Today, cosmetic surgery is an every day occurrence for both men and women. Because it has become so popular, there is an enormous amount of hype and misinformation. The media often sensationalizes, presenting either the illusion that cosmetic surgery is a quick, simple panacea offering “perfection, with no downtime”, or telling horror stories that often are the result of unqualified physicians using poor judgment and inadequate facilities, compromising safety by taking shortcuts. Neither is a realistic expectation for anyone considering cosmetic surgery and some pertinent information follows.   •Many TV shows, articles, etc. use information that preys on common fears and unrealistic expectations, promising ‘cheap, quick fixes with no downtime’. We call them the ‘procedure du jour’, ones that disappear as quickly as they appear, often leaving patients with wasted time and money and worse still, disfigured. Think back on the ‘new’ cosmetic procedures, LASERS and miracle creams you’ve read about in the past few years. Most have disappeared.   • Because of the lack of state laws, many office surgical facilities are neither regulated nor accredited  - a situation that can pose life-threatening dangers. Untrained doctors can legally do whatever operation they want in their own office surgical suite, using untrained assistants and outdated equipment. REALLY!!   • Franchised, ‘Doc in a Box’ cosmetic surgery centers have burgeoned, using trigger words like ‘cheap, quick, no down time, local anesthesia, no bruising, non-invasive’ cosmetic surgery. You should know that they often use hard-sell tactics and inexperienced, non board certified plastic surgeons offering limited, cookie-cutter procedures for everyone.   • MYTHS: General anesthesia is dangerous (i.e., more dangerous than local anesthesia with sedation).   The risk of death or life-threatening complication from a general anesthetic in a healthy adult is less than for a healthy 18 year old woman to be pregnant and deliver a baby. To insure maximum safety, general anesthesia should be administered by a fully trained physician anesthesiologist in a certified facility (better still - physically close to a full service hospital). Taking shortcuts such as using less fully trained people such as nurse anesthetists in a non certified office setting to save a few dollars makes no sense at all when your health and safety is at stake. Also, during a cosmetic procedure under general anesthesia the operated area is infiltrated with a local anesthetic so the procedure now becomes essentially painless; therefore the anesthesiologist needs to use much less general anesthetic than for i.e., intra-abdominal or orthopedic surgery. A responsible plastic surgeon will be sure you are healthy enough for elective surgery.   The longer a procedure, the more hazardous it is.    While it is true that a very long procedure (i.e., 12 Hours) is somewhat more dangerous than a 1 hour procedure, it is not true that a 2 or 4 hour procedure is more dangerous than a 1 hour procedure. An analogy can be made with an airplane flight, where the hazardous parts are the takeoff and landing - a 4 hour flight is not more risky than a 1 hour flight.    A smaller/shorter, less invasive procedure is better/preferable.   Consider quality, not quantity. For lesser problems a less invasive procedure might produce nearly as good a result, or at least an ‘acceptable’ result. However, if there are several significant problems to correct such as excess wrinkled skin, sagging muscle and missing fat, then a less invasive or less extensive procedure may well result in an unsatisfactory or unnatural looking result. There are safe and effective procedures that address the less-invasive, less down time concerns, but discuss options and expectations with a plastic surgeon who can do BOTH types of procedures. ------------- There is no shortage of qualified plastic surgeons who will help guide you to the procedure that is right for you – one that will be safe, effective and provide a long lasting result that will make you happy. You should feel comfortable with your plastic surgeon – not rushed or pressured into a decision. Armed with information, healthy skepticism, and realistic expectations, choosing which procedure will be effective for your concerns, who should do it, the kind of anesthesia that’s appropriate and where it should be done will be lots easier.    The caveat – is the same universal truth for success in anything –– use your common sense and do a ‘reality check’ - if it sounds ‘too good to be true’ odds are, it is.