Let’‘s face it, you don’‘t need a pretty face to get on television anymore; nowadays it helps to have an ugly one.

And if you come with crooked teeth, small breasts and cellulite to boot, that’‘s even better. These qualities will make you a perfect candidate for one of the various reality “makeover” plastic surgery shows proliferating across the tube these days.

And while the viewers and participants may be riveted by the results, plastic surgeons who don’‘t appear on shows such as The Swan (Fox), I Want a Famous Face (MTV) and Extreme Makeover (ABC) find that while the programs have given visibility to the field, generally the negatives outweigh the positives.

“It exposes people to what potentially can be done by plastic surgeons, that it’‘s not just frivolous, it’‘s not just ridiculous, so in that sense it’‘s very helpful,” said Dr. Nolan Karp, an associate professor of plastic surgery at New York University School of Medicine in New York City.

On the other hand, Karp continued, “a lot of the result is not related to the surgery. A lot of the results in many cases are related to the dental work, to the grooming. Some of these shows sequester people for two months and give them a special diet and get them trainers and buy them new clothes.”

It comes down to portraying the procedure and the patient in the best possible light, something television can do very well.

“These shows basically select patients from a large number of candidates so they pick the people who are the best candidates to have an extreme makeover because they have the kind of features that lend themselves to a home run,” explained Dr. Peter B. Fodor, president of the American Society for Aesthetic Plastic Surgery, who was asked to be a surgeon on one of the shows. (He declined.)

For example, removing a “big nasal hump” is going to have the kind of instant, dramatic effect broadcasting executives love. Similarly, the smart producer is only going to perform on-camera liposuction on someone with “good, elastic skin.”

Many patients are also shown in the worst possible light for their “before” pictures (no makeup, etc.), and in the best possible light after.

“Reality television shows really promote unrealistic expectations, and to get patients to have realistic expectations is one of the hardest things we do in our practice,” Fodor said.

Dr. Terry Dubrow, the board-certified plastic surgeon who is one of two plastic surgeons making up the Dream Team of The Swan conceded that what you see on TV is quite different from what you will encounter in “real life.”

“It is unusual that a person can come in with a laundry list of things they want done and be able to afford them,” he said. “On the show, just as long as they were significant issues and realistic expectations and because they didn’‘t have to pay for them and because they would be monitored closely, we could go ahead and do all of those things.”

He also pointed out that this is not a “don’‘t do this at home kind of thing.” Anyone ostensibly wanting 10 different things done by a plastic surgeon would still need to get a doctor to agree and most would not. “In my opinion, that whole unrealistic expectations thing is unfounded,” he added.

But detractors say not only are these shows deceptive in a certain way, the procedures performed can actually be dangerous.

“The issue has to do with the number of surgeries that patients receive, and the average surgeon cannot do in one sitting what is being done on these patients unless you rush or keep them under anesthetics for longer than six hours,” Fodor said. “It’‘s clearly shown that the chance for complications goes up exponentially if you keep patients more than six hours under anesthesia.”

Dubrow verified that most of the patients on the show had two separate sets of surgery.

“The potential for complications increases,” added Dr. Darrick Antell, a New York City plastic surgeon and a spokesman for the American Society of Plastic Surgeons.

There may also be psychological issues.

“I know that it’‘s difficult enough for patients to adjust to one new portion of their face, let alone three or four new things at one time,” Antell said.

Introducing the element of competition, as is done on The Swan, can accentuate the psychological difficulties.

“To be on national television for this and to be in a contest where one person will eventually win and someone eliminated every show, that’‘s not necessarily all that good at a time when people are emotionally fairly fragile,” Fodor said. “It’‘s not uncommon for patients in the early postoperative period to be a little depressed. At first, they are bruised and swollen and they look worse. It’‘s tough enough without having a circus environment added to it.”

And the carnival aspect could potentially affect the surgeon as well. “It violates our code of ethics,” Fodor said. “Maybe you’‘re getting to the borderline of how much is safe to do. When you start putting an element of showmanship into this, then even patient selection suffers a little bit.”

“The Swan and I Want a Famous Face border on hype and get to the freaky side of medicine,” Antell stated. “Good plastic surgery should not be extreme and it should not scream. It should whisper.”

But shows like The Swan may represent equal opportunities for the patient and the physician.

Dubrow said he agreed to join the show for two reasons. “It was an amazing opportunity for myself to really comprehensively work on someone. Typically a patient comes in and says I have this bump on my nose,” he said. “When does a plastic surgeon get to be part of a team that gets to work on an entire patient? It’‘s the whole transformation process.”

The other reason? His wife is actress Heather Page and he loves reality television. “I got to be a surgeon and a fan at the same time,” he said.