Netflix’s Skin Decision: Before & After Is Surprisingly Real for a Show About Plastic Surgery

Despite its rising popularity and acceptance, plastic surgery is still largely treated like the butt of a joke when it comes to TV shows and movies—think Botched, Sex and the City, or even RuPaul’s Drag Race. Even though I’m a beauty editor with access to info on the most up-to-date procedures and the firm belief what you do with your body is up to you, when I hear the words plastic surgery, I can't help but think of the swollen lips, Playboy-worthy boob jobs, and stiff face-lifts mocked in the media. But Netflix’s new reality show Skin Decision: Before & After, now streaming, is the first I’ve personally seen to handle plastic surgery with the care and nuance usually reserved for other medical issues. 

On the surface, Skin Decision is a makeover show in a similar vein to What Not to Wear or How Do I Look? Each episode features two different subjects with something specific they'’ like to change about their appearance. After we’re introduced to their stories, they meet with two experts: Sheila Nazarian, M.D., a board-certified plastic surgeon, and Nurse Jamie (Jamie Sherrill), a skin-care expert and registered nurse who works with celebrities like Lisa Rinna and most of the Kardashians. The experts will meet with the subjects, then debate whether the person is a better candidate for a surgical procedure, performed by Nazarian, or a series of nonsurgical treatments (lasers, fillers), done by Nurse Jamie. 

The reasons the subjects appear on the show are as varied and complex as why people seek out plastic surgery in real life. No one ever needs to justify why they want to undergo plastic surgery, but the stories they share on Skin Decision are emotional, powerful, and in some cases, shocking. Several people featured have survived tragic incidents that left them with major scarring or disfigurement. Sanaz, a woman who’s dealt with extreme acne for half her life, tells us she quit dating because she felt so insecure about the scars it left behind. Atticus, meanwhile, wants gender-affirming top surgery. Others come onto the show because their body changed following major life events like giving birth or turning 50. Regardless of the reason, the series (and experts) treats each patient with the same amount of care. 

Just 10 minutes into the first episode, it becomes clear that Skin Decision is equally about healing and trauma as about looks. I was immediately captivated by Katrina, who has several scars—including a literal bullet hole in her side—from when she was shot by her ex-husband before he took his own life. The scars wore on her self-confidence and were a physical manifestation of her trauma. After her procedure, which I won’t give away all the details of, she was ready to start fresh. 

On Botched, we learn about procedures at the expense of the patient. Although the doctors ultimately help their clients, it comes at the cost of treating them like a spectacle. The show also largely ignores the fact that many people seek out these questionable treatments because of barriers to entry like cost. In Skin Decision, the focus on education is done with care and empathy and without judgment. 

While I learned a lot in terms of how these procedures work and what’s available—I had no idea there were so many types of lasers—to call it a makeover show doesn’t quite fit. Maybe “beauty as therapy.” There’s a heavy emphasis on changing the stigma around plastic surgery—it’s not about changing who you are, but rather a means to become the best version of yourself. 

From the preview I expected the show to be a little cheesy. And in some ways it is. Not in the editing or production, or even the procedures themselves—which always turn out incredibly natural—but in the way it’s clearly manufactured to make you cry. But…it worked. I found myself tearing up at least twice every episode.  Though I especially related to the pain of the acne patients—I’ve broken down in several dermatologists’ chairs over feeling trapped in my own skin—it’s easy to empathize with at least one part of every patient’s story. It’s not all heavy, though! The light in the patients’ eyes when they look in the mirror for the first time was also responsible for several tears.

Overall, the show paints a positive and realistic picture of what cosmetic procedures can do. Dr. Nazarian and Nurse Jamie are kind, understanding, and realistic with the patients’ expectations. Not everyone one looks “perfect” at the end, but the change in their confidence is palpable. It hammers home what I as a woman, acne-haver, and beauty editor already knew: How we look on the outside directly affects how we feel about ourselves and, in some cases, how the world feels about us. I wish the show did more to question why these pressures exist, but perhaps that’s a lot to ask from a glossy reality show set in an expensive med spa. 

All in all, I was entertained. I sped through the eight episodes in two days, even as I covered my eyes during the surgery scenes (which are a bit graphic but very short). I tried to resist it, but I became emotionally invested by the end. It made me wish we lived in a world where these life-changing procedures were accessible to all because everyone deserves to be comfortable in their own skin. Until then, I’ll be anxiously awaiting season two. 

Bella Cacciatore is the beauty associate at Glamour. Follow her on Instagram @bellacacciatore_.

Originally Appeared on Glamour