16 Behind-the-Scenes Secrets of Plastic Surgeons

IStock
IStock

Our culture is pretty obsessed with what it sees in the mirror: Cosmetic procedures have risen an astounding 115 percent since 2000, with nearly 16 million procedures performed in 2015 alone. Breast augmentation, buttocks lifts, and minimally-invasive “injectables” have all conspired to literally change the shape of the male and female form.

For insight into the highly skilled hands that make these transformations possible, mental_floss spoke with several accomplished plastic surgeons about the living sculptures they create.

1. THEY SEE BEAUTY AS A MATHEMATICAL EQUATION.

Early in his career, Donald Kress, M.D., a plastic surgeon in Baltimore, Maryland, would find himself puzzled when encountering facial features he found unappealing. “I couldn’t figure out what it was,” he says, “until I’d match the face with the Golden Ratio.” The Golden Ratio, or Golden Mean, is a formula first articulated by Greek mathematician Euclid and later used to theorize that the most pleasing appearances in art and nature are created at a ratio of 1.618:1. In the 1970s, surgeon Stephen Marquardt, M.D., began to study commonly appreciated beauties like Marilyn Monroe and Sophia Loren and found the ratio applied to many seemingly universal standards of attractiveness.

Visualizing the formula using a “mask” designed by Marquardt in 1992 (above, middle) can reveal where a face is asymmetrical, though experienced surgeons can make a similar evaluation intuitively. “It comes up when you’re younger and don’t have a good eye for things,” Kress says. “After a few thousand patients, you can see it in your head.”

2. THEY HOST “BROTOX” PARTIES.

OnabotulinumtoxinA—commonly referred to by the brand name Botox—has been used for decades to paralyze muscles at a local injection site, which can prevent the contractions that cause wrinkles and frown lines. Some practices have taken to hosting the increasing number of male patients coming in by offering “Brotox parties,” where a number of friends will schedule at once to make the treatment a social event.

Z. Paul Lorenc, M.D., F.A.C.S., a plastic surgeon in New York City, says that “Brotox” is a result of men who have had a good experience recruiting their friends. “It’s kind of a support group,” he says. “They can interact in the waiting room. Men used to do this at parties, but that’s become passé. It was always a bad idea. You should never have alcohol involved.”

3. THEY’RE DRAWING LANDMARKS ON YOU.

Watch enough reality television and you’ll eventually spot a plastic surgeon taking a black marker to the bare torso of a patient. Matthew Schulman, M.D., a plastic surgeon based in Manhattan, says that surgeons are basically acting as topographers, marking areas of the body that may change shape or become less visible when a patient is lying down. “We’re drawing landmarks for ourselves because a person looks different when on the table,” he says. “I might circle where the fat is thickest, or where the nipple is while standing.” No special medical ink is used: It’s just a Sharpie.

4. BREAST IMPLANTS CAN CREATE “MOTION ARTIFACTS.”

There are several ways to insert breast implants, but Kress says that one in particular can create problems for patients who do a lot of jumping up and down. When an implant is inserted in a subpectoral incision under muscle tissue, it can give off the appearance of remaining stationary while the rest of the breast moves during physical activity, creating a visual ripple effect. “If there are big arm movements, or if they’re in front of people teaching or on television, I advise them of the potential consequences,” Kress says.

5. THEY CAN’T MAKE YOU LOOK PHOTOSHOPPED.

Schulman says that social media—especially the popularity of impeccably-proportioned Instagram models—has created a few headaches for his practice. “The problem with pictures is that they’re just a guide, but it’s not like picking a body off the shelf,” he says. “Half of the Instagram models are Photoshopped, so when you say you want to look like this, I can’t do it. I can’t give you an 18-inch waist.” Though Schulman does like having a visual reference for what patients have in mind, he prefers they understand it's a starting point, not a preview.

6. THEY DON’T WANT YOU TO LOOK GOOD ON THE TABLE.

“Everyone,” Schulman says, “looks great lying down.” But trying to achieve aesthetic perfection in the operating room is a recipe for disaster. “One of the first things we learn as plastic surgeons is that just because something looks good on the table doesn’t mean it’ll look good six months later. We want to make the result less than ideal to account for healing.” Breast implants, for example, might be placed higher than desired so they can “settle in.” Making them perfect during surgery means they’re likely to drop too low once the body recovers.

7. IT TAKES EXACTLY 90 DAYS TO GET USED TO A NEW FACE.

According to Kress, there’s a tremendous difference between a facelift and a procedure that radically alters the face. “In a facelift, you’re turning back the clock and people can adjust to it quickly,” he says. “But a new nose, a new chin, taking away a bump, you’re creating a person they’ve never seen before.” In his experience, it takes patients almost 90 days exactly to get used to the image in the mirror. “On day 87, they’ll see someone else’s chin. On day 91, it’s you. It’s freaky how accurate it is.” Kress will normally refuse to remove an implant (chin, cheeks, breasts) prior to the 90 days to account for this phenomenon.

8. MORNINGS ARE BEST FOR DETAIL WORK.

If you’re opting for cosmetic surgery and have a nose job scheduled for late in the day, you may want to reconsider. According to Kress, procedures that require fine motor skills like nose jobs, facelifts, or eyelid surgeries are best performed in the morning, while gross motor work like breast implants and liposuction can come later. “You don’t want to reverse the order because it can take between 45 minutes to an hour for fine-touch motor skills to return. I start with the most delicate surgeries first, have a good lunch, and do bodies later.”

9.  THEY CAN MAKE YOU LESS ANGRY-LOOKING.

Not all cosmetic surgery is focused on restoring the appearance of youth: Some people just want to look happier. “Many of my Botox patients coming in say that everyone thinks they’re angry all the time,” Lorenc says. “They want to correct a frown or a heavy brow.” Kress has also seen people ready to go on the job market for the first time in years who want to appear more awake—or sober. “Sometimes eyelids can make you look like you drink, or don’t get enough sleep,” he says.

10. THEY WORK WITH WITNESS PROTECTION.

That gangster-movie cliché of having to modify your face to avoid being spotted after offering damning testimony? It’s true. Kress has operated on several government witnesses, and they can forget about follow-up visits. “I’ve had Federal Marshals come in and tell me, ‘This is the only time you’re going to see this guy, so give him whatever instructions he needs,’” he says. Kress has also worked on covert military operatives who have had their name and image published in media and run the risk of being recognized. 

11. THEY HAVE SIGNATURE NOSES. (AND BUTTS.)

Many surgeons get into the cosmetic field because of an artistic impulse: They don’t want to perform cookie-cutter procedures and like to improvise. But a certain segment can also offer procedures with a dependable aesthetic outcome that becomes a kind of signature. “Some doctors are known for noses I can spot across the street,” Schulman says. “I do a lot of butt-lifts and make them look like an upside-down heart. Patients come in because they want that result.”

12. CALF IMPLANTS ARE A THING.

And not just for men, either. Lorenc regularly sees patients of both genders who want to rectify their genetic misfortune and sport shapely, powerful-looking calves. “I’m one of the few surgeons who does them,” he says. “The stereotype is that it’s only bodybuilders, but that’s not true. They make up only a percentage. Some people just can’t develop them in the gym no matter what they do.”   

13. BEING A SMOKER IS A REAL NO-NO.

One universal truth of cosmetic surgery: Operating on a smoker is never a good idea. Nicotine constricts small blood vessels, which can delay healing and open up the door for complications. “Every good plastic surgeon will require a patient stop smoking before a procedure,” Schulman says. His patients sign an agreement requiring them to cease any kind of smoking four weeks prior and for eight weeks following an operation. “They agree I can nicotine-test them [via urine] and if they’re positive, the operation is canceled and I keep their money.”

14. THEY’LL WORK ON KIDS FOR ONE REASON.

There are very few cases of surgeons electing to work on anyone under the age of 18 for purely cosmetic purposes, with one key exception: protruding ears. Kress says that ears that stick out too much can become a psychological burden and that there’s a sweet spot to get them pinned back. “Around age 5 or 6, the ear has gotten big enough to work on and see a lot of the underlying structure,” he says, “but it’s also before they get into grade school and the taunting really starts.”  

15. THEY THINK TRANSPLANTS ARE THE FUTURE.

While fat transplantation is an increasingly popular and effective alternative to artificial fillers—adipose tissue can be harvested from unwanted areas and injected into the butt or face—Schulman sees the future of plastic surgery being far more radical, and less focused on aesthetics. “I think in the next ten years, we’re no longer going to be doing reconstructive work for trauma,” he says. “If you need breast tissue after a cancer operation, it will be from a donor. Things like face transplants and hand transplants are being led by plastic surgeons, by microsurgeons. I see full limb transplants. The possibilities are endless.”

16. THEY’RE NOT REALLY STRESSED.

Lorenc finds it amusing when friends or acquaintances remark that being a surgeon must be one of the most stressful jobs you can have. “When I step into the operating room, it’s like nirvana,” he says. Barring the rare complication, no one is in critical condition, bleeding to death, or under any extreme duress. Surgeons tend to work at their own pace, sometimes with a soundtrack. “I listen to Pink Floyd, the Allman Brothers, Jimi Hendrix. Sometimes reggae.”  

All images courtesy of iStock unless otherwise credited.

10 Secrets of Brewmasters

Being a brewmaster is about more than just sampling beer and coming up with new recipes. Maintenance and sanitation also play a huge role in the job.
Being a brewmaster is about more than just sampling beer and coming up with new recipes. Maintenance and sanitation also play a huge role in the job.
Stone Brewing

With roughly 7500 craft beer breweries in the United States—a number that continues to grow—it’s clear consumers like their ales and lagers. And as more of these breweries pop up in towns and cities every month, it’s up to brewmasters to constantly produce new beers to satisfy demanding (and evolving) palates, maintain a sterile workspace, and properly operate all the complex machinery that pumps out your favorite IPA. To find out what goes into owning and operating a brewery, Mental Floss spoke with a number of brewmasters about what their days entail. Here’s what they had to say about taste tests, oyster beer, and getting doused in hop sludge.

1. A lot of brewmasters started out as home brewers.

Stone Brewery equipment.
A brew kettle from Stone's Richmond, Virginia, location.
Stone Brewing

While brewmasters sometimes attend college to study chemistry or even specific brewing courses, a fair number get their start in their own homes. “When I started, I would say about 50 percent [were home brewers],” Tom Kehoe, co-owner of Yards Brewing Company in Philadelphia, Pennsylvania, says. This was back when there were only around 649 breweries in the country, according to Kehoe. That number has only grown with time, and now he says as many as 90 percent of current brewers experimented with home brewing before moving on to larger productions.

While home brewing can be a good start, Kehoe says that there’s a limit to how much you can learn in a garage setting. “The basic knowledge of how beer is made is exactly the same. However, good brewing practices need to be learned on site. The environment working in a brewery is a lot different than brewing at home.”

One example? Size. According to Jeremy Moynier, brewmaster of Stone Brewing in San Diego, California, people are surprised when they see the scale of some brewing operations. "A home brewer is used to making a few gallons," Moynier says. "We could be making a 250-barrel batch [at Stone]. Each barrel is 30 gallons."

2. Brewmasters use sound almost as much as taste to evaluate the brewing process.

Brewing equipment from Yards Brewing.
This is just a sample of the brewing equipment employed by Yards.
Yards Brewing

Breweries come in all shapes and sizes, but all of them implement a lot of machinery, stainless steel vats, pumps, and bottling lines to concoct their brews. It becomes a symphony of sorts, according Moynier. And if one instrument sounds off, he can tell.

"You use all of your senses, from taste to sound," he tells Mental Floss. "Breweries are noisy, and there are sounds you get attuned to. If something sounds wrong, you know there’s a problem somewhere. Your senses being in tune are important."

Once, Moynier heard an unusual squeaking noise in the factory. He discovered that the tank that held the crushed malt was backed up, which would eventually ruin the conveyor belts if no one noticed in time. Thankfully, Moynier picked up on that change in noise, and the problem was corrected before the machine required a more expensive repair.

3. Brewmasters are always trying novel flavors. Even oysters.

There’s no shortage of creativity among brewmasters, with breweries constantly experimenting with different flavor profiles, from tea to chocolate to fruit. "There are so many different styles, flavor, and aroma profiles you can hit," Moynier says. "We’re constantly learning about new ingredients.” One that impressed Moynier recently was an oyster stout, a style that was originally billed as a beer that simply paired well with oysters more than a century ago, but has since evolved to include actual oyster meat and stock in modern recipes. This one came from Liberty Station, one of Stone Brewing’s locations in San Diego. "It was pretty fascinating," he says. "They got a real briny, oyster thing going."

4. Sanitation is one of the most important parts of being a brewmaster.

A picture of Stone Brewing's beer equipment.
Stone's barrels hold 30 gallons of beer.
Stone Brewing

The stereotype of brewmasters sipping beer all day and hovering over batches is slightly misguided. According to John Trogner, co-owner with brother Chris of Tröegs Independent Brewing in Hershey, Pennsylvania, most of the job is making sure beer is made in clean conditions. “People usually think you’re sitting around all day dreaming up recipes and tasting beer,” Trogner says. "That’s a very small component. Physical cleaning is probably 80 percent of it. Sanitation is paramount. It’s like a chef keeping a kitchen clean. Workers spend most of their time scrubbing."

Just because the breweries are kept clean doesn't mean the brewmasters are quite as lucky. Depending on the valve and your luck that day, that could sometimes mean an unintentional beer shower for workers. "I’ve taken baths in yeast and beer sludge," Trogner says of his early days, explaining it's a hazard you face when you're opening the valves on the brew tanks.

5. Brewmasters know they're expected to bring beer to most gatherings.

A look at the Tröegs brewery.
Foeders are large wooden vats that age a beer to create a unique flavor profile. It's part of Tröegs's Splinter Cellar, and each foeder was custom made and shipped to the brewery.
Tröegs Independent Brewing

Like any other profession, brewmasters can sometimes be greeted with an expectation that their services and goods are free for friends and relatives to enjoy at gatherings and family events. "If it’s appropriate to bring beer, I will," Kehoe says. "And sometimes when it is not so appropriate. I have brought beer to a business networking breakfast and somehow it turned out to be a great icebreaker. I find that people are disappointed if I don’t have at least some beer at the ready."

6. The job can make you critical of other beers and even food.

Working to perfect beers all day can have an effect on how brewmasters regard other beer options. "I still love beer, but it changes the way you approach it," Moynier says. "You pick out a flaw, and it will bother you. It might ruin your enjoyment. But if you find a beer you really like, it can also make it more enjoyable."

A brewmaster doesn’t just develop a sense of what makes for a good beer; they’re also constantly thinking about what type of food pairs well with certain beers. "It definitely affects the way you taste things," Moynier says. "It’s made me a pickier eater. You’ll think about how food will pair with beer sometimes, where you wouldn’t necessarily think about that before. It made me appreciate how things go together."

7. Brewmasters know names and logos can make or break a beer.

Tröegs Independent Brewing Mad Elf beer is pictured
Tröegs's Mad Elf is one of the most recognizable beers around the holidays.
Tröegs Independent Brewing

With so many beer options, it’s imperative for brewmasters to use marketing as a way of setting up a consumer’s palate before they sample anything. For Tröegs's Haze Charmer, which offers pineapple and grapefruit notes, the brewery went to great lengths to describe how the "haze" of the recipe carries hop oil into the mouth.

"Haze Charmer emerges from a soft, swirling cloud of oats and unmalted wheat. Vigorous dry-hopping adds a second phase of haze, propping up the oils of Citrus and El Dorado," the website description of the beer reads.

"The name is a critical component," Trogner says. "Consumers are getting to know it before they try it."

The right—or wrong—name and design can make all the difference. Trogner promoted a cherry, honey, and chocolate ale around the holidays and called it Mad Elf, with bottles and packaging decked out in cartoon images of a tipsy elf enjoying one too many. It's become a perennial hit.

"It’s a celebration of the holidays," Trogner says. "Mad Elf is kind of part of social webbing, which is nice to hear. Grandmothers come in and buy five or six cases for family coming over for the holidays."

Similar beers with different branding didn't fare as well. "We’ve done beers like Mad Elf out of season and it didn’t have near the fervor or excitement," he says.

8. A brewmaster associates a beer’s personality with color.

Yards Pale Ale is pictured.
Yards's Philadelphia Pale Ale is lighter in color and far more citrusy than an amber lager.
Yards Brewing

According to Kehoe, light and dark beers each give off a distinctive personality trait depending on their color, which comes from the grains used. "To me, the color of the beer is the mood of the beer," he says. "Light color is fluid and exciting; darker [is] slower and more filling and relaxing." Amber is more middle-of-the-road and more versatile. "[It] can be whatever personality that you want to project in the moment."

9. Smells are a big inspiration for new beers.

Don’t think brewmasters develop recipes based just on tasting other beers; it’s more of a multi-sensory experience. Trogner says that most beer ideas come from everyday life. “We’re not sitting around and looking at other types of beer,” he says. “It’s more about an experience, like having an amazing dish at a restaurant. Or you might be hiking and smell something floral in the air, like pine.”

10. Yes, brewmasters sometimes drink early in the morning.

While downing beer is probably not as common an occurrence as you might think, brewmasters are still expected to sample their wares before it goes out for distribution. According to Moynier, those executive samples can happen at odd times of the day depending on schedules.

"Tastings can happen at six in the morning," he says. "We also have structured tasting and daily taste panels to approve beer about to be packaged. Three times a week we have a brewmaster taste panel where we focus on new beers we’re trying out for release or changes to recipes. There’s an executive panel once a month with [Stone's founders Greg Koch and Steve Wagner]."

Or, as Kehoe puts it, “I don’t drink all day, but I do drink every day.”

14 Secrets of TSA Agents

Being a TSA agent means plenty of job stress.
Being a TSA agent means plenty of job stress.
Joe Raedle/Getty Images

Last year, more than 964 million people boarded airplanes departing or arriving within the United States. Barring any special security clearance, virtually all of them were filtered through the Transportation Security Administration (TSA), a federally operated branch charged with screening passengers to ensure they’re complying with the rules of safe air travel.

Some travelers believe the TSA’s policies are burdensome and ineffectual; others acknowledge that individual employees are doing their best to conform to a frequently confusing, ever-changing set of procedures. We asked some former TSA officers about their experiences, and here’s what they had to say about life in blue gloves.

1. CATS ARE THE REAL TERRORISTS.

A cat escaping from its carrier.
"Cats are a nightmare."
Lightspruch/iStock via Getty Images

According to Jason Harrington, who spent six years at O’Hare Airport as a Transportation Security Officer (TSO), rogue felines have created more havoc and confusion than any suspected criminal. “Cats are a nightmare,” he says. “They don’t want to come out of their carriers, they scratch and claw, and they don’t come when you call them.” A cat that’s made a break for it and who hasn’t been patted down to check for weapons is technically a security breach, which a TSA supervisor could use as justifiable cause to shut down an entire terminal.

Dogs, however, are no problem. “A pat down on a dog amounts to going over and petting them,” Harrington says. “That’s actually pleasant.”

2. THEY HAVE CODE WORDS FOR ATTRACTIVE (AND ANNOYING) PASSENGERS.

Because TSOs are usually in close proximity to passengers, some checkpoints develop a vocabulary of code words that allows them to speak freely without offending anyone. “Code talk for attractive females was the most common,” Harrington says. An employee might say “hotel papa” to alert others to an appealing traveler heading their way—the “h” is for “hot.” Others might assign a code number, like 39, and call it out. Harrington was also informed by a supervisor that he could signal for a prolonged screening for an annoying passenger if Harrington told him that the traveler was “very nice.”

3. FANCY HAIRDOS ARE A SECURITY RISK.

Any passenger coming through with an elaborate hairdo—either carefully braided hair or the kind of up-do found on women headed for a wedding—means additional inspection will be required, because piled-up hair can conceivably conceal a weapon.

“Just about anything can set off an anomaly in the head area, from braids to a scrunchie to a barrette to a bad hair day,” Harrington says. “And those body scanners are especially fussy when it comes to the head, giving false positives there more than any other area.”

4. THEY LIKE YOU BETTER WHEN YOU’RE EXHAUSTED.

A customer sleeping in the airport.
A tired customer is a pleasant customer.
AlexBrylov/iStock via Getty Images

“Tina”—a former TSO in the northeast who prefers not to use her real name—says that travelers taking evening flights are typically more cooperative than morning passengers. “People are actually much nastier when they’re flying out in the morning,” she says. “The really late-night travelers are the best ones to be around.” (Also on Tina’s naughty list: business travelers. “They’re generally meaner.”)

5. THEY SOMETIMES LIE ABOUT WHERE THEY WORK.

Because public criticism of the TSA is so pervasive, Harrington has found that many employees stretch the truth about where they work when asked. “If I had to admit it, I’d say I was working for the Department of Homeland Security,” he says. “When I made mention of that on Facebook, I got a ton of officers who said they did the same thing.”

6. CHEESE CAN LOOK JUST LIKE A BOMB.

Airport X-ray screening.
The foods in your bag can really confuse agents during an x-ray screening.
EvgeniyShkolenko/iStock via Getty Images

That giant wheel of cheese you’re bringing back from the holidays? It’s going to cause a lot of agitation among employees monitoring the x-ray machine. “A block of cheese is indistinguishable from C4,” Harrington says. “There is no difference on the screen. Meats, too. All organic products look orange on the display and similar to explosives.”

7. YOUR GENDER CAN CONFUSE THEM.

When a passenger enters a full-body scanner, the device operator hits a button to tell the unit whether it’s a he or she. It makes a difference, since a female passenger’s anatomy would raise a red flag when the machine expects to see male-only parts, and vice versa. If a person's gender isn’t easily ascertained on sight and a TSO guesses, a pair of breasts could initiate a delay. “The machines detect things under clothes, and if it doesn’t match what’s been pressed, it means a pat down,” Harrington says.

8. THEY DON’T DO THE SAME THING ALL DAY.

TSOs typically get assigned to different stations (ticket taker, x-ray operator, shouting-at-you-to-take-your-shoes-off officer) at the security checkpoint, and never for very long: 30 minutes is typically the limit before a new officer is brought in. According to Tina, the revolving schedule is to avoid employee error. “After 30 minutes, you may begin to miss things,” she says.

9. OPTING OUT GETS THEM ANNOYED.

Harrington’s security checkpoint had a code word for passengers who “opted out,” or refused to submit to the full-body scanners—they were “tulips,” and they proved to be an annoyance.

“It slows down the whole operation and a lot of guys would hate it,” he says. “Now that it’s millimeter [radio] waves and people still opt out, they get annoyed, thinking the passenger doesn’t even know what they’re opting out of.”

10. THEY’RE WRITING ON YOUR TICKET FOR TWO REASONS.

A TSA agent looking at a traveller's documents
No, TSA agents don't love it when you opt out of their full-body scans.
John Moore/Getty Images

Policies can vary by airport, but generally, security officers sitting up front and checking tickets are looking for irregularities in your identification: If something causes them to be suspicious, they’ll write something on your ticket that would prompt a more thorough inspection. “They’ll also write their badge number and initials,” Tina says, “so the airline knows they’ve been through security when they board.”

11. “CREDIBLE THREATS” STRESS THEM OUT.

According to Tina, turnover rates for TSOs can be high, and that’s due in large part to the perpetual stress of preparing for a hazardous situation. “In 10 months’ time, we went through active shooter training three times,” she says. “Another time, we were told there was a credible threat against the airport and not to wear our uniforms to or from work.”

12. THEY HATE WHEN YOU ASK THEM TO CHANGE GLOVES.

"The most common complaint [from TSOs] is when passengers ask them to change their gloves before a pat down," Harrington says, "because we change them all the time. We might have changed them just before getting to someone and passengers will still insist they use new ones in front of their face."

13. IT’S REALLY HARD TO GET FIRED.

TSOs undergo regular training and performance reviews where they're expected to simulate a screening in a private room for supervisors. After two years, the probationary period is over, and employees are generally set. “They’d call it being a ‘made’ man or woman,” Harrington says, referring to the mafia term for acceptance. “It’s really hard to get fired at that point. The only way to lose your job would be to commit a crime.”

14. THEY DON’T GET AIRPORT PERKS.

As federal employees, TSOs don’t enjoy any perks from airlines: Accepting a gift could be cause for termination, according to Tina. “But there’s a loophole,” she says. “If you’re friends with a pilot or have a personal relationship with an airline employee, you can accept it.”

A version of this story originally ran in 2016.

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