Throughout my career as a board-certified Beverly Hills plastic surgeon, I have performed cosmetic procedures involving the face, breasts and body. That experience has reinforced an important lesson: the fact that a treatment is technically possible does not automatically make it the right choice for every patient.
When evaluating elective surgery, I consider how predictable and reversible the outcome will be, the potential risks, how long the results are likely to last and, ultimately, whether I would feel comfortable recommending the procedure to a member of my own family.
With those standards in mind, these are six procedures I rarely—or never—recommend, listed from options that may have a role in carefully selected cases to the one I would avoid altogether.
1. Cheek implants
Cheek augmentation with solid implants involves placing permanent material over the cheekbones to increase projection and define the midface. The procedure can produce attractive results for the right patient, so I would not describe it as inherently problematic. My concern is what can happen over time.
The face continues to age while the implant remains unchanged in size and shape, potentially creating an unnatural appearance years later. Implants may also shift, become visible beneath the skin or develop an infection, which can lead to revision surgery or removal.
Today, surgeons have more nuanced ways to restore facial volume and tailor treatment to an individual’s anatomy. I generally favor techniques that allow the face to be sculpted and refined rather than committing patients to a permanent implant.
2. Chin implants
For carefully chosen patients with a recessed, under-projected or “weak” chin, an implant can be an effective option. But it is not the appropriate solution for every person whose chin appears small.
The first step is identifying the underlying cause. Is the concern strictly cosmetic, or does it reflect a structural or medical issue that needs separate treatment?
Some patients have a skeletal imbalance or bite abnormality that a chin implant cannot fix, since the device sits on the outer surface of the lower jaw. Based on the patient’s anatomy and the amount of correction required, more extensive surgery may be necessary to cut and reposition the jawbone itself.
Chin implants can also lead to malposition, asymmetry, infection or numbness. If the implant settles in an unfavorable position, prolonged pressure may cause changes to the underlying bone.
3. Lip implants
Lip implants are permanent synthetic devices inserted through the lip to create lasting fullness. Although permanence may sound appealing, the lips are constantly moving as we speak, smile, eat and kiss.
A permanent implant may feel excessively firm, become noticeable to the touch, migrate, become infected or look unnatural as the surrounding face changes with age.
If a patient becomes unhappy with the lips’ size or shape, correcting the result requires another operation. I prefer using temporary hyaluronic acid filler for subtle enhancement because it can be adjusted gradually and, when necessary, often dissolved.
I prefer temporary hyaluronic acid filler for subtle, adjustable lip enhancement
4. Buttock implants
CHECK THIS OUT: China and Europe Agree to More Than Halve Chinese Hybrid Vehicle Exports
Unlike breast implants, solid silicone buttock implants are placed in a region exposed to considerable pressure and muscular activity from sitting, walking and exercising.
Recovery can be especially challenging because patients cannot completely avoid using the gluteal area in daily life. Possible complications include wound separation, in which the stitched incision reopens, along with infection, fluid buildup, implant displacement and the potential need for revision surgery.
In patients seeking gluteal enhancement, I would rather evaluate whether there is a safer, anatomically appropriate alternative rather than placing a large permanent implant in an area exposed to so much mechanical stress, including surgical fat transfer and good old-fashioned exercise.
5. Transumbilical breast augmentation
Transumbilical breast augmentation (TUBA) places breast implants through an incision hidden inside the belly button and advances them through a tunnel up to the breasts.
Typically, empty saline implants are inserted into the body empty and then filled, as opposed to silicone gel implants which arrive from the manufacturer filled to a fixed volume.
The obvious selling point is no incision on the breast, but I don’t believe hiding a small scar justifies sacrificing surgical control. The technique limits a surgeon’s ability to visualize placement of the implant.
For me, breast augmentation is about precision: controlling the pocket, position, symmetry and implant relationship to the patient’s anatomy.
I prefer an incision that gives me direct access and maximum control rather than choosing a technique primarily because the incision sounds more appealing.
6. The procedure I would NEVER recommend
Injectable silicone is in a completely different category from an FDA-approved silicone breast implant.
For me, breast augmentation is about precision: controlling the pocket, position, symmetry and implant relationship to the patient’s anatomy
In this procedure, silicone is injected directly into tissues to enlarge areas such as the buttocks, breasts, face or lips. I would never recommend cosmetic free-silicone injections.
Silicone can migrate from where it was injected and trigger chronic inflammation, granulomas, tissue destruction, infection and other serious complications that may appear years later.
Once injected, it can be extraordinarily difficult, or impossible, to remove completely because it becomes incorporated throughout the tissues. Some complications require multiple operations and can cause permanent deformity. For me, the risk-benefit equation simply does not make sense.
The common thread is that aesthetic medicine should never be about doing a procedure simply because it exists or because it is trending. My job as a plastic surgeon is as much to operate as it is to know when to say ‘no.’
The best procedure is the one that gives the individual patient the safest, most predictable, most natural-looking result, with risks that are justified by the potential benefit.
