full risks of what plastic surgery entails,” he says. “In many clinics now you’ll see that patients have to watch videos prior to the procedures so that they are not only seeing the before and after images, but what happens in between, in theatre. I think that can really make you more informed.”
Dr Esho has taken part in several shows, becoming something of a “media doctor”; he was part of a show called Bodyshockers, as well as Body Fixers with E4, and has been part of dramas where producers hired experts in the field like himself to understand what actually happens in a clinic, and how to bring that out in a visually arresting but also accurate way. As for a problematic representation, he mentions Nip/Tuck: “It was hugely popular but more for drama and entertainment. Many scenes weren’t representative of what really happens now, and that miseducates people.”
“We’ve all seen programmes like Botched, and the extents people go to in order to have ridiculous kinds of surgery. Last week I saw a programme where the lady had six of her ribs removed so she could have a tiny waist but that has serious medical implications, it is dangerous” – Amir Nakhdjevani, surgeon
Nakhdjevani says that balanced representations of plastic surgery are important because they also help debunk the stigma around people who have surgery. “On some of these shows, all you see is people who are addicted to plastic surgery, and so having things that are not ethical. Quite often, the general public’s perception of plastic surgery is extreme vanity and addiction to plastic surgery and the idea that people want to look strange or alien-looking. Those kinds of things aren’t what we see every day in our practice. Maybe every five years you might see one patient who may be that way. They need guidance, not surgery. But for entertainment value, some TV shows certainly highlight plastic surgery to be like that.”
Perhaps all of this controversy and exaggeration goes some way to explain why we are so interested in shows that lift the lid on surgery; according to Nakhdjevani, it’s usually to do with either voyeurism – particularly our obsession with botched surgery – or aspiration. He points to the enduring popularity of shows where surgery has gone wrong. “We’ve all seen programmes like Botched, and the extents people go to in order to have ridiculous kinds of surgery. Last week I saw a programme where the lady had six of her ribs removed so she could have a tiny waist but that has serious medical implications, it is dangerous. So I guess the people watching, they’re just curious to see what’s going to be done next.” On the other end of the spectrum to disgust, is looking up to people with surgical enhancements on TV in the same way we do in magazines or on social media: “We see pouty lips, fake curvy figures, people with toned bodies, and various other things. When there is an appetite for that in society, wherever you’re looking, it will be an interest for people to watch it.”
If my surgeon isn't doing this after my surgery, I will riot! #Botchedpic.twitter.com/e1j51p3RJY
— Botched (@BotchedTV) February 4, 2020
Nakhdjevani claims that being on Plastic Surgery Undressed has not increased the number of people coming in for procedures, it has just made those who do “ask more of the right questions”. However, shows like Love Island and the adverts they have shown for cosmetic surgery in the ad breaks have been found to increase the demand of people having surgery.
Still, Dr Esho says that, in his experience, social media provided more of a shift than TV. When he started practising, people used to bring in images of famous people like Angelina Jolie, which was fine as a reference point in that some people can’t articulate what they want verbally so using an image can help as a guide – ”as long as they know it’s a reference point that’s ok,” says Dr Esho. “But with the evolution of filters people started using them to adjust an image and bring that image in. The problem was a number of these people bringing in images weren’t just wanting it as a reference point they would say they wanted to look exactly like that, an image that would contain an unrealistic expectation and was, therefore, a concern,” he says, “so snapchat dysmorphia is a true psychological condition.”
“I always say being a good doctor is not just about what you’re able to do, it’s being able to realise when to say no. If someone just wants what they’ve seen on social media or TV they are not going to be happy because that landscape is always going to change” – Dr Esho
In this climate, he concludes, we actually need responsible TV shows about plastic surgery more than ever before – in order to debunk myths. However, as the cosmetic industry is getting bigger year on year, with more people going overseas for surgeries, both doctors point out that responsibility lies with surgeons as well as TV shows. Plastic surgery should be for people that want to improve their quality of life, not follow trends or meet lofty ideals, says Nakhdjevani: “It is a physical change to make people feel better, make them more confident.”
Dr Esho agrees: “We need to remember that the gatekeepers are the doctors and we’re the ones that need to be autonomous, act ethically and prevent people from having treatments that are solely based on those pressures or trends from TV or social media,” he says.“I always say being a good doctor is not just about what you’re able to do, it’s being able to realise when to say no. If someone just wants what they’ve seen on social media or TV they are not going to be happy because that landscape is always going to change.”