'Plastic Disasters,' a Documentary on Cosmetic Surgery, Has Its Premiere on HBO HBO By NATASHA SINGER Published: June 5, 2006 Cosmetic surgery is fast becoming the new national pastime. Viewers are devoted to reality programs like the Discovery Health Channel's "Plastic Surgery: Before & After" and E! Entertainment Television's "Dr. 90210." They set their TiVos to capture the drama "Nip/Tuck." They pass around articles from Allure and Vogue and discuss the latest procedures touted on the "Today" show. And they trade gossip about star doctors. But like other body obsessions — fitness, dieting or tanning, for example — cosmetic procedures can sometimes cause extreme harm. That is the subject of "Plastic Disasters," an hourlong documentary on plastic surgery patients that has its premiere tonight at 10 p.m. on HBO. The film, directed and produced by David Heilbroner and Kate Davis, who won an Emmy Award for her 2004 HBO documentary "Jockey," positions itself as the antidote to television shows like "Extreme Makeover" and "The Swan." Those reality programs, both now defunct, promoted plastic surgeons as fairy godmothers, transforming patients (after hours on the operating table and months of recovery time) from frumpy Cinderellas to plasticized clones of Pamela Anderson. "Plastic Disasters" takes the opposite point of view, that plastic surgery is not a welcome boost to self-esteem. The show posits cosmetic surgery as an agent of total ruination, leaving its victims scarred, both physically and emotionally. The documentary is gruesomely compelling, complete with shots of gore and gangrene. It focuses on three patients who have had bad experiences: Mona, who had a botched liposuction; Tony, who undergoes a series of operations to correct a faulty nose job; and Lucille, who, after a nose job and two face lifts, is obsessed with her appearance. Each is presented as a plastic surgery victim possessed of a heroic survival story. And that is what the filmmakers boil it down to: superficial survival tales, devoid of the most basic biographical details, including the patients' last names, locations, ages and professions. Physically, the most horribly scarred is Mona, who had been an avid bowler. After seeing television advertisements for a local cosmetic surgery center, she underwent liposuction. But her intestines were perforated during the procedure, she says, and she was hospitalized with a massive infection in her abdomen. That was just the start of her troubles. After operations to repair her intestines, she developed bedsores — most likely because she is a diabetic with poor blood circulation — that left her with huge scars. Then veins in one foot collapsed and gangrene set in. Doctors amputated one of her legs above the knee, then the other. The camera follows Mona as she adjusts to life as an amputee, hoisting herself in and out of her bathtub, reaching for groceries located on tall shelves and maneuvering herself from car seat to wheelchair. (According to the film, she settled a malpractice suit against the center where she had surgery.) "I was told that this was such a simple procedure. No downtime," Mona says. "I never recovered and never will." Lucille, another of the documentary's victims, says she believes her facelifts have made breathing and swallowing difficult, and offers a similar sentiment. "I never wanted cosmetic surgery," she says. "In hindsight, it was the biggest mistake I ever made in my life." And that is the documentary's real theme, that cosmetic surgery is bad — an anti-vanity message straight out of the Old Testament, or at least rooted in the fable of Narcissus. It is a simplistic, anti-betterment view told through maudlin tales of malpractice, with little medical context for balance. But there is no gotcha here. No doctor is ambushed leaving a medical complex, or forced to dodge microphones and cameras. In fact, the documentary never interviews or even really describes the doctors who are the real villains of these tales. Viewers will be left wondering why these events occurred. Why would surgeons risk operations on a diabetic like Mona or on an emotionally overwrought character like Lucille, who clearly has body issues? Were these patients originally operated on by experienced plastic surgeons, inexperienced gynecologists or emergency room physicians? Were they physicians in good standing, or were they doctors with long malpractice records who had been disciplined by their state medical boards? The filmmakers don't tell us. The medical omissions are particularly frustrating in the case of Mona Alley (we discover her last name because the camera momentarily pans across one of her bowling trophies). According to interviews she gave to The Boca Raton News and U.S. News & World Report, Ms. Alley had liposuction at the Florida Center for Cosmetic Surgery in Fort Lauderdale. At least two patients died soon after having surgery there; the clinic settled 18 lawsuits with patients who claimed their operations were botched, according to The South Florida Sun-Sentinel. The center could have provided the filmmakers with a perfect case study on how the facility, abetted by lax state oversight, developed such a controversial reputation. But the film never asks why the Florida Department of Health and its Board of Medicine were slow to discipline some of the doctors from the center. Not one state or federal health official or representative from a medical association appears in the film. "Plastic Disasters" concludes with a caution that reads: "Over 9,000,000 cosmetic surgeries are performed each year in the United States. The total number of complications is not a matter of public record." But according to the American Society of Plastic Surgeons, an association of about 5,000 board-certified doctors, Americans had about 1.8 million cosmetic surgical procedures last year. And while it is true that no single national agency collects statistics on every problem caused by plastic surgery, researchers do publish data on complications. The filmmakers could easily have found a provocative number, for example, in a recent article in "Clinics of Plastic Surgery," which put the death rate from liposuction at one in 5,000 procedures. Still, the documentary is as gripping as any horror movie, and it offers a powerful counter to the sensational reality-television world of augmented physiques. "Plastic Disasters" makes clear that cosmetic surgery can change lives. But not always in the way that viewers of "The Swan" might expect. Natasha Singer covers the beauty industry for The New York Times.