Just previously, Burge said that she gave her daughter a £6,000-voucher for breast augmentation as a present for her birthday.

First and foremost, plastic surgery should never be imposed by parents to their children unless these are purely done for reconstructive purposes—and apparently, liposuction and breast augmentation are not.

Dr. Tarick Smaili, one of the leading Los Angeles plastic surgeons, said that cosmetic surgery should only be conducted on patients who are physically and emotionally mature, adding that “such procedures should never be brought up by parents to their children, especially those who are not bothered by their appearance.”

“The desire to have cosmetic surgery should only come from the patients themselves, not from anyone else.  Even your parent, husband, wife, or friend should not dictate what you have to do with your appearance,” Smaili said.

However, Burge claimed that she just want to “invest in her daughter’s future” and even compared the plastic surgery vouchers to something like “an investment for education.”

Burge, who has been reported to spend nearly $1 million for cosmetic plastic surgery, disproves accusation that she is a bad mother and defends her stance by saying that “good looks is important and there should be no stigma for anyone wanting to be beautiful.”

But despite her claims, Smaili believes Burge’s presents to her daughter can send a bad message to her young mind.

“Any ethical, self-respecting cosmetic surgeon would not recommend such thing.  First and foremost, board-certified plastic surgeons like me would not perform procedures if there is really no flaw or if the patients are too young to understand the ramifications of such procedures,” he said.

Last year, Burge gave her daughter a breast augmentation voucher and claimed that it has always been a request of her child.  (In the UK, the legal age for this procedure is 16, while in the US the Food and Drug Administration requires a patient to be at least 18 if she will choose saline implants, or 22 if she wants to have silicone implants.)

Meanwhile, perhaps Burge has to realize that the best gift she can give her daughter is letting her develop physically and emotionally at an appropriate rate for her age.

These two companies, while there is no legal limit on the breast implant size, do not produce silicone breast implants that are over 800 cubic centimeters (cc) due to the significant health risks and unnatural appearance.

On the other hand, saline implants can go as large as 950cc, although patients should bear in mind that the bigger the size is, the more risks they have to accept.  First and foremost, going for an extreme size can increase the chance of developing palpable and visible rippling even for those with an ample amount of tissue and fats in their breasts.

Another concern is that large breast implants can lead to chronic back pain or even spinal curvature as the body is forced to carry the extra weight.  This is more of a concern of women with petite or small body frame.

A good plastic surgeon will never push the body’s limit that he will turn down the request of a patient who is asking for an extreme size.  And because of the strict medical malpractice law in the US, no self-respecting board-certified doctor will use breast implants that are over 800cc.

In fact, Houston resident Sheyla Hershey, who has the biggest breast implants in the world, has to go abroad just to undergo breast augmentation surgeries to achieve her 38KKK bust size.

Dr. Tarick Smaili, a Los Angeles plastic surgeon who did not treat Hershey, warns that sooner or later she will experience complications.

“I’m quite concerned with the severe scarring of her breasts, as going for the 38KKK size requires countless of surgeries in order to expand the skin,” Smaili said.  According to reports, Hershey had has over 30 breast augmentation surgeries to beat the world record for having the largest breast implants.

Smaili said that the overall body frame, rib cage, and chest width of a patient should be considered when choosing the “right implant” size; in this way, achieving a natural result would be easy.

Aside from the natural-looking breasts, Smaili believes that choosing the “appropriate” implant size can also make breast augmentation as safe as possible because it can lower the risk of rippling and wrinkling and back pain, in addition to quicker recovery and less pain and discomfort during the healing period.

Perhaps the story of Vera Lawrence is one of the most unforgettable cases of underground plastic surgery which resulted to a tragic ending.  In May 2011, the woman died shortly after receiving a procedure to augment her buttocks and define her hips.

According to a police report, the victim has been injected with a liquid silicone to augment her buttocks and hips, a procedure that has been banned in the US for several years because of the “unacceptable” risks.

Today, the only safe and “legal” way to augment the buttocks is through the use of SOLID silicone implants which do not pose any risk of leak.  And unlike the LIQUID silicone, they will not inadvertently travel to other areas of the body, resulting to serious complications such as severe inflammation, discoloration of the surrounding tissue, infection, and formation of lumps.

While injecting a banned substance to the body is bad enough, the surgery has become more dangerous because it was performed in an apartment.  For this reason, the victim did not receive immediate medical care after she experienced breathing difficulty.

The stories of botched surgeries continue to make headlines.  Just recently, two women also fell victim to underground plastic surgery as a “fake” doctor injected their buttocks with a dangerous concoction of cement, tire sealer, and mineral oil; and to make matters worse, the incisions were closed using an “industrial” superglue.

Fortunately though, the victims were immediately treated with revision plastic surgery and have survived to tell their terrible experience.  However, it is not hard to imagine the medical costs and emotional trauma they went through.

Another horror story of botched plastic surgery involves a woman who woke up with conjoined breasts (or in layman’s term called uniboob) after her breast augmentation that was performed by an unqualified doctor.

A few months ago, Dinora Rodriguez had undergone breast augmentation without knowing that her surgeon was not certified to perform cosmetic surgery.  And to make matters worse, her doctor had also performed an eyelid lift without her consent; and now she has to put eye medications everyday for the rest of her life because she cannot close her eyes completely.

These stories of botched surgery conducted by unlicensed practitioners are a wakeup call for people who are considering underground plastic surgery because of its cheap price.  They should bear in mind that their quest to “save” money may instead result to more costly revision cosmetic surgeries.

Perhaps the best way to ensure one’s safety is to only choose a plastic surgeon certified by the American Board of Plastic Surgery.

The Advertising Standards Authority (ASA) believes that Groupon has been irresponsible for sending plastic surgery ads that were pressuring consumers to buy the vouchers for a limited period of time.  The promotional email was sent in May with the procedure to take place on November 28 at a clinic in Manchester.

The ban was imposed after ASA received complaints from the Independent Healthcare Advisory Service and a private individual.

But when asked for comments, Groupon officials said they did not believe the promotional emails “encouraged people to frivolously buy the vouchers” or force them to make “rushed decision.”  But despite such claim, the ads had a 24-hour deadline, as with any discount vouchers offered by the online company.

Any ethical plastic surgeon would likely agree with the decision of ASA.  First and foremost, having cosmetic surgery is a serious decision to make that is why lengthy consultation between a doctor and his patient is very important.

The ban was also justified since the British Association for Aesthetic Plastic Surgeons (BAAPS) prohibits adds that offer discounts to cosmetic surgeries that have a deadline date for booking appointments.  Authorities believe that “date-linked incentives” often result to rushed decision to have such invasive procedures.

But despite the obvious violation of marketing and ethical code imposed by BAAPS, Groupon is still adamant that their ads did not encourage people to rush their decision of having cosmetic surgery, adding the discount vouchers do involve consultation.

The online company also said that it has allowed refunds for customers deemed to be not qualified to have cosmetic plastic surgery.

But just to allay the concern of authorities, Groupon officials said they have extended the plastic surgery deals’ expiration time limit to at least three days.  However, even extending the promotions still violates the ban on “date-linked incentives” in cosmetic surgeries.

People should remember that plastic surgery is a serious decision to make as it involves a great deal of preparation, some risks, lengthy recovery, and expensive fees.  With this consideration, surgeons require their patients to be emotionally, psychologically, and physically healthy to avoid or at least minimize the risk of complications.

Patients should also consider that cosmetic surgery is not something that can give them a perfect appearance but just some level of improvement.

However, what is more surprising is that she is still determined to hold the record for having the largest breast implant size in the world.  In fact, she was reported to have traveled to Mexico in order to receive a new operation to “reinflate” her breasts, even without her husband’s knowledge.

In an interview with the Daily Mail, Hershey was quoted saying that she felt “deformed without her breasts.”

“I feel like I lost my leg,” she added.

Hershey regained her previous 38MMM cup size with a procedure that injected saline solution inside her breast implants.  Her husband only thought that she was going to Mexico in order to reconstruct her bust.

With the result of her new operation, she said she was happy and “felt whole again.”  Meanwhile, some experts believe she was suffering from body dysmorphic disorder, a type of mental illness in which the sufferers are extremely conscious to their body image and preoccupied with their slight or imaginary defects of their physical features.

According to previous reports, Hershey is also suffering from bipolar disorder.

Dr. Tarick Smaili, one of the leading Los Angeles plastic surgeons, said that breast implants are reasonably safe “as long as they come in sizes appropriate to the body-frame and amount of tissue and skin of patients.”

“A good and ethical plastic surgeon will not push the body’s limit by introducing breast implant size that is way too large for a patient.  Violating this principle will likely result to higher risk of implant visibility, unusually painful recovery, and other serious complications,” Smaili said.

Smaili said that he was also concerned with the significant scar tissue associated with having multiple breast surgeries, which are necessary if one is going to have inordinately large breast implants.

“Hershey is likely having multiple breast implant surgery to slowly stretch her tissue and skin, however, it is also possible that she is using tissue expanders, which are temporary implants injected with saline every couple of weeks, so her breast can house larger sizes”, the surgeon added.

Meanwhile, the US Food and Drug Administration does not impose any limit on breast implant size although US manufacturers Mentor and Allergan do not offer implants larger than 800cc.

While this plastic surgery procedure is commonly known as a way to aesthetically improve the body, this is also used to treat the physical symptoms associated with panniculus (excess, hanging skin in the abdominal area).  These include back problem, foul odor, breakdown of skin, ulcers, irritation, poor hygiene, and difficulty in walking and sitting.

However, not all patients who have panniculus can have tummy tuck as this procedure, as with any plastic surgery, involves recovery and certain risks especially for individuals who have serious health issues and healing problem.  For this reason, doctors perform a screening test that will differentiate a good candidate from a high-risk patient.

A good candidate should have a normally functioning immune system to ensure that she will not be exposed to skin necrosis (death of skin tissue), unnecessary scarring, infection, and other complications.  But aside from being physically healthy, it is also important that she is emotionally and psychologically stable so that she can have a full understanding on the limitations and risks of this surgery.

It is also important for a patient to have realistic goals and expectations which can determine if she will be satisfied with the result, according to plastic surgeons.

Most patients who ask for tummy tuck surgery are women who are left with sagging skin and weakened muscles due to several pregnancies.  However, plastic surgeons recommend postponing this procedure for individuals who are still considering having babies as childbearing can reverse its result.

Massive weight loss patients are also a good candidate for this procedure, especially if they have had weight loss surgery such as gastric bypass and lap band.  According to plastic surgeons, shedding more than 100 lbs. of weight will usually result to the development of panniculus and hanging skin in other areas of the body.

But since these patients have a significant amount of excess skin and tissue and pockets of fats, they will receive a more extensive technique in tummy tuck which involves longer incisions, more scarring, and higher risk of complications.  But despite such downsides, this approach may be the only way to provide the best result for these individuals.

Nowadays, most plastic surgeons use tumescent solution in removing the fats.  In this way, the fatty deposits become swollen and firmer, thus making them easier to be removed without exposing patients to high levels of surgical trauma and bleeding.  For this reason, there is no need to perform blood transfusion which was a common practice during the previous liposuction techniques.

Despite the safety of the tumescent solution, which is injected directly to the treated area, there is still a risk of toxicity.  Fortunately, plastic surgeons can easily avoid this complication by limiting the amount of lidocaine (a type of local anesthesia mixed into the solution) to 50 milligrams per kilogram of a patient.  In fact, there are no reported deaths with this approach unlike when using general anesthesia, IV sedation, and more than 75mg/kg of lidocaine.

To further reduce the risk of toxicity, lidocaine is combined with epinephrine which is a drug that constricts the blood vessels to prevent bleeding and to spread the effect of this local anesthesia for longer hours, according to plastic surgery specialists.  And since the effect of lidocaine is spread, its numbing effect can last for up to 36 hours which means that patients can skip pain medications within this period.

Aside from the introduction of tumescent liposuction technique, medical guidelines have further made fat removal surgery significantly safer compared to previous years.  For example, plastic surgeons today conduct several sessions if they need to collect more amounts of fats to limit the surgical trauma.

According to experts in plastic surgery, a prudent doctor will not collect more than 3 or 4 liters of fats in a single session as doing so can expose patients to high surgical trauma and more risks.

As with any plastic surgery, liposuction involves certain risks such as bleeding and delayed recovery.  Fortunately, such complications can be significantly reduced by avoiding aspirin, ibuprofen (Advil), red wine, vitamin E, and herbal supplements several weeks before and after the procedure.

To be on the safe side, patients should inform their doctors about their current medications, medical history, and previous surgeries.

It is also important that the patients are not smoking or not exposed to second-hand smoke since the nicotine, carbon monoxide, and other chemicals found in the cigarettes can delay the body’s healing ability by interfering with oxygen absorption and diminishing the blood supply from the incision site.  In most cases, delayed healing results to risks of skin necrosis (death of skin tissue that results to unnecessary scarring) and also infection.

To reduce the risk of skin necrosis and other complications associated with smoking, most plastic surgeons ask their patients to stop the habit several months before and after the surgery.  Following such advise is critical since a recent study shows that smokers are 1,500 more likely to develop skin necrosis compared to individuals who are not smoking.  (See picture below.)

Because of the risk of smoking, majority of plastic surgeons are now refusing to operate on smokers, especially those who seek breast surgery, facelift, tummy tuck, and other procedures that require skin to be shifted, unless they are willing to quit the habit well in advance of their plastic surgery.

Aside from being physically fit, a good candidate for breast augmentation surgery should have realistic goals and expectations which can have a significant impact on the satisfaction of patients after the surgery.  It is important to note that with realistic and attainable expectations, this plastic surgery can improve a person’s confidence and body image.

Meanwhile, breast augmentation is usually performed with the use of silicone or saline implants, although fat grafting (using a patient’s own fats to augment the bust) is increasingly becoming a popular alternative for women who want to slightly increase their size (this approach can only increase the bust with less than a “cup”).

With this consideration, breast implant surgery is usually recommended on patients with smaller breasts who want to significantly increase their size.  However, petite women who usually have limited breast tissue and skin may not accommodate larger implants because they are at higher risk of rippling and wrinkling.

While more commonly used to increase the bust size, plastic surgeons also perform breast implant surgery to address asymmetrical appearance (one breast is smaller or sags more than the other), make the breast appear fuller again after weight loss or pregnancy, and reconstruct the breast of post-cancer patients.

For example, otoplasty which is a plastic surgery used to pin back the ears can be performed on patients as young as five.  Ideally, this procedure is conducted on children and teenagers because their tissue is easier to work with compared to adults.  But still, some patients choose to have this procedure in later years.

In case the ears of a child are extremely deformed, his parents can decide on his behalf.  But in the situation of a mild aesthetic problem, most plastic surgeons believe that it is better for parents to wait for their kids to ask for any medical intervention since not all them are bothered with their appearance.

To know if a teenager is a good candidate for plastic surgery, doctors not just perform physical examination (to determine the health status) but also discussion to explain the benefit and limitations of a certain procedure.  It is important to note that a good candidate should have realistic goals and expectations which can determine if he will be satisfied with the result.

During the discussion, plastic surgeons will also examine if their teenage patients have enough maturity that will help them cope with the temporary discomfort and downtime after a surgical procedure.  In general, cosmetic surgery is not recommended for patients who have erratic behavior, extreme mood swings, mental illness, and clinical depression.

Aside from having a stable mental and emotional health, teenage patients should also reach a certain age before they can receive a procedure, especially if performed for aesthetic reasons.  For example, cosmetic rhinoplasty (“nose job”) is only ideal for individuals who are at least 14 or 15 years old (or slightly older for male) to make sure that the result will not be affected by the physical changes in later years.

If this procedure is performed below the age limit, patients may need a revision rhinoplasty.  However, most plastic surgeons do not follow this age requirement if the surgery is going to be performed as a way to reconstruct the nose after an injury or treat breathing problems due to abnormal growth and birth defects.

Most plastic surgeons agree that underwire bras should not be worn unless the breast implants have “dropped” and “settled” into their proper position.  Patients should remember that wearing the right medical garments and support can lead to a more natural-looking bust.

(Note: The breast implants will appear unnaturally high during the first several months, although they will eventually drop into their correct placement with the use of medical bra.  In some cases, plastic surgeons may recommend their patients to perform breast massage that will further promote better placement of the implants, resulting to a natural appearance.)

For women who have received breast crease incision, they should have to wait until the surgical cuts are completely healed before they can wear underwire bras.  The wire may create friction or pressure on the incisions, which may result to pain, unnecessary scarring, and delayed healing, according to plastic surgery specialists.

In some cases, the skin near the incision sites may be numb for several months after the plastic surgery.  With this, patients may not feel any pain even if the underwire actually digs into their skin.

For patients who experience irritation, pain, or redness around the incisions that last for at least a week, they should immediately inform their plastic surgeons since these may be a symptom of infection and other complications.

To be on the safe side, patients should ask their doctors if wearing an underwire is safe for them.

In most cases, plastic surgery specialists recommend medical bra especially designed for post breast augmentation that will prevent sagginess and back and shoulder pain.

Even if the incisions are already closed, these may still be irritated with common fabric used in most bras.  For this reason, most doctors require women to wear an elastic bandage or wrap foam padding around their breasts; if necessary, this garment may be worn under the bra to provide better support during their recovery.

Aside from wearing the proper garments, patients should also take care of the incision site to prevent infection, bleeding, and unnecessary scarring.  And to prevent the incision line from becoming dark, they should not expose it under the sunlight for at least six months to a year.

For patients who are concerned with scarring, there are ointments and creams that can minimize its appearance, although they should only apply these after the incision sites are completely healed.