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.

Wayfair’s Fourth of July Clearance Sale Takes Up to 60 Percent Off Grills and Outdoor Furniture

Wayfair/Weber
Wayfair/Weber

This Fourth of July, Wayfair is making sure you can turn your backyard into an oasis while keeping your bank account intact with a clearance sale that features savings of up to 60 percent on essentials like chairs, hammocks, games, and grills. Take a look at some of the highlights below.

Outdoor Furniture

Brisbane bench from Wayfair
Brisbane/Wayfair

- Jericho 9-Foot Market Umbrella $92 (Save 15 percent)
- Woodstock Patio Chairs (Set of Two) $310 (Save 54 percent)
- Brisbane Wooden Storage Bench $243 (Save 62 percent)
- Kordell Nine-Piece Rattan Sectional Seating Group with Cushions $1800 (Save 27 percent)
- Nelsonville 12-Piece Multiple Chairs Seating Group $1860 (Save 56 percent)
- Collingswood Three-Piece Seating Group with Cushions $410 (Save 33 percent)

Grills and Accessories

Dyna-Glo electric smoker.
Dyna-Glo/Wayfair

- Spirit® II E-310 Gas Grill $479 (Save 17 percent)
- Portable Three-Burner Propane Gas Grill $104 (Save 20 percent)
- Digital Bluetooth Electric Smoker $224 (Save 25 percent)
- Cuisinart Grilling Tool Set $38 (Save 5 percent)

Outdoor games

American flag cornhole game.
GoSports

- American Flag Cornhole Board $57 (Save 19 percent)
- Giant Four in a Row Game $30 (Save 6 percent)
- Giant Jenga Game $119 (Save 30 percent)

This article contains affiliate links to products selected by our editors. Mental Floss may receive a commission for purchases made through these links.

11 Secrets of Aldi Employees

Aldi is known for its unique cost-cutting measures that allow the chain to have some of the lowest prices for groceries.
Aldi is known for its unique cost-cutting measures that allow the chain to have some of the lowest prices for groceries.
Christopher Furlong/Getty Images

Since opening its very first store in Germany in 1961 and then coming to America in 1976, discount grocery chain Aldi has grown to over 1900 stores in 36 states. Using inventive cost-cutting measures—customers are responsible for returning their own carts and the store charges for bags unless you bring your own—the brand has become synonymous with quality at an affordable price.

Tasked with overseeing the long hours of daily operations are the company’s 25,000-plus store employees, who are typically part of a small team of 20 or fewer people per location. Aldi workers are expected to be proficient in everything from unloading pallets and stocking shelves to checking out customers at a speed that meets or exceeds standards—employees are even timed on how fast a customer pulls out their credit card.

To find out more about this challenging line of work, Mental Floss reached out to several current and former Aldi employees. Here’s what they had to say about memorizing barcode numbers, how many miles they walk during a typical shift, and why sitting down at the register is actually more efficient than standing.

1. Working at Aldi means walking. A lot.

At Aldi, employees aren’t given set roles when it comes to unloading, stocking, cleaning, or working the register. Everyone is expected to be able to do everything, which means a lot of physical effort. “Our job is considered physically demanding, because Aldi has very few employees running per shift, meaning there are more expectations placed on each of us,” Jonah, an Aldi employee in Pennsylvania, tells Mental Floss. “If you aren't ringing, you are expected to be cleaning, stocking, re-stocking, or organizing the shelves. There is no ‘down time.’”

That suits many employees just fine. “I don’t like to sit around and do nothing, and this job is the complete opposite,” Kyle, an Aldi employee in Virginia, tells Mental Floss. “I actually wear a Fitbit when I work, because I have been curious about how many steps I take. I average about 127,000 steps every [five-day] work week. I’d say an estimate is 25,400 steps a shift.”

2. Aldi employees sit down at the register for a very good reason.

An Aldi employee is pictured ringing out a customer in Chicago, Illinois in June 2017
Aldi employees are expected to ring customers out as quickly as possible.
Scott Olson/Getty Images

Employees can sit on stools while ringing guests up at a register, but getting a little rest isn't the sole reason for the seat. “While [resting] is true, Aldi says that cashiers sit at the register because, according to their testing, it allows us to ring up items faster,” Jonah says.

3. Aldi employees are monitored for their ringing speed.

Part of the reason Aldi can get away with as few as three to five employees in a store at any one time is because customers can be processed quickly. Aldi typically sets performance standards for employees at the checkout, who might be expected to process as many as 1200 items per hour. “We are given reports at the end of each day for our ringing statistics,” Jonah says.

And that’s not the only performance metric used to evaluate workers. “Ringing is the only part where we get an actual report, but managers will tell us that we are expected to knock out two pallets per hour, or one pallet every half hour," Jonah says.

4. Aldi employees “train” customers to move quickly.

Part of an employee’s register performance review depends on how quickly they can get a customer away from the register and toward an area where they bag their own groceries. To do this, employees encourage customers to have their payment method ready and inserted into the card reader before their items are done being scanned. “Aldi is all about efficiency, and encouraging our customers to ‘pre-insert’ their card while we are ringing allows the payment process to be near instant, rather than having our customers wait for us to finish ringing and then pull out their card and insert it,” Jonah says.

5. Aldi employees need Tetris-type skills to load carts.

Aldi shopping carts are pictured in Chicago, Illinois in June 2017
There's even a science behind how an Aldi cart is loaded.
Scott Olson/Getty Images

When an employee rings up a customer, items are loaded from the cart to the conveyor belt and then back into the cart. Because heavier items need to be placed first, employees need to be strategic when placing products. “[We put] light items like eggs, bread, chips, etc. at the top of the cart and everything else on the bottom,” Sara, an Aldi employee in Indiana, tells Mental Floss. “However, it really just depends on the order that customers put their items on the belt.” (They prefer you put heavy items like bottled water first.)

For maximum efficiency, Jonah prefers customers take products out of their display boxes and avoid trying to bag their groceries while cashiers are still ringing them out. “It slows us down and causes a longer wait for everyone,” Jonah says.

6. Aldi employees memorize barcode numbers.

An Aldi shopping basket is pictured in Cardiff, United Kingdom in August 2018
Aldi employees know the barcode numbers for several products by heart.
Matthew Horwood/Getty Images

Ringing speed is so crucial to Aldi’s success—and an employee’s job performance—that many workers memorize barcode numbers to keep the line moving. “Items like milk and water have codes that we memorize,” Sara says. “For example, someone could be buying six gallons of milk, and instead of having the customer put all of them on the belt for us to scan one by one, we tell them to leave them in their cart and we key in the codes, making the checkout process faster.”

7. Aldi employees may or may not give you a quarter if you forget one.

Because it would take time and money to collect shopping carts, Aldi has a system where customers insert a quarter to unlock a cart from the collection area. When they return it, they get the quarter back. But not all customers remember to bring a quarter, and first-time shoppers might not even know they need one. And if they ask an Aldi employee to borrow one, they may or may not get it.

“I try not to give them a quarter because the quarters we give come out of our own registers,” Kyle says. “So if we don't get them back, we end up losing money out of our own drawer. If it's a first-time shopper, I gladly give them a quarter and explain to them why we have this system in place, and pretty much every person is very understanding on why we do it.”

If you’re short a quarter, don’t try shoving anything else in the slot. “People will try to use foreign currency that are the same size as quarters,” Kyle says. “Doesn't hurt us; it's just annoying to deal with.”

8. Aldi has a store phone, but customers shouldn’t bother calling.

Customers are pictured in front of an Aldi store in Edgewood, Maryland in December 2017
Aldi employees are too busy in the store to answer the phone.
Sean Gallup/Getty Images

Aldi keeps the phone numbers for individual stores unlisted, preferring that employees deal with customers already in the store. Limits are placed on when the phone can be used. “We do technically have a store phone, but this phone is strictly used for receiving calls from the warehouse, global help desk, and to our security company we use,” Kyle says.

9. Aldi’s return policy is something employees can find a little too generous.

Aldi has a unique return policy for items purchased in their stores. Under their Twice as Nice Guarantee, customers can return a product and not only get a replacement item but a refund, as well. “Our Twice as Nice Guarantee is a very good system; I'd say one of the best in grocery,” Kyle says. “That doesn't mean it's perfect, though. I have seen people abuse this system. It's happened in my own store numerous times.”

Kyle declines to explain how it’s abused, though anecdotal reports are that perfectly good items are sometimes brought back to exchange for the benefit of a new item plus the refund. Serial returners are sometimes flagged and told to ease up. (The policy is currently suspended due to the coronavirus pandemic but is expected to return in the future.)

10. Aldi employees are required to wear steel-toed boots.

Work boots are pictured
Aldi employees need to protect their feet from inventory mishaps.
banjongseal324/iStock via Getty Images

Check out the footwear of an Aldi employee and you’ll notice they have on steel-toed boots normally seen on construction sites or warehouse jobs. That’s because workers are expected to unload the massive inventory pallets that arrive regularly. “All associates are required to wear steel-toed boots because of the equipment we use on the job,” Kyle says. “We use pallet jacks and it is just a safety precaution.” (Aldi does reimburse workers for the boots.)

11. Aldi employees appreciate you taking the survey.

Customers are pictured inside of an Aldi store in Chicago, Illinois in June 2017
Aldi employees say that receipt surveys can make a real difference in stores.
Scott Olson/Getty Images

The customer surveys that appear on Aldi receipts might go ignored by many, but they serve a real purpose. Employees are expected to meet a store quota of completed surveys, and customers can actually influence the selection inside the store. “We encourage customers to fill them out if they want a certain item brought in since the surveys go straight to corporate,” Sara says.

Regardless of how they offer their input, customers can often get what they want. “One thing that may surprise people is that you have a very strong voice on what items we should carry in our stores,” Kyle says. “A prime example of this is the [L’Oven Fresh] Zero Net Carb Bread. It was an Aldi Finds [a limited-time item] and people wanted this item to be a normal item so badly, and the company listened.”