Most of the 15.6 million procedures performed by plastic surgeons in 2020 were relatively safe, straightforward, and sometimes even affordable. Patients were largely in and out of the surgeon’s office with little recovery time and few, if any, complications.

But not always. Multiple people have died after getting Brazilian butt lifts or BBLs, a procedure in which a surgeon moves fat from other parts of the body to the buttocks. Most of those cases occurred at high-volume, low-budget clinics, and the Los Angeles police charged a mother and daughter with murder after they injected liquid silicone into a patient in an unlicensed procedure at a private home.

There are other risks when it comes to plastic surgery, even when conducted by a licensed professional: medical complications, fixes that don’t last, surgeries that don’t deliver what they were supposed to, or treatments that are simply the wrong procedure for the wrong person performed by the wrong surgeon.

“Some people have unrealistic expectations,” said Dr. Anthony Youn, a plastic surgeon in Troy, Michigan, who is a cosmetic surgery influencer on TikTok. “Not everybody is a good candidate for every procedure.” Youn estimates he turns down one out of every seven or eight patients who come to see him.

Most cosmetic procedures are safe, but there are a few treatments plastic surgeons that say they’d refuse to undergo, and others they perform only selectively on certain patients.

Buccal fat removal

No doubt you’ve heard of buccal fat removal. This procedure is the reason some celebrities, including model Chrissy Teigen, appear to have newly chiseled cheekbones. But the procedure, which involves removing a gumball-sized piece of fat from the inside of your cheek (the buccal space) to narrow your face, isn’t for everyone and could backfire over time.

“It can be a helpful procedure for someone who has a bottom-heavy type of face and wants to reshape it a little bit,” said Youn, who has a list of cosmetic procedures he recommends against.

Unfortunately, it’s being done on young people who have a narrower face. The problem? “Fat decreases with age anyway,” said Dr. Kenneth O. Rothaus, a board-certified plastic surgeon in Manhattan. That means people who have had the procedure may look older earlier than they normally would. It’s also a difficult procedure to undo, Rothaus added.

Brazilian butt lift

While people who’ve had buccal fat removed may regret it later in life, people who get so-called Brazilian butt lifts are undergoing a seriously risky procedure. The procedure, which involves taking fat from one part of the body, like the hips or thighs, and injecting it into the buttocks, has the highest death rate and greatest risk of any procedure done in cosmetic plastic surgery, said Rothaus, who does not perform the procedure.

The American Society of Plastic Surgeons estimates the death rate at about 1 in 3,000 procedures, much higher than any other cosmetic procedures.

The fat is autologous (meaning it’s your own), which decreases the risk of rejection, but it doesn’t have a blood supply in the new location to allow it to take well and survive, said Dr. Carolyn Jacob, a board-certified plastic surgeon and founder of Chicago Cosmetic Surgery and Dermatology.

Jacob does not recommend the procedure. Even if the patient does not experience severe complications, the surgery may not produce a lasting look.

Butt implants

Another gluteus maximus–enhancing procedure involves surgically inserting a silicone implant — basically a solid piece of material — into your buttocks. Adding implants to your tush can create problems.

“There’s a tremendous amount of pressure put on that area by sitting,” said Dr. David Cangello, a double board-certified plastic surgeon affiliated with Lenox Hill Hospital in New York City. “When you have an implant underneath, you’re limiting blood supply to the soft tissue of the buttock and it can lead to all kinds of problems.” Tissue can get infected and even die. Sometimes implants end up extruding — popping out — from the buttock cheek or the original incision.

Then, if you try to undo the damage by removing the implant, you end up with empty space. “There’s no good way for the tissue to rebound,” Cangello said. “You could end up with a real deformity where the buttocks are sagging, and you look terrible and require a very big surgery to lift the buttocks. Even then, it’s not usually the best outcome.”

Thread lift

Also known as the “lunchtime lift,” the thread lift firms up skin with barbed sutures, according to the American Society of Plastic Surgeons. This procedure can be performed on your face, eyebrows or neck skin, and sometimes even breasts.

“The barbs and sutures will hook on to tissues and pull on them,” said Youn, who does not perform the procedure. Results are immediate (hence “lunchtime”) but tend not to last very long. “The tissue can start to emerge through the sutures pretty quickly,” Youn said. “The results last maybe six months, yet the sutures are permanent so they would be sticking out of your face, sometimes years later.”

Absorbable sutures partly remedy these problems but they don’t mean the results will last any longer.

High-volume liposuction

Liposuction — removing fat via suction — is a common procedure and one of the safest. Problems arise when you take out too much fat, said Rothaus, who won’t perform liposuction on people with a high body mass index, or BMI.

“You have potentially life-threatening complications and certainly they have to be limited,” he said. “[If you] remove six to seven liters of fat, people can get huge volume shifts in their body and huge shifts in electrolytes that have effects on every organ system. They can faint, have respiratory problems, cardiac problems.” Rothaus limits liposuction procedures to two liters, saying that the complication rate for those more modest interventions is almost zero.

High-volume liposuctions also mean a lot of time on the operating table, which can result in clots, infection, and other complications, as with any long surgery. For the same reason, many surgeons won’t perform multiple cosmetic surgeries at one time. “Having more than one procedure in one operation is not reasonable,” Cangello said. “What becomes unreasonable is when a surgeon allows somebody to have so many procedures at once that the operative time becomes so long it becomes dangerous. Six hours is the cap.”

Lipodissolve

Another way to banish unwanted fat involves injecting chemicals to dissolve unwanted extra body mass, known as mesotherapy. “Personally, I don’t love it,” Cangello said.

In a mesotherapy procedure, the needle is aimed at a specific area of the body, but once the syringe is discharged, a doctor can’t control where that solution moves to, Cangello said.

That means it can go anywhere it wants. That’s one problem. Another is that the acid in the solution can damage nerves, affecting facial movement, Cangello said. “The nerves are not able to conduct signals and you lose facial function.”

Breast saline injections

In this case, a surgeon injects a simple saline solution into your breasts, which can plump them up in time for a short-term purpose, like a party. This really doesn’t last. “You inflate the breasts, and it’s gone the next day,” Cangello said.

The saline is easily absorbed by your body but it is an invasive procedure, he cautions. “Putting a needle in can create a hematoma,” Cangello said. “Any time you put a needle underneath the surface of the skin, it causes inflammation, which also creates scarring.”

Penile enlargement

“There’s a trend where people are doing penile enlargement with dermal fillers like hyaluronic acid,” said Cangello, who said that it doesn’t make sense to him. While the procedure adds girth to the shaft of the penis, it doesn’t add length, he noted.

Injecting a foreign substance underneath the skin creates inflammation, which can then leave a scar. “You’re creating a lot of scar underneath the skin of the penis,” Cangello said. “What that can do to that organ, which is a sexual organ and very important to everyone, over an extended period of time, God only knows. If you cause necrosis [death of tissue], that is a devastating consequence.”

The procedure also has a limited track record, and Cangello said he would never perform the treatment.

Selecting the right surgeon

If you’re considering plastic surgery, make sure you select one certified by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery. Some plastic surgeons are also certified by the American College of Surgeons.

Look for a surgeon who has extensive experience with the procedure you want — someone who is excellent with liposuction may not be the best choice for breast augmentation. If you don’t like the feel of the surgeon sitting across from you, find another one, Cangello advised.