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 Products for a Better Night's Sleep

Amazon/Comfort Spaces
Amazon/Comfort Spaces

Getting a full eight hours of sleep can be tough these days. If you’re having trouble catching enough Zzzs, consider giving these highly rated and recommended products a try.

1. Everlasting Comfort Pure Memory Foam Knee Pillow; $25

Everlasting Comfort Knee Pillow
Everlasting Comfort/Amazon

For side sleepers, keeping the spine, hips, and legs aligned is key to a good night’s rest—and a pain-free morning after. Everlasting Comfort’s memory foam knee pillow is ergonomically designed to fit between the knees or thighs to ensure proper alignment. One simple but game-changing feature is the removable strap, which you can fasten around one leg; this keeps the pillow in place even as you roll at night, meaning you don’t have to wake up to adjust it (or pick it up from your floor). Reviewers call the pillow “life-changing” and “the best knee pillow I’ve found.” Plus, it comes with two pairs of ear plugs.

Buy it: Amazon

2. Letsfit White Noise Machine; $21

Letsfit White Noise Machine
Letsfit/Amazon

White noise machines: They’re not just for babies! This Letsfit model—which is rated 4.7 out of five with nearly 3500 reviews—has 14 potential sleep soundtracks, including three white noise tracks, to better block out everything from sirens to birds that chirp enthusiastically at dawn (although there’s also a birds track, if that’s your thing). It also has a timer function and a night light.

Buy it: Amazon

3. ECLIPSE Blackout Curtains; $16

Eclipse Black Out Curtains
Eclipse/Amazon

According to the National Sleep Foundation, too much light in a room when you’re trying to snooze is a recipe for sleep disaster. These understated polyester curtains from ECLIPSE block 99 percent of light and reduce noise—plus, they’ll help you save on energy costs. "Our neighbor leaves their backyard light on all night with what I can only guess is the same kind of bulb they use on a train headlight. It shines across their yard, through ours, straight at our bedroom window," one Amazon reviewer who purchased the curtains in black wrote. "These drapes block the light completely."

Buy it: Amazon

4. JALL Wake Up Light Sunrise Alarm Clock; $38

JALL Wake Up Light Sunrise Alarm Clock
JALL/Amazon

Being jarred awake by a blaring alarm clock can set the wrong mood for the rest of your day. Wake up in a more pleasant way with this clock, which gradually lights up between 10 percent and 100 percent in the 30 minutes before your alarm. You can choose between seven different colors and several natural sounds as well as a regular alarm beep, but why would you ever use that? “Since getting this clock my sleep has been much better,” one reviewer reported. “I wake up not feeling tired but refreshed.”

Buy it: Amazon

5. Philips SmartSleep Wake-Up Light; $200

Philips SmartSleep Wake-Up Light
Philips/Amazon

If you’re looking for an alarm clock with even more features, Philips’s SmartSleep Wake-Up Light is smartphone-enabled and equipped with an AmbiTrack sensor, which tracks things like bedroom temperature, humidity, and light levels, then gives recommendations for how you can get a better night’s rest.

Buy it: Amazon

6. Slumber Cloud Stratus Sheet Set; $159

Stratus sheets from Slumber Cloud.
Slumber Cloud

Being too hot or too cold can kill a good night’s sleep. The Good Housekeeping Institute rated these sheets—which are made with Outlast fibers engineered by NASA—as 2020’s best temperature-regulating sheets.

Buy it: SlumberCloud

7. Comfort Space Coolmax Sheet Set; $29-$40

Comfort Spaces Coolmax Sheets
Comfort Spaces/Amazon

If $159 sheets are out of your price range, the GHI recommends these sheets from Comfort Spaces, which are made with moisture-wicking Coolmax microfiber. Depending on the size you need, they range in price from $29 to $40.

Buy it: Amazon

8. Coop Home Goods Eden Memory Foam Pillow; $80

Coop Eden Pillow
Coop Home Goods/Amazon

This pillow—which has a 4.5-star rating on Amazon—is filled with memory foam scraps and microfiber, and comes with an extra half-pound of fill so you can add, or subtract, the amount in the pillow for ultimate comfort. As a bonus, the pillows are hypoallergenic, mite-resistant, and washable.

Buy it: Amazon

9. Baloo Weighted Blanket; $149-$169

Baloo Weighted Blanket
Baloo/Amazon

Though the science is still out on weighted blankets, some people swear by them. Wirecutter named this Baloo blanket the best, not in small part because, unlike many weighted blankets, it’s machine-washable and -dryable. It’s currently available in 12-pound ($149) twin size and 20-pound ($169) queen size. It’s rated 4.7 out of five stars on Amazon, with one reviewer reporting that “when it's spread out over you it just feels like a comfy, snuggly hug for your whole body … I've found it super relaxing for falling asleep the last few nights, and it looks nice on the end of the bed, too.” 

Buy it: Amazon 

10. Philips Smartsleep Snoring Relief Band; $200

Philips SmartSleep Snoring Relief Band
Philips/Amazon

Few things can disturb your slumber—and that of the ones you love—like loudly sawing logs. Philips’s Smartsleep Snoring Relief Band is designed for people who snore when they’re sleeping on their backs, and according to the company, 86 percent of people who used the band reported reduced snoring after a month. The device wraps around the torso and is equipped with a sensor that delivers vibrations if it detects you moving to sleep on your back; those vibrations stop when you roll onto your side. The next day, you can see how many hours you spent in bed, how many of those hours you spent on your back, and your response rate to the vibrations. The sensor has an algorithm that notes your response rate and tweaks the intensity of vibrations based on that. “This device works exactly as advertised,” one Amazon reviewer wrote. “I’d say it’s perfect.”

Buy it: Amazon

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

Meet Ice Cream Scientist Dr. Maya Warren

Maya Warren
Maya Warren

Most people don’t think about the chemistry in their cone when enjoying a scoop of ice cream, but as a professional ice cream scientist, Dr. Maya Warren can’t stop thinking about it. A lot of complex science goes into every pint of ice cream, and it’s her job to share that knowledge with the people who make it—and to use that information to develop some innovative flavors of her own.

Unlike many people’s idea of a typical scientist, Warren isn’t stuck in a lab all day. Her role as senior director for international research and development for Cold Stone Creamery takes her to countries around the world. And after winning the 25th season of The Amazing Race in 2014, she’s now back in front of the camera to host Ice Cream Sundays with Dr. Maya on Instagram. In honor of National Ice Cream Month this July, we spoke with Dr. Warren about her sweet job.

How did you get involved in food science?

I fell in love with science at a really young age. I got Gak as a kid, you know the Nickelodeon stuff? And I remember wanting to make my own Gak. I remember getting a little kit and putting together the glue and all the coloring and whatever else I needed to make it. I also had make-your-own gummy candy sets. So I was always into making things myself.

I didn't really connect that to chemistry until later on in life. When I was in high school, I fell in love with chemistry. I decided at that point I should go to college to become a high school chemistry teacher. One day I was over at my best friend's house in college, and she had the TV on in her apartment. I remember watching the Food Network and there was a show on called Unwrapped, and they go in and show you how food is made on a manufacturing, production scale. In that particular episode, they went into a flavor chemistry lab. It was basically a wall full of vials with clear liquid inside them. They were about to flavor soda to make it taste like different parts of a traditional Thanksgiving meal. So you had green bean casserole-flavored soda, you had turkey and gravy-flavored soda, cranberry sauce soda. And I was like, "Oh my gosh, like how disgusting is this? But how cool is this! I could do this. I'm a chemist."

I love the science of food and how intriguing it is, and I had to ask myself, "Maya, what do you love?" And I was like, "I love ice cream! I’m going to become one of the world’s experts in frozen aerated deserts." I found a professor at UW Madison [where I earned my Ph.D. in food science], Dr. Richard Hartel, and he took me under his wing. Six and half years later, I’ve become an expert in ice cream and all its close cousins.

How did you arrive at your current position?

I didn't actually apply for the job. Six years ago, I was running The Amazing Race, the television show on CBS. After I was on it, a lot of publications reached out wanting to interview me. I did a couple of interviews and someone from Cold Stone found my interview. They noticed that I’m a scientist, and they were looking for someone with my background, so they reached out to me. I was actually writing my dissertation, and I was like, "I'm not looking for a job right now. I just want to go home and sleep."

I originally told myself I wasn't going to work for a year because I was so exhausted after graduate school and I needed some time off. But I ended up going to their office in Scottsdale for an interview. At that time, I still wasn't sure if was going to do it or not because I didn't want to move to Arizona. It's just so incredibly hot. I ended up being able to work something out with them where I didn't have to move Arizona. I came on board back in 2016. I started as a consultant at first because I didn't want to move. But then I proved I could make this work from afar.

What does your job at Cold Stone Creamery entail?

I'm the senior director for international research and development for Cold Stone Creamery. A lot of what I do is establishing dairies and building ice cream mixes for countries all across the globe. Dairy is a very expensive commodity. Milk fat is quite pricey. Cold Stone has locations all over the world, and they all need ice cream mixes. But sometimes bringing that ice cream from the United States into that country is extremely expensive, because of conflicts, because of taxes, different importation laws. A lot of what I do is helping those countries figure out how they can build their own dairies, or how can they work with local dairies to make ice cream mixes more affordable.

The other part of what I do is create new ice cream flavors for these places. I look at a local ingredient and say, "I see people in this country eating a lot of blank. Why don’t we turn that into ice cream? How would people feel about that?" I try to get these places to realize that ice cream is so much more than a scoop. In the States, we have ice cream bars, ice cream floats, ice cream sandwiches. But many countries don’t see ice cream like that. So getting these places to come on board with different ideas and platforms to grow their business is a big part of my job.

Ice cream scientist Maya Warren.
Maya Warren

What’s your favorite ice cream flavor you made on the job?

I made a product called honey cornbread and blackberry jam ice cream. Ice cream to me is a blank canvas. You can throw all kinds of paint at it—blue and red and yellow and orange and metallic and glitter and whatever else you want—and it becomes this masterpiece. That's how I look at ice cream.

Ice cream starts out with a white base that's full of milk fat and sugar and nonfat dry milk. It’s plain, it’s simple. For this flavor, I thought, "Why don’t I throw cornbread in ice cream mix?" I put in some honey, because that’s a good sweetener, and a little sea salt, because salt elevates taste, especially in sweeter desserts. And why don’t I use blackberry jam? When you’re eating it, you feel the gritty texture of cornbread, which is quite interesting. You get that pop of the berry flavor. There’s a complexity to the flavors, which is what I enjoy about what you can do with ice cream.

What is the most rewarding part of your job?

One of the most rewarding things is being able to produce a product and see people eat it. The other part of it is being able to have a hand in helping people in different countries get on their feet. Ice cream isn’t a luxury for many people in America, but there are people in other countries that would look at it that way. Being able to introduce ice cream to these countries is fascinating to me. And being able to provide job opportunities for people, that sincerely touches my heart.

The last part is the fact that when I tell people I’m an ice cream scientist, it doesn’t matter how old the person is, they can’t believe it. I’m like, "I know, could you imagine doing what you love every day?" And that’s what I do. I love ice cream.

What are some misconceptions about being an ice cream scientist?

When I tell people what I do, they automatically think I just put flavors in ice cream. They don’t know that there’s a whole other part of it before you get to adding flavor. They don't think about the balancing of a mix, the chemistry that goes into ice cream, the microbiology part that goes into ice cream, the flavor science that goes into ice cream. There’s so much hardcore science that goes into being an ice cream scientist. Ice cream, believe it or not, is one of the most complex foods known to man (and woman). It is a solid, it’s a gas, and it’s also a liquid all in one. So the solid phase comes in via the ice crystals and partially coalesced fat globules. The gas phase comes in via the air cells. Ice cream usually ranges from 27 to 30 percent overrun, which is the measurement of aeration in ice cream. You also have your liquid phase. There’s a semi-liquid to component to ice cream that we don’t see, but there’s a little bit of liquid in there.

People don’t think about ice crystals and air cells when they think about ice cream. They really don’t think partially coalesced fat globules. But it’s really fun to connect the science of ice cream to the common knowledge people have about this product they eat so much.

If you weren't doing this, what would you be doing?

If I wasn’t an ice cream scientist, I think that I would have been a motivational speaker. When I was a kid, my parents would send me to camp, and I remember having a lot of motivational speakers that would come in and talk to us. I always wanted to do that as a kid. So it’s either between that or a sport medicine doctor, because that was the track I was on in college. So if I didn’t figure out food science, I probably would have gone back to sports medicine. But I’m glad I didn’t go down that path, because I think I have one of the coolest and sweetest jobs—pun intended—that exists on planet Earth.

You’ve been hosting Ice Cream Sundays on Instagram Live since May. What inspired this?

At the beginning of quarantine, I was like, "What am I going to do? I can't travel anywhere. What am I going to do with all this extra time?" I was on Instagram, and I started seeing people at the very beginning of this make all this bread. And I was like, "I need to start talking about ice cream more. Ice cream can’t be left out of this conversation."

I started making ice cream and posting here and there, and people would ask me about it, and I would ask them, "Do you have an ice cream maker?" I put a poll up and 70, 80 percent of people who replied did not have ice cream makers. So I was like, "How am I going to make people happy with ice cream if all I do is show photos and they can’t make it?" Then I decided to make a no-churn ice cream. That’s not how you make it in the industry, but it’s how you make it at home if you don’t have an ice cream machine. I think it was around May 3, I decided I was going to do an Instagram Live. I’m going to call it Ice Cream Sundays with Dr. Maya, and I’ll just see where it goes from there.

I did one, and from the beginning, people were so in love with it. Then I thought, "Whoa, I guess I should continue doing this." I’ve made a calendar. People really attend. People make the ice cream. People watch me on Live. I’ve always wanted to have a television show on ice cream. I figured, if I can’t do a show on ice cream right now on a major network, I might as well start a show on Instagram.

What advice do you give to young people interested in becoming ice cream scientists?

My advice is: If you want to do it, do it. Don’t forget to work hard, but have fun along the way. And if ice cream isn’t necessarily the realm for you, make sure whatever you do makes your heart flutter. My heart flutters when I think about ice cream. I am so intrigued with it. So if you find something that makes your heart flutter, no one can ever take away your desire for it. If it is ice cream, we can get down and dirty with it. I can tell them about the science behind it, the biology, the microbiology that goes into ice cream itself. But I just encourage people to follow their heart and have fun with whatever they do.

What’s your favorite ice cream flavor?

If we’re talking just general flavors, I love a good cookies and cream. I’m an Oreo fan. I also make a double butter candy pecan that is my absolute jam.