Inside the Dark, Sometimes Deadly World of Cosmetic Surgery

Getting a little work done can either be a dream come true or your worst nightmare.

The bone-chilling reality is that going under the knife comes with a cost. For supermodel Linda Evangelista, it was a CoolSculpting treatment that she said left her "brutally disfigured," while Wild 'N Out's Jacky Oh paid the ultimate price when she died from complications due to a gluteal augmentation (a.k.a. a Brazilian Butt Lift or BBL).

And yet, despite some of the horrifying outcomes of plastic surgery, getting nipped and tucked is still very much in demand. According to the American Society of Plastic Surgeons' 2022 report, body-centric procedures increased by 25 percent, while facial-related surgeries grew by 18 percent. In the non-invasive categories, fat reduction treatments rose by 77 percent, and so did cosmetic injectables between 70 to 73 percent.

But why are so many people quite literally willing to risk it all? Board-certified plastic surgeon Dr. Ari Hoschander put it simply, telling E! News in an exclusive interview, "There's people that feel, 'That's not going to happen to me.'"

For others, the decision to move forward with an operation is more than just skin deep.

"I drank the magic potion," Linda told Vogue U.K. in 2022 about being charmed by the promises of the CoolSculpting treatment, "and I would because I'm a little vain. If I had known side effects may include losing your livelihood and you'll end up so depressed that you hate yourself, I wouldn't have taken that risk."

The '90s icon developed paradoxical adipose hyperplasia (PAH)—a reported side effect of the body-contouring procedure, in which the fat cells grow instead of shrink, per Healthline.

"I have incisions all over my body," Linda said of the two liposuction procedures she underwent to remove her protruding skin. "I have had stitches, I have worn compression garments under my chin, I've had my entire body tightly girdled for eight weeks—nothing helped." 

As she attempted everything from temporarily starving herself to going under the knife, desperate to fix herself, "I was losing my mind."

And yet, despite her cosmetic procedure nightmare, the 58-year-old revealed she's still drawn to the allure of being beautiful. "I want wrinkles," she told Vogue in August, "but I Botox my forehead so I am a hypocrite."

Linda is hardly alone in her experience, as other celebrities like Sharon Osbourne, Heidi Montag and Tara Reid have succumbed to the pressures of needing to maintain their appearance.

Sharon recently told E! News that she's made so many enhancements to herself over the years, she could be an example of what not to do.

"If anybody should do an advisory on plastic surgery, it should be me," she said in a Sept. 7 interview. "There's not one part of my body I haven't had twisted, lifted, elongated. I've been messed up many times."

Heidi, who famously underwent 10 cosmetic procedures in one day back in 2009, admitted that her beauty makeover almost landed her six feet under.

"I died for a minute," The Hills star revealed to PAPER in 2018, reflecting on the time she got a chin reduction, brow-lifts, ear pinnings, a second rhinoplasty and a second breast augmentation, among others. "With that much surgery, I had to have 24-hour nurse care."

The whole time, she said, husband Spencer Pratt "didn't want to leave my side."

After her brush with death, she noted, "Cutting yourself up isn't something I'd recommend."

It's a perspective she was fortunate to gain. But others aren't as lucky as the reality TV star. 

Kanye West's mom Donda West died in November 2007 from heart disease, in addition to "multiple post-operative factors" after a liposuction, tummy tuck and breast reduction operation, per an autopsy report obtained by E! News at the time. She was 58.

More than 15 years later, MTV star Jacky Oh suffered a similar outcome as the rapper's mom, passing away on May 31 at the age of 33 after a gluteal augmentation procedure—in which the autopsy report revealed she had liposuction and transferred the fat to her butt.

According to the National Library of Medicine, studies have shown that liposuction fatalities are as high as one in 5,000 surgeries. Liposuction deaths are so well-known that even Alicia Silverstone's character Cher in Clueless makes an offhand comment that her mom died of "a fluke accident during a routine liposuction."

The stats for Brazilian Butt Lifts are even more chilling with the American Society of Plastic Surgeons reporting that one in 3,000 BBL's result in death.

Dr. Hoschander's advice? "Don't do it," he told E! bluntly. "You have to think: Is it worth it to have a procedure that it's going to, ultimately, deform your body and that you have a risk of death from? I don't know how many people truly understand that."

It's clear stars are hoping their transparency about the good, the bad and the ugly might help others on their journey to alter their appearance.

"Transparency is always good, no matter what," Dr. Hoschander noted. "Otherwise, people will just think, 'That woman or man is beautiful and I'm not.' It's empowering to know you can change something if you don't like it. And having celebrities say, 'I never liked my nose, I got it done and now I'm happy.' That's wonderful transparency."

Though he cautions, seeing isn't always believing, noting that with editing and filters, "The reality is [celebrities] don't have the body that you think they have."

While stars are just now lifting the plastic tarp on plastic surgery, our desire to get work done and share it with the world goes back nearly a full century. Back in 1931, Dr. John Howard Crum performed the first public facelift at the International Beauty Shop Owners' Convention on Martha Petelle—a 66-year-old actress—who volunteered for the procedure in the hopes of securing more screen work. Sound familiar?

"The operation, as publicly performed, appeared amazingly simple—about as easy as peeling a banana," Thyra Samter Winslow wrote in The New Republic at the time, per Teresa Riordan's Inventing Beauty book. "The surgeon drew up the sagging face. Snipped it. Sewed it together into a semblance of youth. He bandaged the two long, narrow wounds. And the old lady, much younger looking, certainly, had her hair waved and her photograph taken!"

Thyra suggested that desperate souls might find the procedure worthwhile. Almost 100 years later, the sentiment rings true as everything from facelifts to Botox injections continue to skyrocket in popularity.

And if you're in the market to make a few enhancements, there are ways to avoid a botched job.

"The most important advice I can give somebody," Dr. Hoschander said, "is that whoever they're seeing, they should be able to see dozens of before and after pictures that their surgeon has done."

He continued, "If you can't find a person's before and after photos or find only a couple of them, it means they're not doing it or they're not good. It's a huge red flag."

And while plastic surgery continues to be in demand, people are slowly starting to take the less is more approach. As Dr. Hoschander summed it up, "The future of plastic surgery is headed more towards the natural look."

Ultimately, loving the skin you're in is a lot more powerful than you think.

"I'm very comfortable with my body now," Tara Reid exclusively told E! News in 2021, recalling her botched breast augmentation, liposuction and reconstructive surgery. "You have to look in the mirror and go, 'I'm OK with myself. I don't care.' I'm in the place in my life where I am happy in my own skin."