Most plastic surgeons will tell you: The best plastic surgery is a subtle transformation—not a drastic change where everyone who looks at you thinks you look completely different. “The biggest giveaway of ‘good’ plastic surgery is when someone looks just too young for their age,” says New York facial plastic surgeon Konstantin Vasyukevich, MD. So how does the bad stuff show? These dead giveaways you’ve had some (ahem…not-so-good) plastic surgery done are 20-plus more reasons it’s vital to find a plastic surgeon who is properly board-certified, up-to-date on the latest techniques, and has an aesthetic vision that’s in line with yours.
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Loved and maligned across the internet and social media, Syosset, NY facial plastic surgeon Eunice E. Park, MD coins buccal fat removal as one of the “more controversial treatments” out there. “Despite some requests to remove all buccal fat to achieve a dramatic and disproportionate facial contour, not everyone is a candidate for this procedure,” she stresses. “It can be a powerful technique to sculpt facial features and oftentimes incorporated in a facelift and necklift procedure, but it has to be done correctly. Judicious and balanced buccal fat reduction will preserve facial volume for a natural appearance as we age.”
The Skin-Care Skip
The close cousin to any plastic surgery procedure, Dr. Park says nothing sours good plastic surgery quicker than neglecting the neck, chest and hands. “Although we love to focus on the face, we should also address skin quality, texture and laxity on our neck, chest and hands. Incorporate a skin care routine and clinical treatments, like laser, microneedling and skin tightening that address these key areas to prevent lines of demarcation and a visible contrast.”
Something You Can Spot Across the Room
Scottsdale, AZ facial plastic surgeon Kelly V. Bomer, MD considers bad plastic surgery something that “you can see from across the room” and points out that it can happen from many types of cosmetic surgery. “A face that’s pulled too tight, prominent facial scars, a face with strange angles of tension, facial proportions distorted with overly large cheeks, chin or overly small nose, oddly shaped face with unnatural asymmetries, rounded eyes, hollow eyes, pulled-down eyes, and waxy skin that wrinkles strangely are all signs of bad plastic surgery.” In her strong opinion: The best cosmetic surgery goes unnoticed. “One of the greatest challenges when performing plastic surgery is to have good judgment with aesthetics, so that the patient maintains and un-operated, natural appearance as if he or she could have been born with their newly refreshed features.”
Lumps, Bumps + Depressions
Brazilian buttlifts, or BBLs, are one of the fastest-growing procedures being performed in the United States and elsewhere, says Newport Beach, CA plastic surgeon Sanjay Grover, MD. “Much attention has been brought up about this procedure due to the high number of deaths occurring, especially in the Florida region where a number of ‘drive-through’ BBL centers exist. Most recently, Florida instituted new laws limiting the number of BBLs to three that one surgeon could perform in any given day.”
While safety is obviously the main concern, Dr. Grover explains that other issues one should worry about are bad aesthetic outcomes following a BBL, which could take the form of a very misshapen or disproportionate appearance or irregularities like lumps, bumps, or depressions. “It is very important that a prospective patient seeks out a plastic surgeon that is board-eligible or board-certified by the American Board of Plastic Surgery and that the procedure is performed with a board-certified anesthesiologist in a fully accredited outpatient surgery center or hospital.”
The Honing Effect
Plastic surgery that creates an immediately identifiable change in a patient’s appearance—and causes the observer to “hone-in” on that one feature—is what New York plastic surgeon Daniel Y. Maman, MD calls a telltale sign of some not-so-subtle results. “Good plastic surgery should be subtle, difficult to identify, and consistent with the patient’s other features. The operated area should look as if it was always intended to be that way.”
A “Pulled” Look
Dr. Vasyukevich says this one is probably the most common sign of “bad” plastic surgery. “That happened a lot with the old-fashioned facelift,” he says. “Fortunately, it is exceedingly rare today. Bald spots in the temple, pulled ear lobes, visible scars that are placed in front rather than inside the ear, wide, cross-hatched appearing scars, and stretched lips are a few other telltale signs of an ‘old’ facelift. All these unsightly changes have been resolved with modern-day facelifts. With an expertly performed facelift, it becomes exceedingly difficult to notice any signs of surgical rejuvenation. The facial contour appears natural and the incision lines are well-placed in the areas around the ear where they are not visible.”
Troy, MI plastic surgeon Anthony Youn, MD explains that this is the term for an elongated earlobe that results from pulling of the earlobe after a facelift. “I avoid this in my patients by securing the facelift to the cartilage of the ear. But if the facelift is secured only to skin, the earlobes can pull down and look like the earlobe of a pixie.”
One dead-giveaway of breast implants is wrinkles on the side of the breasts when a woman bends over. “This is due to wrinkling of the implants, which is especially worse with saline implants,” Dr. Youn says, and adds silicone implants can reduce this issue.
Belly Button Anomalies
Tummy tucks can produce belly buttons that are too round, too narrow or too tight and have a visible circular scar around them. “This is often a dead giveaway for a tummy tuck.”
“When you hug someone and it feels like two cantaloupes on the chest, then it could be that she has excess scar tissue around breast implants, called capsular contracture,” Dr. Youn explains.
Lack of Animation
While this can apply to pretty much any aesthetic procedure, Pasadena, CA plastic surgeon Lily Lee, MD says it’s a sneaky one that can happen with the breasts, specifically, when implants are placed under the pectoralis major muscle. “While most of us agree that a dual-plane pocket for implant-based breast augmentation looks more natural, that is if you are looking at breasts with arms at rest. I remember being at a cocktail party once and a friend of mine—who I previously did not know had implants—waved at me with a low-cut dress on. Her secret was revealed as soon as she was moving her arms.”
Westborough, MA facial plastic surgeon Min S. Ahn, MD also lists lack of movement as a major nod to the unnatural. “A telltale sign that you have not had a deep plane facelift is when the person is moving around animated and talking and smiling and you see that the skin has tension lines that are pulling in a horizontal direction that are not moving naturally with their facial muscles. A deep plane facelift makes sure that the skin, soft tissue and muscles move as a unit—in a more natural way.”
“If any neuromodulator is injected into the forehead in a certain way, some men and women can develop an over-arching of the brow, resembling Cruella de Vil,” Dr. Youn says. The good news: Even though it looks odd when it happens, it is easily treated.
The Botox Cosmetic Brow’s cousin is the Frozen Forehead. “This is what results when too much Botox Cosmetic is injected into the forehead, causing it to lose all movement. In some people, it can cause the eyebrows to droop unnaturally as well. The only treatment is to wait it out.”
A conservative amount of filler in the cheeks can look naturally youthful. “But too much can cause a person to look like a muppet (aka pillow face),” Dr. Youn says.
Nashville, TN plastic surgeon Daniel A. Hatef, MD calls this term something that happens when surgeons “over-reset tip support structures, don’t adequately support the tip, and/or don’t lower the dorsum enough” during rhinoplasties, which can lead to drooping of the tip after the surgery. “The nose often looks amazing on the operating room table, but within a year it looks operated on and deformed,” he explains. “That’s one reason why patients shouldn’t trust ‘on-table’ rhinoplasty pictures that come through their social media feeds—things can change a lot.”
“Some doctors remove too much cartilage from the tip of the nose during a rhinoplasty, resulting in a pinched nasal tip. The nose can look skinny and the nostrils can even cave in with breathing. Although this can occasionally be found naturally, in many cases this is a dead giveaway for a nose job.”
Dr. Youn says a “tiny waist with big butt, thin figure with massive breasts” equals unnatural proportions that are often dead giveaways for plastic surgery.
A Face + Neck That Doesn’t Match
Encino, CA plastic surgeon George Sanders, MD lists “an incomplete job of rejuvenation of the face and neck” as a big no-no. “You don’t want a wrinkle-free face that is free of brown spots next to a wrinkled and discolored neck,” he says, adding that the same goes for a wrinkle-free forehead next to eyes that are framed by crow’s-feet.
“Grid Belly” or “Waffle Belly” is something Dr. Hatef sees in men who have had poorly done abdominal etching or high-definition liposuction, which he says appears as a grid-like appearance in their abdomen. “There are a couple of reasons for this: One is that the anatomical structures are fascial ligaments that insert into the skin and they are never symmetric in nature. When a surgeon makes it too symmetric and doesn’t follow the natural line, it’s a giveaway that the patient has had etching. It’s super disharmonious to have a ‘dad bod’ and then six-pack lines etched in. The eye knows something isn’t right.” Something else tummy-related that’s a sign of some unnatural-looking results, Dr. Sanders says: “A flat and featureless abdomen with a belly button that is flush with the skin surface. You want contours and undulations in the abdominal area with a belly button that is recessed with a hood over its top.”
The bottom line, stresses Los Angeles plastic surgeon Ben Lee, MD: Plastic surgery should be about balance and proportion. “The goal should be to subtly enhance features, not to distort or take things to unnatural extremes. Along those lines, surgical results that are way outside the norms—too tight, too high, too big—are undesirable. The old adage that ‘the enemy of good is better’ is one of the guiding principles of plastic surgery. Plastic surgeons have always sought to produce natural results, but it doesn’t always seem that way. We would rather enhance features and turn back the clock than totally transform how a patient looks. However, in some populations and geographic areas of the country, certain looks become trendy, and surgeons respond accordingly. Social media picks up on these trends, and makes it seem that we like to produce extreme results.”
“Consider, for example, facelift. The procedure is one of the most powerful tools we have to rejuvenate the face. However, the perception among the public is not always a good one. The popular perception is that patients tend to look overly tight. It is true that there have been some highly visible people in the public eye who have an overly done appearance. Nevertheless, the emphasis in modern facelift is to place sagging structures back where they used to be. The result is that patients look a decade younger, rather than pulled. After all, we simply replace tissues to their original position rather than pull them to places they were never meant to be. Hopefully, patients will come to realize that natural, balanced results are preferable to overly exaggerated features.”