The homely housewife transformed in a magical hour into a drop-dead beauty queen and pitted, in a Miss America-type pageant, against a whole bevy of other made-over beauties — it's an unhealthy, trivializing twist on a very serious subject, warn plastic surgeons.

By their frivolous treatment of the topic, some TV shows can miss the point of plastic surgery, says Patrick Hudson, M.D. The Albuquerque, N.M., plastic surgeon favors the makeover programs that make self-satisfaction — not one-upping other after-surgery contestants — the ultimate prize. Hudson fears that some shows also set up unrealistic expectations of plastic surgery's potential, and underplay the procedures' risks and recovery times.

It's important to present the real face of plastic surgery, Hudson says, because unidealized hopes, as much as successful surgical results, can be the difference between a patient pleased with life after surgery and one who’s sorely disappointed.

Getting Real About Results

While cosmetic plastic surgery is perfect for fine-tuning a flawed body part — and providing a bonus self-esteem boost for some — it's no primrose path to a beautiful existence, say plastic surgeons about their medical art form. "It's true that plastic surgery can profoundly affect how people think and relate to the world around them," Hudson says. "But it's real surgery, not like getting your hair cut."

Most cosmetic surgery patients — some 90 percent, according to one recent study — are well-satisfied by their new look. Among them: Jill (who asked that her last name not be used), who had her breasts upsized from a 34A to a fuller, B cup.

"I just wanted some breast tissue," says the Albuquerque event planner, who longed to return to the modestly buxom body she enjoyed in her breastfeeding days. "It wasn't about vanity or suddenly having double-D breasts, but about feeling more feminine in a swimsuit or, of all things, pajamas."

By helping people take pride in their appearance, cosmetic surgery can enhance their day-to-day outlook on life. Breast augmentations, in particular, "can be bound up with the psyche," Hudson says, "and can produce the most dramatic changes in people's lives." Dr. Hudson has seen patients' newfound confidence translate into huge life-improving steps: finding new jobs or relationships, or leaving unfulfilling ones. Many of his patients have returned to school after surgery to pursue their college degree or GED.

Jill got her hoped-for body image boost — whether donning a business suit, bumming around with friends in a T-shirt and jeans, or wearing the once-dreaded bathing suit at the beach, the new look "made me feel better about myself," says the 34-year-old mother of one.

All the Wrong Reasons

Jill's Valentine's Day upgrade came at a time when her seven-year marriage was "flailing." But, Jill explains, the cosmetic operation "wasn't about 'suddenly I'll be more sexually attractive to my husband.' It doesn't do all that."

A cosmetic change is not a beeline to a better sex life, confirms plastic surgeon Hudson, and shouldn't be viewed, either, as a straight course to a carefree attitude. Four more things plastic surgery can't do for you, say doctors who want to set the record straight:

  • Dig you out of emotional turmoil. An emotional or stress-ridden period is the worst time to undergo a cosmetic operation, and if you're prone to mood swings or drug or alcohol abuse, don't consider cosmetic surgery. For many patients — Jill among them — plastic surgery can carry its own psychological challenges, tied up with physical recovery. "Many people have this surgery and can show up back at work in three days," Jill says. "I had extreme pain that painkillers didn't help. I figured out I was trying to numb psychological pain from where I was in my life and marriage, not just physical pain from surgery."
  • Replace your face with a favorite sexy celebrity's. Your facial features and bone structures are unique to you, so don't be lured by unrealistic aspirations of getting George Clooney's face or Halle Berry's physique.
  • Fix a relationship by pleasing a partner. Plastic surgery is about patients — making them feel better about themselves — and is a bad bet for salvaging a relationship on the rocks. For Jill, surgery was actually followed within a year by the breakupof her marriage — not that the change in her appearance corroded the relationship between her and her husband. Jill explains: "It gave me the self-esteem to end a marriage that needed to end." And, she adds, "It changed my relationships with men by giving me more confidence in dating."
  • Change your appearance with zero risk. Only in TV-land is plastic surgery "presto-chango" — from ugly duckling to dazzling swan. Those considering surgery should ask about risks and anticipate a possibly difficult time during recovery, depending on the procedure. They can reduce their risks by choosing an experienced, board-certified doctor.

It's "dangerous," Hudson says, when the plastic surgeon's office is viewed as a nothing-to-lose, one-stop shop for buying a perfect appearance. Though the risk-reward comparison falls ultimately to the patient's judgment, a responsible surgeon will try to rein in unrealistic expectations.

"Plastic surgeons don't operate on everyone who comes through their door, or shouldn't," Hudson says. "We have become gatekeepers of reality in an unreal world of distorted expectations."