"Don’t just polish the surface when the foundation has cracks" – a saying from the construction industry that surprisingly fits well with aesthetic procedures. Cosmetic surgery can improve appearance and self-image, but the shiny exterior often conceals complex medical and psychological risks. Those seeking high performance need not only quick results but also durable decisions: informed, self-determined, and health-oriented.

Cosmetic procedures aim to enhance appearance rather than treat a medical condition. This includes surgeries like rhinoplasty and breast augmentation, as well as minimally invasive procedures such as fillers or botulinum toxin. It is important to distinguish between aesthetic surgeryplanned interventions for shape alteration in healthy individuals and reconstructive surgeryrestoration after injury, illness, or malformation. Risks arise from the procedure itself (anesthesia, bleeding, infection), from the materials used (e.g., fillers as foreign bodiessubstances that the immune system recognizes as non-self), and from psychological factors like Body-Dysmorphic Disorder (BDD)excessive preoccupation with perceived flaws despite intact appearance. Additionally, medical tourismsurgeries abroad with subsequent return travel alters the safety landscape because continuity of care and aftercare are compromised.

The health consequences range from scarring and tissue damage to psychological distress. Repeated procedures increase the structural stress on tissues: experiments with repeated skin expansion show microscopic injury patterns and altered biomechanical properties – a hint that "more is better" does not apply here ^[1]. Psychologically, the outcomes are heterogeneous: many patients report improved body image, but self-esteem and depressive symptoms do not automatically improve; for certain groups, they may even worsen ^[2]. Particularly alarming: after breast augmentation, the suicide risk was significantly higher compared to other cosmetic surgery patients ^[2]. Unsafe or unapproved fillers can trigger severe reactions, from necrosis to chronic complications, where not only the material but especially technique and expertise are crucial ^[3]. Moreover, there is a risk of inadequate aftercare in medical tourism: complications can escalate when qualified, timely treatment is lacking, leading to legal and ethical issues ^[4].

A systematic review of psychological outcomes after invasive cosmetic procedures shows: body image often improves, but self-esteem frequently remains unchanged; depressive symptoms may persist or increase. Those particularly at risk are individuals with BDD, who do not realize psychological gains after surgeries; the authors call for standardized pre- and postoperative psychological screenings, which currently occur too infrequently ^[2]. In another overview of predictors of dissatisfaction after facial surgery, young patients, unrealistic expectations, minimal baseline findings, demanding behavior, and certain personality traits were identified as risk factors. A valid, brief tool for preoperative assessment of these factors is still lacking, emphasizing the importance of clinical evaluation and expectation management ^[5]. For fitness evaluation before surgeries, a clinical validation of an AI-supported tool shows a high agreement with experienced surgeons in patient selection. This suggests that structured, data-driven decision support can help identify unsuitable candidates and reduce risks ^[6].

- Make an informed decision: Research the benefits, specific risks, complication rates, and aftercare requirements of your desired procedure (e.g., official professional societies, peer-reviewed sources). Use the preliminary consultation to obtain a check of your individual risk profile ^[7].
- Evaluate clinic quality: Ask about hygiene and infection prevention standards (preoperative decolonization, perioperative antibiotic strategy, temperature management), complication rates, and the specialization of the surgeon. Evidence on safe standards – such as to prevent wound infections – supports careful selection ^[8].
- Psychological preparation: Get your expectations calibrated. A structured screening for depression, anxiety, BDD, and unrealistic goals increases the chance of a good outcome; studies emphasize that the lack of screening increases psychological risks. Consider preoperative psychological counseling, especially in cases of perfectionism or "minimal flaws" motivation ^[2][5].
- Clarify medical fitness: Conduct a comprehensive health assessment (medical history, medications, coagulation status, nicotine status, pre-existing conditions). Use standardized selection instruments where available; AI-supported tools can complement the surgical assessment and reduce contraindications ^[6].
- Set boundaries: Avoid cascading procedures without medical necessity. Repeated interventions increase the risk of scarring and tissue damage; plan recovery times and long-term goals instead of short-term "fixes" ^[1].
- Safe materials, safe hands: Use only approved products by experienced specialists; unofficial fillers or "vitamin injections" pose serious complications, including necrosis – steer clear of gray market offerings ^[3].
- Caution with medical tourism: Organize aftercare at home in advance, clarify documentation, availability of the surgeon, and legal framework; missing continuity increases morbidity and mortality risks ^[4].

Cosmetic procedures can be sensible – if you plan them with the same commitment to evidence, safety, and self-care as your training. Research, screen, choose the right clinic, and prepare psychologically: this is how you protect health, performance, and joy of life. Make an informed decision now that strengthens your best self long-term.