- Extreme plastic surgery procedures carry a large amount of risk, and some may exist only on the black market.
- Many plastic surgeons won’t perform these procedures and advise strongly against them.
Most of us are aware of common cosmetic procedures such as breast augmentation, abdominoplasty, and rhinoplasty, but there is also a class of far more ambitious procedures that can only be found on the fringes of the aesthetics industry.
“Extreme” plastic surgery procedures promise amazing results, and often exist beyond the edges of what is currently allowed by law. They also carries higher risks, which means that many surgeons perform them only in very special cases — or refuse to perform them altogether.
For some patients the temptation of possible physical perfection outweighs any fear of plastic surgery gone wrong. Below are seven of the most unusual and extreme plastic surgery procedures.
What constitutes an “extreme procedure”?
According to the American Society of Plastic Surgeons, the plastic surgeries most commonly performed in the United States are:
- Breast enhancement surgery, including breast lifts and breast implant surgery
- Rhinoplasty surgery — more commonly known as a “nose job”
- Tummy tuck surgery to remove lower abdominal fat, loose skin, and stretch marks
- Liposuction surgery for fat removal and body sculpting
Today these procedures are so commonplace that the clinical risks are quantifiable and generally considered to be very low. And because requests for these surgeries are so common, it’s easy to find a skilled plastic surgeon who has extensive experience performing any one of them.
The more unusual the procedure, however, the more difficult it can be to find a surgeon who has experience performing it. While there’s no exact definition of what constitutes an “extreme procedure,” it can generally be considered any procedure that exists in a legal gray area, and/or any procedure that for safety reasons the majority of plastic surgeons will not perform.
1. Rib removal
While there are some legitimate medical reasons to remove a rib—an extremely serious fracture, aggressive bone cancer, for use as a bone graft—removing a rib as part of a cosmetic procedure meant to give the patient an hourglass figure is considered extreme.
The earliest surgery to remove ribs for cosmetic purposes is believed to have taken place in 19th century France. As the story goes, in the 1890’s a Parisian actress by the name of Polaire went under the knife to squeeze herself into a smaller corset.
Whether or not the story is true, there are now many documented cases of models who took this extreme step in order to achieve what they saw as a perfect body contour.
Valeria Lukyanova, the Instagram star known as “Human Barbie,” had multiple procedures to achieve her almost cartoonish physical appearance. Among those procedures, Lukyanova is said to have had four ribs removed.
In 2015, Swedish model and North Carolina resident Pixee Fox went one step further and had a total of six ribs removed, sculpting an extraordinarily small waist. Thanks to her rib removal surgery, Fox’s waist now measures only 18 inches, squeezing down to a mere 14 inches with the help of a corset.
And in 2017, “human Ken Doll” and self-described plastic surgery addict Rodrigo Alves became the first high profile male to have a total of four ribs removed. Alves originally wanted to remove six ribs, but his plastic surgeons declined to perform the procedure. As a result of the procedure, Alves now has a 20 inch waist.
We asked Dr. Deepak Dugar, medical director at The Scarless Nose clinic in Beverly Hills, if he had ever come across rib removal plastic surgery for cosmetic purposes. Dr. Dugar, who does not perform the procedure, did not mince words: “There are all types of internal organ damage at risk with this procedure and it should never be done. It is beyond high risk.”
Still, despite clear warnings from experienced board certified plastic surgeons like Dugar, the procedure is said to be performed in several American clinics and abroad.
2. Toe shortening and Cinderella surgery
“Cinderella surgery,” or cosmetic enhancement of the feet, is a blanket term for a number of cosmetic foot procedures. Often inspired by the desire to fit into sleeker high-heeled shoes, these procedures include fat pad augmentation, toe liposuction, and the surgical removal of bunions.
At the extreme end of Cinderella surgery is surgical toe shortening. The procedure is typically performed on the second toe in cases where it extends past the big toe, which often causes extreme discomfort for women who wear tight fitting shoes.
During the procedure some of the bone is removed from the elongated toe, and pins are inserted to hold the toe in place until the (now shorter) toe heals.
Toe shortening, which requires a hefty six to eight week postoperative recovery period, carries potential risks including blood clots, restricted joint movement, and in rare cases ongoing chronic pain.
Still, for many shoe lovers the perceived benefits of toe shortening are worth the downtime and potential risks.
3. Forehead shaving
Forehead shaving, or “forehead contouring surgery,” shaves down the scalp to create a less prominent brow ridge and a smoother forehead contour.
Forehead shaving is often referred to as a “facial feminization” surgery because it removes the larger, more pronounced brow ridges which tend to distinguish male and female facial anatomy. This results in a smoother curve to the upper face that’s generally seen as more feminine.
The procedure involves making a horizontal incision into the skin across the top of the forehead. After making the incision, the plastic surgeon peels the forehead skin down as far as the eye sockets and then shaves the forehead and brow bone with a drill.
The risks of forehead shaving include asymmetry, the possibility of uneven contouring, and some loss of sensation to the forehead.
4. Salivary gland removal
While there are a few non-cosmetic reasons to remove salivary glands—such as sialadenitis, an infection of the salivary glands, and salivary tumors—the procedure may also be performed for solely aesthetic reasons.
As we get older the salivary glands in our jaw often descend and enlarge. Because as we age we also lose fat and collagen within the surrounding skin, these glands often become more visible over the years. Low-hanging salivary glands can be removed as part of a facelift procedure or during a separate parotidectomy procedure.
Removing salivary glands results in a smoother, more defined jawline and can give the neck and the area beneath the jaw a tighter, more toned look. At the same time, this procedure runs the risk of causing issues related to chronic dry mouth.
5. Penile enlargement
History is filled with snake oil salesmen peddling pills, creams, gadgets, and pumps, all of which have promised to enhance the male member’s size. In reality, there are no topical treatments or personal contraptions which can permanently increase the length or girth of the penis.
Plastic surgery on the other hand does have some answers, though none of them are for the faint of heart.
Penoplasty is a procedure meant to increase the “size” of the penis by severing the ligaments that attach the penis to the pelvis. Once the ligaments are severed, more of the shaft becomes visible.
To be clear, the procedure does not actually make the penis longer, rather it makes more of what’s already there visible. How much more? Less than an inch, on average.
The visual effect can be enhanced by liposuction to the lower abdomen. And the width of the penis can also be increased, using a fat graft (from the lower abdominal fat).
While these procedures are available in the United States, The American Urological Society has warned on multiple occasions that neither penoplasty nor the subsequent injection of subcutaneous fat (meant to increase penile girth) have been shown to be safe or effective.
6. V-Line jaw surgery
Korea’s top models and actresses, including superstar Kim Hee Sun (seen below), have made V-shaped, doll-like faces a “must have” look among Korea’s celebrity set.
The extremely sought after V-line jaw contouring procedure changes the physical shape of the jawbone and alters the length of the chin. The changes are so extreme that patients often look like completely different people afterwards.
During surgery the sides of the jaw bone and parts of the chin are cut down to give the face a more slender appearance. This results in a smaller, more graceful jawline and a narrow, delicate chin shape. The procedure is especially popular among women who have a square jaw or a large, wide chin.
While V-Line surgery is still commonly thought of as a Korean procedure, it is increasingly available in the United States.
“Surgery to narrow the jawline and define the chin can achieve better facial harmony in patients with a wide lower face, or short chin,” says Dr. Randall Feingold of Aesthetic Plastic Surgery in Great Neck, NY.
V-line surgery isn’t nearly as extreme as rib removal surgery, but as Feingold points out, anyone considering the procedure should be aware of its potentially serious downsides, which include nerve damage.
“One concern would be thinning of the bulky masseter muscle,” says Feingold. “It needs to be done cautiously to avoid facial nerve injury that could result in an asymmetric smile.”
7. Extreme-sized breast implants
The largest breast implants that can legally be sold in the United States are the 800cc XL breast implants. But for those with ambitions beyond that already large 800cc limit, there are options that involve implant sizes of 1000cc, 2000cc, and even 2500cc.
The technique used to achieve these extreme breast sizes is called “overfilling,” in which an overfilled implant is inflated with additional saline to achieve sizes that surpass the 800cc legal limit.
While overfilling does carry a slightly increased risk of implant rupture, the procedure is extremely common, and many current implants are designed to be filled to moderately larger sizes.
There are however some other negative outcomes which should give pause to all but the most ambitious patients. Extreme-sized implants carry increased risks of capsular contracture, back pain, sagging, reduced nipple sensation, extrusion, implant folds, breast tissue atrophy, hematoma, malposition, displacement, and other complications.
Whether or not a plastic surgeon will overfill breast implants to extreme sizes is up to that individual surgeon, and will likely depend on a patient’s age, weight, body frame, overall health, and existing breast anatomy. Implants filled to 1000cc and 1500cc are becoming increasingly common, and many plastic surgeons specialize in this approach.
How big can extreme breast sizes go? The largest breast implants in history were given to Sheyla Hershey of Houston Texas. Hershey began her pursuit of maximum breast augmentation at the extreme high end, with 2500cc implants. After several additional increases, she achieved the incredible size of 4300cc.
Hershey’s original plan to increase her implants up to 5500cc was cut short due to infection and other serious health complications directly resulting from her extreme implants.
A final word of caution
All plastic surgery procedures carry some level of risk, though most plastic surgery today is low risk when performed by an experienced surgeon.
If you’re considering any plastic surgery procedure, whether commonplace or extreme, it’s in your best interest to consult only with a plastic surgeon who is a member of the American Society of Plastic Surgeons.
- U.S. Food and Drug Administration: Risks of Breast Implants (2018) fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064106.htm