But the explosion of reality TV shows in the last four years has upset that paradigm -- especially in Los Angeles and especially in the ultra-competitive field of cosmetic plastic surgery. Even as shows such as "Doctor 90210," "Extreme Makeover" and "The Swan" have thrust telegenic doctors into the limelight, it remains unclear what standards networks use in selecting the physicians -- or how closely they check credentials.
Style Ad Supplement
Cosmetic surgery information from our preferred advertisers.
- Considering change
Information on the latest cosmetic surgery procedures
Find valuable information about what to do before surgery
More: Cosmetic Surgery of Southern California
See more topics »
Plastic surgeon: An article in Section A on Tuesday about cosmetic surgery and TV said that Dr. Jan Adams had been a frequent guest on "Oprah." In fact, he appeared once on "The Oprah Winfrey Show" and once on "Oprah: After the Show" that aired on the Oxygen cable network. —
Now this uneasy partnership between medicine and reality television is getting its own reality check. On Nov. 10, Donda West, the mother of rap star Kanye West, died a day after undergoing cosmetic plastic surgery performed by Dr. Jan Adams, a celebrity doctor in Brentwood who was the host of his own Discovery Health channel show, "Plastic Surgery: Before and After."
The resulting spotlight has been a good deal harsher than the one that celebrity plastic surgeons encounter on the set. Meanwhile, their rank-and-file colleagues and the American Medical Assn. are growing worried that reality-TV doctors and the producers of the shows distort what plastic surgeons do by over-hyping the results and downplaying the pain, complications and risks associated with surgery. The shows and their celebrity doctors, they contend, mislead consumers into thinking cosmetic surgery is not much more complicated than buying a new dress.
"TV is looking for the best doctors who will show well and get ratings. They have to have looks and personality," said Dr. Valerie J. Ablaza, a board-certified plastic surgeon in Montclair, N.J. "But there are no criteria for evaluating their medical credentials. That's a big problem."
West's autopsy has not been completed but preliminary results released by the Los Angeles County coroner last week concluded that the 58-year-old former college professor and businesswoman died "as a result of surgery or anesthesia."
The Discovery Health channel did not return calls seeking comment on what criteria it uses to select physicians to host shows, but a spokesman for the network said Monday that it has decided to pull reruns of Adams' show for the immediate future.
One Los Angeles-based producer for a plastic surgery reality show, speaking on condition of anonymity, said the shows seek doctors with successful practices because they have a larger patient clientele from which cases can be chosen to film. The producer spoke on background for fear of being associated with the West case. He is not associated with the case or with Discovery Health channel.
But TV-star demeanor also matters.
"Doctors are chosen, ideally, for being good doctors and for being comfortable in front of a camera," he said. "There is a lot of care taken in who you select. And there is a lot of care taken in who the doctor selects for the surgery" that will be filmed.
The doctors who do the shows, he said, have to be secure enough in their own skills to allow cameras to follow their every move. The shows, he added, have been "realistic" in showing the pain, complications, costs and emotions surrounding cosmetic surgery; criticism, he said, tends to come from "old school" doctors who think doing television is "lacking in dignity."
The group of doctors who are TV stars is small, but their influence on their peers and the public can't be underestimated. Cosmetic plastic surgery, which includes invasive procedures such as tummy tucks and simple injections such as Botox, has been embraced by Americans from Los Angeles to Little Rock. Almost 11 million cosmetic procedures were performed in the United States last year, according to the American Society of Plastic Surgeons, a 48% increase over 2000.
Even critics of TV celebrity doctors -- and there are many -- concede that the publicity has had benefits. The shows demonstrate technological advances and have helped soften the perception that cosmetic surgery is vain and indulgent. Few patients now claim their refreshed look is simply the result of a long vacation in the south of France.
"It has brought plastic surgery to the mainstream," said Dr. Rod J. Rohrich, chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center and a past president of the American Society of Plastic Surgeons. "It's not just for the rich and famous. It's for everyone."
In the first study documenting the influence of shows such as "Extreme Makeover," researchers found that reality TV shows directly influence first-time patients who decide to have cosmetic plastic surgery. The study was published in the July issue of the journal Plastic and Reconstructive Surgery.
"These folks were really avid watchers and believed what they saw on TV was a reflection of reality," said Dr. Richard A. D'Amico, president of the American Society of Plastic Surgeons and chief of the department of plastic surgery at Englewood Hospital and Medical Center in Englewood, N.J.