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When to Say "No" to the Knife
by: Dr. Bunkis
Don't let doctor's persuade you into over-doing it.
Don't let doctor's persuade you into over-doing it.

Q: I was in the mall yesterday and noticed this woman that had so much plastic surgery she looked scary! When is too much too much and why would a doctor make someone look like that? Wouldn’t a doctor think to himself, "wow, this kind of thing could actually damage my reputation?"
-Stacy F., Trabuco Canyon

A: That is a good question, Stacy, but I think that even though the problem clearly involves both the doctor and the patient, the final responsibility in deciding which procedure to do belongs to the doctor. I am sure that I am no different from any other aesthetic surgeon who has been around for a while in as much as I can tell you a myriad of stories of patients who came in with unreasonable requests.

These range from young and thin females who notice the fist sign of inner thigh or inner arm laxity requesting an arm or thigh tuck, to very young patients, without any drooping, requesting face lifts because they noticed a line on their necks or a minor skin pucker when they dropped their chins, to older patients who have had many prior face lifts, who look incredibly stretched, coming in “for a last facelift”! Other examples include patients without a fatty excess requesting liposuction of their hips or abdominal wall, and patients with relatively normal noses, requesting thinning of the nasal tip or dropping a dorsum which already matches the patient’s profile.

Some doctors will tackle these patients, whether out of greed or a lack of experience, deluding themselves into thinking that they can make an improvement, only to be haunted for years by an unhappy patient who can no longer be helped. Don’t you think that Michael Jackson’s rhinoplasty surgeons wished that they would not have done his last few procedures and absolutely crippled his face?

When I take into account a patient’s best interests, even tough all of us have heard, “Pull it as hard as you can doc, this will be my last facelift!” More is rarely better! No patient should ever agree to a procedure without seeing a multitude of photographs of similar patients done by the surgeon, staff members who have had similar procedures, or a computer simulation of the expected result. The patient and the surgeon should be on the same page before the trip to the operating room. When a patient asks me to do a procedure, their job is to communicate their desires with me so we can decide if I can deliver what the patient expects, and my job is to educate the patient regarding expectations, or to turn them down if totally unreasonable. Otherwise, the surgeon will get, as you said, a bad advertisement in the community and damage his reputation.

In closing, it is always better to be on the conservative side rather than the aggressive side when doing a face or brow lift, rhinoplasty, breast procedure or any other aesthetic procedure I can think of. You can imagine that it is possible with any of these procedures to go back and to do a little more and still end up with a great result, rather than being faced with a situation where the tissues have been over stretched, over stuffed, over resected, or over liposuctioned – many of these deformities are very difficult, if not impossible, to correct. When I do a rejuvenating facial procedure, my goal is to turn the clock back and leave the patient with a natural, youthful appearance, not to pull the face taunt or to lift the brows unnaturally high to a point where they have never been before.

As an example, here are two front view photographs of Tina in our office. The first is at age 23 and the second is years later in her 50’s, after a face and brow lift.

Actual patient of Dr. Bunkis; your results may vary.


I have also included before and after side views so show you the degree in which the neck, jowls and brow position improved,quite dramatically, but when looking at the youthful and 50’s front shots, you can see that she was not overdone! 

Actual patient of Dr. Bunkis; your results may vary.

Note that before the procedure, her brows had drooped down to the point where they were touching her eyelashes – yet in the after photos, they are located a few millimeters higher, just where they were when she was young, not a half an inch higher where they have never been and would have made her look like an overdone, freaky person!

Sometimes a very pleasing change over can be achieved with a relatively simple and minimally invasive procedure! One of the best ways to envision how you would look following such procedures is through the use of computer imaging. If you would like to set up a complimentary computer imaging session, please feel free to contact Orange County Plastic Surgery at 949-888-9700.

949.888.970 | 30212 Tomas Ste. 275, Rancho Santa Margarita, CA 92688 |

As Medical Director of Orange County Plastic Surgery, Juris Bunkis, M.D., F. A.C.S. brings 30 years of surgical expertise to our communities. Dr. Bunkis is a Harvard trained, Board Certified Plastic Surgeon and Member of numerous prestigious organizations including the American Society of Aesthetic Plastic Surgeons, The International Society of Aesthetic Plastic Surgery, the American Society of Plastic Surgeons and the California Society of Plastic Surgeons. Dr. Bunkis, a former faculty member at the University of California, San Francisco, has published more than 40 scientific publications, abstracts and book reviews, and 17 book chapters in plastic surgery text books. For questions or advice, please contact Dr. Bunkis directly at

What do you think? Leave your comment here.

Comment by Jacqueline Holmes 10/31/2009 10:27:00 AM

I have had some work done by Dr. Bunkis and am very happy with the results. Thank you Dr. Bunkis your the best!!

Comment by Stephanie 10/29/2009 10:37:00 AM

I would love to get a consultation.

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