In a world where fame is built on infamy, pop culture offers rather disturbing images of the cult of plastic surgery. See the celebrity mongering doctors, the sliced-and-diced-24-year-old-step-and-repeat-princesses, and the wealthy housewives who monstrously balloon and bulge their bodies as a public rite of passage.

But despite this rather morbid snapshot, there is a subtle and ethical side of plastic surgery. The danger of cosmetic procedures, particularly the version portrayed in the media, resides in the retail component of elective surgery, says Dr. Reza Nabavian, M.D., USC Clinical Assistant Professor of Plastic Surgery. “Patients come in and ask for something and pay for a service. In this scenario, patients become like customers.” And medical doctors then become like salesmen.

“As a physician you have to be a doctor first, especially in terms of plastic surgery,” says Nabavian. Doctors should be mindful of smaller procedures that may be a better option for patients. But a doctor, like anybody, has to pay his rent and so may recommend more invasive and expensive procedures to turn a profit.

So what can be done about this?

What we need, says Nabavian, is a public education campaign so that healthy plastic surgery seekers can get safe and comprehensive treatment. “Physicians are somewhat regulated but basically plastic surgery and what doctors prescribe is more or less based on an honor system,” explains Dr. Nabavian. The only way to safely avoid the doctors who are akin to used car salesmen is to do your homework. “Be sure that your doctor is making decisions in the best interest of the patient.”

Dr. Nabavian prescribes asking a lot of questions and doing a lot of research. Educate yourself on the latest technology and be sure to distinguish between fad procedures and procedures that deliver safe and tested results. “Be aware that doctors are often trying to sell you things that you’re not asking for or don’t need.”

Still, patients aren’t the only ones who have to be careful. Doctors must be hyper aware of the psychology and motivation of their patients, says Nabavian. As a professor at USC, Dr. Nabavian teaches young plastic surgeons how to perform safe, effective and ethical cosmetic plastic surgery. And his curriculum has always been hyper focused on ethics.

Dr. Nabavian explains that plastic surgery is often elected based on the perception of patient, and his/her motivation for undergoing any procedure is often hard to discern. “There is so much psychology and human nature that goes into evaluating what exactly a patient needs,” explains Nabavian. The nuance of prescribing procedures then is tied in to many factors. “You must ask, why does this person need this? Is it for them? Is it so that they can be someone else? What exactly do they want?”

Dr. Nabavian says that it’s important to communicate patient goals and to take into account the risks and limitations of surgical procedures. “This type of screening is exactly the kind of thing that makes me successful in my private practice. I try and mirror my own ethical standards and teach residents to develop those skills.”