16 Behind-the-Scenes Secrets of Plastic Surgeons

IStock
IStock

Our culture is pretty obsessed with what it sees in the mirror: Cosmetic procedures have risen an astounding 115 percent since 2000, with nearly 16 million procedures performed in 2015 alone. Breast augmentation, buttocks lifts, and minimally-invasive “injectables” have all conspired to literally change the shape of the male and female form.

For insight into the highly skilled hands that make these transformations possible, mental_floss spoke with several accomplished plastic surgeons about the living sculptures they create.

1. THEY SEE BEAUTY AS A MATHEMATICAL EQUATION.

Early in his career, Donald Kress, M.D., a plastic surgeon in Baltimore, Maryland, would find himself puzzled when encountering facial features he found unappealing. “I couldn’t figure out what it was,” he says, “until I’d match the face with the Golden Ratio.” The Golden Ratio, or Golden Mean, is a formula first articulated by Greek mathematician Euclid and later used to theorize that the most pleasing appearances in art and nature are created at a ratio of 1.618:1. In the 1970s, surgeon Stephen Marquardt, M.D., began to study commonly appreciated beauties like Marilyn Monroe and Sophia Loren and found the ratio applied to many seemingly universal standards of attractiveness.

Visualizing the formula using a “mask” designed by Marquardt in 1992 (above, middle) can reveal where a face is asymmetrical, though experienced surgeons can make a similar evaluation intuitively. “It comes up when you’re younger and don’t have a good eye for things,” Kress says. “After a few thousand patients, you can see it in your head.”

2. THEY HOST “BROTOX” PARTIES.

OnabotulinumtoxinA—commonly referred to by the brand name Botox—has been used for decades to paralyze muscles at a local injection site, which can prevent the contractions that cause wrinkles and frown lines. Some practices have taken to hosting the increasing number of male patients coming in by offering “Brotox parties,” where a number of friends will schedule at once to make the treatment a social event.

Z. Paul Lorenc, M.D., F.A.C.S., a plastic surgeon in New York City, says that “Brotox” is a result of men who have had a good experience recruiting their friends. “It’s kind of a support group,” he says. “They can interact in the waiting room. Men used to do this at parties, but that’s become passé. It was always a bad idea. You should never have alcohol involved.”

3. THEY’RE DRAWING LANDMARKS ON YOU.

Watch enough reality television and you’ll eventually spot a plastic surgeon taking a black marker to the bare torso of a patient. Matthew Schulman, M.D., a plastic surgeon based in Manhattan, says that surgeons are basically acting as topographers, marking areas of the body that may change shape or become less visible when a patient is lying down. “We’re drawing landmarks for ourselves because a person looks different when on the table,” he says. “I might circle where the fat is thickest, or where the nipple is while standing.” No special medical ink is used: It’s just a Sharpie.

4. BREAST IMPLANTS CAN CREATE “MOTION ARTIFACTS.”

There are several ways to insert breast implants, but Kress says that one in particular can create problems for patients who do a lot of jumping up and down. When an implant is inserted in a subpectoral incision under muscle tissue, it can give off the appearance of remaining stationary while the rest of the breast moves during physical activity, creating a visual ripple effect. “If there are big arm movements, or if they’re in front of people teaching or on television, I advise them of the potential consequences,” Kress says.

5. THEY CAN’T MAKE YOU LOOK PHOTOSHOPPED.

Schulman says that social media—especially the popularity of impeccably-proportioned Instagram models—has created a few headaches for his practice. “The problem with pictures is that they’re just a guide, but it’s not like picking a body off the shelf,” he says. “Half of the Instagram models are Photoshopped, so when you say you want to look like this, I can’t do it. I can’t give you an 18-inch waist.” Though Schulman does like having a visual reference for what patients have in mind, he prefers they understand it's a starting point, not a preview.

6. THEY DON’T WANT YOU TO LOOK GOOD ON THE TABLE.

“Everyone,” Schulman says, “looks great lying down.” But trying to achieve aesthetic perfection in the operating room is a recipe for disaster. “One of the first things we learn as plastic surgeons is that just because something looks good on the table doesn’t mean it’ll look good six months later. We want to make the result less than ideal to account for healing.” Breast implants, for example, might be placed higher than desired so they can “settle in.” Making them perfect during surgery means they’re likely to drop too low once the body recovers.

7. IT TAKES EXACTLY 90 DAYS TO GET USED TO A NEW FACE.

According to Kress, there’s a tremendous difference between a facelift and a procedure that radically alters the face. “In a facelift, you’re turning back the clock and people can adjust to it quickly,” he says. “But a new nose, a new chin, taking away a bump, you’re creating a person they’ve never seen before.” In his experience, it takes patients almost 90 days exactly to get used to the image in the mirror. “On day 87, they’ll see someone else’s chin. On day 91, it’s you. It’s freaky how accurate it is.” Kress will normally refuse to remove an implant (chin, cheeks, breasts) prior to the 90 days to account for this phenomenon.

8. MORNINGS ARE BEST FOR DETAIL WORK.

If you’re opting for cosmetic surgery and have a nose job scheduled for late in the day, you may want to reconsider. According to Kress, procedures that require fine motor skills like nose jobs, facelifts, or eyelid surgeries are best performed in the morning, while gross motor work like breast implants and liposuction can come later. “You don’t want to reverse the order because it can take between 45 minutes to an hour for fine-touch motor skills to return. I start with the most delicate surgeries first, have a good lunch, and do bodies later.”

9.  THEY CAN MAKE YOU LESS ANGRY-LOOKING.

Not all cosmetic surgery is focused on restoring the appearance of youth: Some people just want to look happier. “Many of my Botox patients coming in say that everyone thinks they’re angry all the time,” Lorenc says. “They want to correct a frown or a heavy brow.” Kress has also seen people ready to go on the job market for the first time in years who want to appear more awake—or sober. “Sometimes eyelids can make you look like you drink, or don’t get enough sleep,” he says.

10. THEY WORK WITH WITNESS PROTECTION.

That gangster-movie cliché of having to modify your face to avoid being spotted after offering damning testimony? It’s true. Kress has operated on several government witnesses, and they can forget about follow-up visits. “I’ve had Federal Marshals come in and tell me, ‘This is the only time you’re going to see this guy, so give him whatever instructions he needs,’” he says. Kress has also worked on covert military operatives who have had their name and image published in media and run the risk of being recognized. 

11. THEY HAVE SIGNATURE NOSES. (AND BUTTS.)

Many surgeons get into the cosmetic field because of an artistic impulse: They don’t want to perform cookie-cutter procedures and like to improvise. But a certain segment can also offer procedures with a dependable aesthetic outcome that becomes a kind of signature. “Some doctors are known for noses I can spot across the street,” Schulman says. “I do a lot of butt-lifts and make them look like an upside-down heart. Patients come in because they want that result.”

12. CALF IMPLANTS ARE A THING.

And not just for men, either. Lorenc regularly sees patients of both genders who want to rectify their genetic misfortune and sport shapely, powerful-looking calves. “I’m one of the few surgeons who does them,” he says. “The stereotype is that it’s only bodybuilders, but that’s not true. They make up only a percentage. Some people just can’t develop them in the gym no matter what they do.”   

13. BEING A SMOKER IS A REAL NO-NO.

One universal truth of cosmetic surgery: Operating on a smoker is never a good idea. Nicotine constricts small blood vessels, which can delay healing and open up the door for complications. “Every good plastic surgeon will require a patient stop smoking before a procedure,” Schulman says. His patients sign an agreement requiring them to cease any kind of smoking four weeks prior and for eight weeks following an operation. “They agree I can nicotine-test them [via urine] and if they’re positive, the operation is canceled and I keep their money.”

14. THEY’LL WORK ON KIDS FOR ONE REASON.

There are very few cases of surgeons electing to work on anyone under the age of 18 for purely cosmetic purposes, with one key exception: protruding ears. Kress says that ears that stick out too much can become a psychological burden and that there’s a sweet spot to get them pinned back. “Around age 5 or 6, the ear has gotten big enough to work on and see a lot of the underlying structure,” he says, “but it’s also before they get into grade school and the taunting really starts.”  

15. THEY THINK TRANSPLANTS ARE THE FUTURE.

While fat transplantation is an increasingly popular and effective alternative to artificial fillers—adipose tissue can be harvested from unwanted areas and injected into the butt or face—Schulman sees the future of plastic surgery being far more radical, and less focused on aesthetics. “I think in the next ten years, we’re no longer going to be doing reconstructive work for trauma,” he says. “If you need breast tissue after a cancer operation, it will be from a donor. Things like face transplants and hand transplants are being led by plastic surgeons, by microsurgeons. I see full limb transplants. The possibilities are endless.”

16. THEY’RE NOT REALLY STRESSED.

Lorenc finds it amusing when friends or acquaintances remark that being a surgeon must be one of the most stressful jobs you can have. “When I step into the operating room, it’s like nirvana,” he says. Barring the rare complication, no one is in critical condition, bleeding to death, or under any extreme duress. Surgeons tend to work at their own pace, sometimes with a soundtrack. “I listen to Pink Floyd, the Allman Brothers, Jimi Hendrix. Sometimes reggae.”  

All images courtesy of iStock unless otherwise credited.

11 Secrets of Tour Directors

iStock
iStock

Tour directors get paid to travel the world, dine at incredible restaurants, and sleep in comfy hotel beds. Of course, there’s a lot more to the job than merely hoisting a brightly colored flag and rattling off pertinent facts. Some would even describe the work as exhausting, both physically and mentally. Unlike tour guides—who provide local expertise about a city or attraction and generally don't have to travel far—tour directors book gigs across the country or abroad via tour operation companies, handle the pre-trip planning, and conduct the tour, all while fixing the problems that pop up along the way. To find out what their day-to-day work is really like, Mental Floss spoke with three tour directors (or managers, as they're also known). Here’s what they had to say about an occupation that many label a “dream job.”

1. FORMAL TRAINING IN TOURISM ISN’T REQUIRED.

While some tour directors hold certificates in tourism and hospitality management, this isn’t a strict requirement, and professional directors come from a range of educational backgrounds. Kimberly Fields-McArthur, an American tour director based in Australia, has a degree in biblical studies and archaeology, and Anne Marie Brooks, a former tour director turned cruise ship worker in Orlando, has a background in musical theater.

More important than education or training: their skills. Tour directors must be highly organized, adept at speaking in front of large groups, and people-oriented. "A lot of it is a personality thing versus a training thing," Brooks says. "You can’t train someone to have a personality to work with people.”

2. WHEN THEY’RE ON A TOUR, THEY’RE ON CALL 24/7.

While they might get to spend the night in a nice hotel, the sleep of a tour director is often interrupted. Brooks, who used to lead city tours for high school performance groups, recalled a time when a large group of rowdy, drunk men stayed on the same floor of a hotel as the girls in her group. Although she was staying on a different floor, she received word around 3 a.m. that the boozed-up bros were making some of the girls—and adult chaperones—uncomfortable, so she went down to the front desk to sort it out. No other rooms were available, but the hotel agreed to hire a security guard to sit in the hallway for the duration of their stay.

Similarly, Fields-McArthur says she’s been forced to respond to issues in the middle of the night quite a few times. “One of them was a gentleman who made a very bad decision about what height he could jump into the pool from and ended up breaking his foot,” she says. “That was 2 o’clock in the morning.”

3. THEY HATE IT WHEN YOU CALL THEIR JOB A “FREE VACATION.”

“There’s nothing about what I’m doing right now that is me on vacation,” Fields-McArthur says. “If I am on vacation, it means I am not doing my job and you are probably not having a good time.”

Kathi Thompson Cullin, a tour director based in Grand Rapids, Michigan, adds: "I was up at 6 o’clock this morning and didn’t go to bed until midnight doing my paperwork.” When they're not traveling, they're handling all the pre-trip arrangements: crafting the itinerary, ordering tickets for activities, taking care of transportation and lodging, and following up with venues to make sure they haven't forgotten about their reservations (a common problem). Plus, there's the added challenge of shepherding dozens of people around a city that's unfamiliar to them, which isn't exactly a walk in the park, either.

4. THEY GO THROUGH A LOT OF SHOES ... AND LUGGAGE.

If you’re looking for a job that forces you to stay active, tour directing might be the profession for you. Thompson Cullin and Brooks say they walk so much they burn through three or four pairs of sneakers per year. (Pro tip: If you’re looking for comfy travel shoes, they both swear by their Skechers.) Suitcases tend to be another casualty of the job. Thompson Cullin says she stopped buying expensive luggage because it would just end up “beat up and broken with the wheels off” by the end of the year.

5. THEY’RE TRAINED TO ANTICIPATE THE WORST ...

People get lost. Accidents happen. Natural disasters strike. Tour directors have to be prepared for the worst-case scenario. “If I’m leading a trip to Indonesia, I need to know volcanoes might be part of the process of being there, and earthquakes might be part of the process,” Fields-McArthur says. So educating herself about potential disasters—and how to deal with them—is part of her pre-trip research.

Things can go wrong with the guests, too. "I’ve had trips where people have gotten very sick," she says. "I had one trip where I had seven people end up in the hospital at different times for completely different reasons. I’ve seen broken bones and illnesses and hospital stays for days on end, where we ended up having the trip continue on to a different country and we had to leave them behind.” (In those instances, the tour director notifies the tour company, which follows up with anyone injured and left behind to ensure they have travel arrangements once they recover.)

6. ... BUT IF SOMETHING LESS SERIOUS GOES WRONG, YOU PROBABLY WON’T KNOW ABOUT IT.

Problems arise more often than you’d expect. A misspelled name could result in the hotel not having any record of a 50-plus person reservation—this once happened to Thompson Cullin—and businesses often forget that large groups are scheduled to come in on any given day. “So many things go wrong on a day-to-day basis that our guests will never know about,” Brooks says. One time, a restaurant she took her group to was understaffed, so she stepped in, grabbed a pitcher of soda and plates of food, and started refilling their glasses and serving them—all while playing it off like she was merely mingling with the group.

The job is hard work, but tour directors never let it show. Fortunately, Thompson Cullin was able to fix the hotel reservation error before her guests ever found out about it. “Think of me as a duck floating on the water,” she says. “To the human eye I’m looking very peaceful floating along, not a care in the world, but underneath my feet are paddling like crazy just to stay afloat.”

7. THEY REALLY LIKE TALL PEOPLE.

While guests do get separated from the group from time to time, tour directors do their best to avoid it. In addition to holding a flag or umbrella at the front of the line to help guests find their way, they have another trick up their sleeve: “What I usually do is try to make friends with somebody who’s very tall in the group,” Fields-McArthur says. She'll ask if they'd mind being the last person in line; that way, when she looks back and sees their head bobbing above the others, she knows that the group didn’t get split up. (Of course, this doesn’t stop the occasional straggler from ditching the group any time they get distracted by a gelato shop or chic boutique.)

8. SOMETIMES THEY HAVE TO BREAK UP FIGHTS.

When you take a big group of strangers from diverse backgrounds and send them on a trip together, it doesn’t always end well. Thompson Cullin said part of her job involves playing mediator and preventing disagreements from escalating. The most extreme example of this is the time when she had to physically break up a fight in the hotel lobby between two women who weren't getting along on her tour. When tensions reached a boiling point, one woman raised her arm to hit the other, but Thompson Cullin arrived in the nick of time. “I grabbed both of their arms and said, ‘Come with me now,’” she says. They did cooperate, but only after they received a warning that they’d be kicked off the tour if they continued to quibble.

9. THEY OFTEN DEPEND ON TIPS.

The median wage for travel guides—those who "plan, organize, and conduct long distance travel, tours, and expeditions for individuals and groups"—is $25,770 annually or $12.39 hourly, according to 2017 data from the U.S. Bureau of Labor. However, Fields-McArthur says many U.S. tour companies pay directors by the day, and wages range from $100 to $300 per day (on the lower end of the scale) to roughly $400 per day for higher-paying jobs. For directors in the former camp, tips are essential. “On some of the older adult tours, sometimes they give you $5 in an envelope and say, ‘That was the best trip of my life,’ and you’re like, ‘Great, I can’t pay my bills now,’” Fields-McArthur says with a laugh. If you’re on a tour and you're unsure how much to tip, check the information packet provided by the company. They usually include tipping guidelines.

10. THEY MEET SOME INTERESTING CHARACTERS.

Tour directors see a steady stream of fascinating people from around the world. One of the most memorable characters that Thompson Cullin ever encountered was a “sweet little old man” from New Jersey on a tour of Sedona, Arizona, who happened to be an ex-con and “retired” member of the Mafia. “He said to me at lunch, ‘You know what Kathi, I like you. You got moxie. Here’s my card. Anybody ever gives you trouble, you call me and I’ll take care of them,'” she says. She thought he was joking at first. He wasn’t.

11. THEY NEVER GET TIRED OF THE AMAZING SIGHTS.

Sure, they may get sick of certain activities—Brooks, for example, has had her fill of Radio City Music Hall—but awe-inspiring sights like the Grand Canyon become no less impressive with repeated viewings. “I never get tired of it. That’s probably the one question I get asked all the time,” Thompson Cullin says. She also enjoys witnessing how her guests react to the sights they’re seeing. “My biggest perk is to see people’s faces transform into childlike wonder when they see things for the very first time—things that they have always wanted to see.”

10 Secrets of Subway Conductors

Chris Hondros, Getty Images
Chris Hondros, Getty Images

Despite listening to their announcements every day, there’s a lot the average rider doesn’t know about being a subway conductor. The men and women at the front of the train are the eyes and ears of the subway system, and they often act as the only line of communication between passengers and the greater transit authority. We spoke with conductors who work for two of the country’s busiest transit systems to learn more about what it's like on the rails—including the real meanings behind the phrases they use, how dirty trains really get, and the one thing they wish more riders would do.

1. IT CAN TAKE A WHILE TO GET A JOB ...

Aspiring transit employees often have to be patient. Candidates must first complete a written exam, and if they pass, their name is added to a list of people waiting to fill whatever jobs open up. The time it takes to reach the top of the list varies: Joe Benton, who's worked for Bay Area Rapid Transit (BART) in San Francisco for 10 years, tells Mental Floss he was hired a year after first submitting his application. Tramell Thompson, a New York City subway conductor since 2013, says he waited nearly four years after taking his civil service exam to secure the job. Once hired, subway conductors must undergo a training process that can take two to three months. This involves riding real trains in the yards, and learning the various signals, regulations, and procedures.

2. ... BUT STAYING IN THE POSITION PAYS OFF.

The typical base salary for a New York subway conductor is $67,000, Thompson says, but both pay and benefits become more appealing the longer a conductor works for the transit authority. As Victor Almodovar, a New York City subway conductor for 15 years, tells Mental Floss, "seniority is everything." After 12 years, he was able to get weekends off, and he now has the freedom to choose which train line he works on—something most conductors just starting out aren't allowed to do.

3. THEY MIGHT TALK ABOUT THINGS BLOWING UP—BUT DON'T PANIC.

If you could eavesdrop on the private conversations between subway personnel, you probably wouldn’t understand them. All transit conductors speak in shorthand specific to the systems they work for: “BART has literally its own language,” Benton says. That language includes a lot of numbers, like track numbers, platform numbers, and train IDs. But other bits of lingo are more colorful—and could potentially cause panic if they were ever broadcast over the wrong intercom. As an example, Thompson notes they sometimes might say "the railroad blew up." While it may sound terrifying, he explains that it means the trains aren't running on their proper schedule.

4. THERE'S A GOOD REASON THEY'RE ALWAYS POINTING.

If you live in New York City, pay close attention next time you’re waiting on a subway platform: When the train pulls in, you should see the conductor pointing a finger out the car window. The object they’re pointing at is a black-and-white strip of wood called a zebra board. It hangs above the center of every subway platform, and when the train pulls into the station correctly, it will line up perfectly with the subway conductor’s window. If the conductor notices the board is a little too far behind or ahead of them when they point their finger, they know it’s not safe to open the doors. The gesture is also a good indicator that your conductor is paying attention.

5. THEY WORD ANNOUNCEMENTS CAREFULLY.

There are a few phrases regular subway riders are used to hearing—“sick passenger,” “police investigation,” and the standard “we are experiencing delays,” to name a few. These may sound like obvious euphemisms, but Thompson promises that using carefully worded language is in the passengers’ best interests. A police investigation, for instance, could refer to someone causing a scene on a train, but in some cases it’s a lot more serious. “If God forbid there’s a terrorism or a bomb scare, that’s not something you want to put over the public address system,” Almodovar says. “It becomes self-preservation and you don’t want that on a packed rush hour train. So instead you say, ‘We have a police investigation,’ which is basically the truth but you’re not telling them the whole truth.”

“A passenger seeking medical attention” is another example of masking something that’s potentially disturbing without being dishonest. Thompson says, “I’m not going to say, ‘Attention passengers, somebody jumped in front of the train and it’s causing delays.’ I would say, ‘There’s an injured passenger on the train ahead of us,’ or ‘There’s a passenger seeking medical attention ahead of us.’” However, with the MTA now pushing its employees to be more transparent, riders may occasionally get conductors who make no effort to mince words.

6. SOMETIMES PASSENGERS KNOW MORE THAN THEY DO.

Passengers aren’t the only ones who are kept in the dark during delays. When a conductor doesn’t give a specific reason for the delay in their announcements, it may be because he or she doesn’t know why the train stopped in the first place. “In that case, I would tell them we’re investigating the issue,” Thompson says. Usually the control center—the hub that keeps New York City’s subways moving—will inform conductors of the problem before too much time passes, but in some cases transit news travels faster by phone. “The information will get to passengers through all these MTA apps before it’s even relayed to us,” Thompson says. “So sometimes I ask them, ‘Hey, can you check your phone and see what’s on the [MTA] website?’” (Conductors are forbidden from using their phones for personal reasons on the job, but the MTA is experimenting with giving employees work iPhones to better keep them up-to-date.)

7. MOST DELAYS AREN’T THEIR FAULT.

For better or worse, subway conductors are the face of city transit systems: That means they’re usually the first people to receive complaints and abuse from passengers when a train isn’t moving fast enough. But if your train has been stuck underground for what feels like forever, there’s only a small chance one of the system's employees is to blame; the much more likely cause is faulty equipment. According to WNYC, signal problems account for 36 percent of extended subway delays (eight minutes or more) in New York City, followed by mechanical problems at 31 percent, and rail and track issues at 19 percent. “When you get mad you have to understand that we are not the ones who made the schedules; we’re ones who have to work with the tracks and the signals which are over 100 years old and they break down,” Almodovar says. “We have to work with what we have."

8. THEY HATE DELAYS MORE THAN YOU DO.

A signal malfunction might mess up the average passenger's morning commute, but it can ruin a subway conductor's whole day—so despite being blamed for them constantly, it’s possible that no one hates train delays more than subway conductors. “I didn’t really have a lunch today,” Almodovar says, recalling how he fell behind schedule when the automatic brakes were activated on the train ahead of his. “I had enough time to run downstairs, get a slice of pizza, then I’m right back on the train.”

On some days, conductors are lucky if they get to eat at all. “With all these signal issues, track issues, and all types of other issues, it’s hard for the schedules to work,” Thompson says. “Sometimes we gotta choose between using the bathroom and eating.”

9. SOME WON’T LET THEIR FAMILIES RIDE.

Staying on schedule is a priority for most subway systems. That means employees might rush through jobs where they would ideally take their time—like cleaning a subway car that a passenger has been sick in, for instance. Thompson says the lax sanitation procedures he sees up-close have convinced him to never let his son ride the subway. “It’s like working in a restaurant—you know the other-end stuff that the customers don’t know,” he says.

10. THEY WISH YOU’D LEAVE THE HOUSE EARLIER.

If you want your commute to go smoothly, subway employees will tell you the best thing to do is plan ahead. This means finding out how delays or construction might impact your preferred route before stepping outside the house. Almodovar recommends downloading a navigation app called Citymapper, which integrates the latest data from city transit systems into one spot. Official transit system websites and Twitter accounts are also good places to go for service updates.

But regardless of what your apps tell you, it’s always safer to assume your train will be behind schedule. “We all know that the transit authority isn’t the most punctual service,” Thompson says. “Leave an extra five to 10 minutes earlier from your house, because things are always happening.”

SECTIONS

arrow
LIVE SMARTER