How Much Is Too Much? When to Pull the Plug on Cosmetic Procedures

·Senior Writer

It’s easier to overdo it on cosmetic procedures than you think. (Photo: Getty Images)

You’ve probably seen it happen. It could be anyone from a celebrity to a co-worker, but one day they appear looking slightly off, like some sort of plastic clone version of themselves. They don’t necessarily look younger or better, which was most likely their goal, they just look weird. It could be a sudden case of chipmunk cheeks, a shiny, frozen, plastic-looking forehead, a droopy Botox-filled eyebrow, or a scary case of duck lips, but when you see someone go from pretty to plastic, it’s terrifying.

Part of the problem is that cosmetic procedures have become so ubiquitous. Celebs are now owning what they are getting done and giving shoutouts to their plastic surgeons. Social media is filled with post-op selfies. Fillers are marketed as something to do on your lunch break. In certain circles, people give Botox parties that pair champagne with filler. It all makes it seem like getting work done is no big deal. It’s not hard to see the appeal; many cosmetic procedures can make people look great. Plus, so many of the new procedures don’t require the pain, trauma, and recovery time of going under the knife. So how can it all go so wrong? And who is to blame?

In a multibillion-dollar industry, there is a lot of profit to be made from doing multiple procedures on patients. The experts say that part of the problem is doctors who do too much and seem to have little discretion about who really needs these procedures. “Five years ago doctors were telling people to start young to prevent wrinkles,” says celebrity facialist Georgia Louise. “But it doesn’t mean you have Botox at 18. I work with a lot of young models, and a lot of them were encouraged to have collagen and Botox. Start as late as you can versus the other way around.” So when should you start, if ever? And is that something you should decide or your doctor? Many doctors believe the responsibility lies with them. Manhattan dermatologist Macrene Alexiades-Armenakas is not afraid to tell her patients to hold off. “When someone looks well-rested, fresh, and beautiful, the last thing you want to do is anything more. You just keep them as they are.”

The issue is that there are a lot of plastic surgeons and dermatologists who don’t say no. “Doctors have taken it to a new extreme, overplumping lips and cheeks,” says plastic surgeon Anthony Youn, MD. For many in the beauty business, there is a growing desire to make people look, well, unlike what people are supposed to look like. Smooth, wrinkle-free skin at 60 shouldn’t be happening. “Do you remember 10 years ago, everyone was filling nasolabial folds? People were walking around like chimpanzees,” says dermatologist Gary Goldenberg. “This is unnatural. More is not always better; sometimes more is just more.”

The key to not looking overdone is to know not only when to start (or not), but also when you’ve done enough. “You can’t chase every little crease,” says Alexiades-Armenakas. “That’s when you go from looking beautiful to not looking good. It is like any work of art — you have to know when to stop.”

But what happens when the patients don’t want to stop? In many circles looking “done” is actually desired. “It is almost like a status symbol,” says Youn, pointing to The Real Housewives of Beverly Hills. “Having a lot of work done is a way to show people ‘I have a lot of money.’” With new technologies emerging every day, many patients also want to try it all. “You are asking for trouble when you want to do five procedures in one day, it’s too much for your body to tolerate. When you compound procedures, that increases the risk of things not going as planned,” explains Alexiades-Armenakas, who on the day we spoke had to tell five different patients they couldn’t do multiple procedures.

The scariest part is that patients cannot be relied upon to know what looks good and what doesn’t. Think you know if you have gone too far with cosmetic procedures? Think again. Once people have work done, their perspective on how they look completely changes. “Immediately after they have a procedure they really don’t remember what they looked like, and when they’ve done too much they can’t put their finger on what’s wrong,” says Alexiades-Armenakas. This explains how so many people go from looking gorgeous to ghastly, seemingly without realizing it. This is especially easy since for many people, the first few times they do something it looks good. But the desire for perfection and to fight the natural aging process with every technology at their disposal is a strong one for many, and they do too much too often. That’s when everything goes awry.

So if you want to do something, how do you avoid crossing the line? Goldenberg believes in going slow and doing things that patients can easily reverse if they don’t like the way it looks. He advises patients to stay away from more permanent fixes. “There are a few doctors that still use silicone. It’s a permanent filler, but what may look good when you are 30 or 40 may not look good when you are 60. Our faces naturally change, and skulls usually shrink.” It’s also key to find a doctor whose aesthetic matches your own. If you don’t want to look like a Kardashian, don’t go to their doctor to have your lips plumped.

Another way to be sure that you won’t head into frozen territory is to explore different options. Louise explains that many of her clients come to her to stay looking fresh-faced and youthful without fillers. “I would say that 80 percent of my clients are looking to do noninvasive procedures so that they look more natural; they don’t want the same shiny skin with no expression.” Clients rely on her to give them a lifted and sculpted look using massage, microcurrents, radio frequency, and a serious skin care routine.

If you have gone too far (and realize it), however, can you reverse the effects of too much filler or too many laser treatments? That depends. You can wait for it to wear off and just not redo it. But that approach will work only if you have done one thing like Botox. If you have done multiple procedures, then it’s harder. There are also enzymes that can be used to dissolve filler. But that works better in some areas than in others. To try to dissolve a filler in the lip area, for example, where the skin has been stretched might leave the patient with new wrinkles. “If it is little tweaks, in all probability I can get you back,” reveals Alexiades-Armenakas. “However, injecting filler can cause permanent scar tissue that is not reversible. If you have gone over the deep end, you can’t delay trying to fix it. There is a point of no return.”


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