Never one for reality TV, I didn’t watch a single episode of The Swan when it aired 22 years ago. While I was vaguely aware of its existence and the extreme plastic surgery premise, it didn’t seem particularly outrageous at the time. This was peak makeover era, after all—content like this defined the early aughts. If a show didn’t shock or mock, it didn’t rate. And, back then, our collective tolerance for bad behavior was shamefully high.

My first real exposure to the show came just days ago in the form of the new Hulu documentary The Swan: Behind The Mirror. Now a journalist whose decade-long beat has been plastic surgery, I emailed my editor at Allure after watching it (thrice): “As a supporter and frequent defender of plastic surgery, I feel rattled by this viewing experience.” Beyond the ugly-duckling implications and the patent objectification and humiliation of women, the show’s portrayal of plastic surgery itself struck me as dark and sort of sickening.

As the documentary explains, Fox initially presented The Swan to the public as inside-out makeovers intended to restore beauty and confidence. The show would provide contestants (“broken women,” by their own description) with cosmetic interventions as well as personal training, nutritional guidance, psychotherapy, and life coaching (courtesy of the show’s creator, Nely Galán). But as one Swan producer shares in the documentary, the network’s true mission quickly became clear: "We’re gonna take ugly chicks and make them hot.” After three months of mandatory surgeries, dental work, starvation, and squats, the contestants see their reflections for the first time during a dramatic onscreen reveal. They’re then forced to compete in a beauty pageant, wearing lingerie and swimsuits, which Galán considers to be the ultimate motivator. “It’s enough to kill yourself,” she remarked in a 2004 interview. (In the documentary, contestants reveal that they were not made aware of the pageant element until weeks into filming.)

Behind the Mirror opens with a flashback to season two: Swan contestant, Kari Bravata, on the operating table, her vitals tanking as nurses struggle to rouse her from anesthesia. Cut to present day: Kari, alive and well, is sharing a sofa with her sister, Gina (also a Swan), and recounting her experience for the cameras. “I almost died for reality television,” she says.

A moment later, we see one of The Swan’s plastic surgeons, Randal Haworth, MD, known for his cutting critiques. (Terry Dubrow, MD, whom one contestant describes as “warm and funny,” played the good cop to Haworth’s bad.) Offering no apologies, Dr. Haworth tells us, “Plastic surgery is barbaric. You’re putting a cold scalpel onto flesh and certain things fail.” This is not a 2004 take, mind you, but Dr. Haworth explaining his craft in 2026. The Swan’s depiction of this doctor, past and present, is disturbing. Callous and offensive then, and ostensibly unrepentant now—even with the benefit of hindsight, he describes the show as “empowering”—he plays the stomach-turning stereotype of a plastic surgeon, seeming almost like a spoof of himself. We reached out to Dr. Haworth this week to ask if he had comment after watching the documentary and he said, “I agreed to participate in the documentary in good faith and spoke candidly because I believed it was important to have the perspective of someone who was actually there. Having now watched it, I do feel some of my comments lost important context in the edit. The former contestants deserved the space to tell their stories fully, and I only wish some of my own explanations had been given the same room.”

Was the approach we saw to plastic surgery in The Swan the norm in 2004? Did the outlandishness of the aughts fuel this sort of behavior? No idea. In 2004, I was 27 and not interested in plastic surgery the way some 20-somethings are today. As someone who now covers the field almost exclusively, I’ve come to know many of the surgeons behind the scalpels. In my experience, the best of them—the sources I call on most frequently—possess credentials and compassion in equal measure. That’s my view of the field through an admittedly modern lens.

Looking back, Beth Lay, the first runner-up from season one, says of The Swan surgeons, “I think they had to dehumanize us, because ultimately we were just a job.” Multiple procedures were foisted upon the contestants, and while some Swans voiced concerns, most acquiesced, believing they had no choice but to submit to the prescribed surgeries. “I was told that if I didn’t get everything that was on my list, I would be sent home,” Lay says. “I didn’t feel like I could say, ‘No, I don’t want that,’” adds Cindy Ingle, a season-one Swan. Turns out, they weren’t wrong: “The women had maybe 1% say over which procedures they had," notes a Swan producer.

In the documentary, we also learn that each woman was put under anesthesia for 10 hours while Haworth and Dubrow performed as many procedures as possible to achieve dramatic, high-impact overhauls. Dr. Dubrow, who did not participate in the film, told Vice in a 2024 video series, “I think in the two weeks of everyday surgery that we did, we did something like 200 plastic surgery operations on these patients. That was more than [what] a typical plastic surgeon would do in an entire year.”

Given how The Swan has aged, one might assume its surgeons have had a certain pall cast over them, but no—both are still practicing successfully in Beverly Hills and have robust followings on social media. Both include The Swan on their websites, Dr. Haworth with considerable detail. He actually attributes his success, in part, to The Swan, noting: “Even though it’s been a number of years since the last episode aired, we still get calls in the office from prospective patients who mention The Swan as their inspiration for coming in to meet us.” Perhaps testament to how the culture around plastic surgery may have evolved less than we think, there are still people seeking out a surgeon who has said things, publicly, like “This nose has got to go.”

In his statement to Allure, Dr. Haworth said, “I’ve changed enormously in 22 years, both as a surgeon and as a person, and I’m comfortable looking critically at the show through the lens of 2026. There are aspects of the format, the language, and the way physical transformation was presented that I would approach differently today… The Swan absolutely deserves to be reexamined, including its shortcomings. My hope is that the conversation can make room for both the women’s experiences and the full context of what happened behind the scenes.” He continued, “I take seriously the women who now describe parts of the experience as difficult or painful, just as I respect those who remember aspects of it positively. There clearly was no single ‘Swan experience.’”

Dr. Dubrow went on to star in E!’s long-running Botched (and its various spin-offs) and appear alongside his wife, Heather Dubrow, in Bravo’s The Real Housewives of Orange County. He declined to be interviewed for the Behind the Mirror documentary, however. When I first heard this, I felt heartened, thinking maybe he wanted to distance himself from the show. But according to Vanity Fair, he had asked for “an incredible amount of money to participate”—a figure that Behind the Mirror director, Erin Lee Carr, told the outlet was neither possible nor appropriate. When Allure reached out to Dr. Dubrow for comment on that assertion, and on the new documentary, his representative shared this statement: “Twenty-three years ago, I was one of two plastic surgeons on The Swan. Today, I sat down and listened to the stories of Delisa, Gina, Kari, Tawnya, Kristy, Cindy, Beth, Dore, and Kelly. I want to thank each of them for sharing their experiences so openly. Their voices deserve to be heard, and I recognize the weight of what they’ve shared. I take seriously my role in the series and the responsibility that comes with revisiting that chapter of television history. I wish each of them continued healing and peace moving forward.” Dr. Dubrow’s representative did not address our request for comment on the statement regarding payment from the director of Behind the Mirror.

The Swan didn’t just center, but really celebrated, a plastic surgery dynamic of misogyny and shame. It normalized medical care that in many ways disempowered patients. This is what I found most unsettling as I watched the documentary. Well, this and the show’s unholy recovery scenes. We see the women wake from surgery, heavily bandaged, incoherent from anesthesia, and already swollen and bruised beyond recognition. For many viewers, these images likely served as a ghastly introduction to plastic surgery, long before social media desensitized us to the healing journey that now often goes viral. After a single day in aftercare, the contestants were shuttled back to their apartments where, at a certain point, there was reportedly one nurse tending to 20-plus women. The Swans say they helped each other through the post-op misery—the lipo leaks and endless icing—all while battling depression and homesickness. (During the filming, one contestant lost a beloved uncle, another discovered she had cancer, and a third was served divorce papers.)

In the early postoperative period, with nose splints and chin straps still firmly in place, the Swans are shown back in the gym, being berated by trainers during twice-daily workouts. In this most critical phase of recovery, they subsisted on (sponsored) Jenny Craig microwavable meals, which “tasted like bad decisions and regret,” one contestant recalls in the documentary.

For me, it’s impossible not to compare the contestants’ ordeal to the plastic surgery experience sold to us today on promises of safety, informed consent, realistic expectations, optimized aftercare, and natural results—a refreshed version of yourself. Or at least a version that your children will recognize (which was, unfortunately, not the case for poor Beth in season one). Modern surgeons boast about their trauma-limiting techniques. They choreograph procedures carefully, aiming to limit anesthesia to six hours. They issue strict dietary guidelines and exercise restrictions to minimize post-op swelling and bruising and thwart complications. They design aftercare protocols complete with luxury suites, private nursing, healing hyperbaric oxygen, lights and lasers, lymphatic massages, supplements, and swag.

How do we reconcile our current impressions of plastic surgery with the culture of cruelty that was embraced by The Swan not all that long ago? Have we been too blithe in accepting the sanitized marketing for ‘glow up’ facelifts and minimally invasive boob jobs—get on the waitlist, go into hawk—certain that the shame and misogyny of the Swan era are entirely behind us. And what about plastic surgeons writ large? How are they reckoning with the legacy of The Swan—“the most sadistic reality show ever made,” as one commentator described it in Behind the Mirror—and their profession’s toxic ties to it?

Twenty-two years out, Swan contestants are still grappling with the consequences of their own “afters”—hardened and ruptured implants, faulty veneers, “destroyed” gums. (They claim they were dismissed from the show without any follow-up care or support.) For some, the damage is more psychological. “I went home feeling emotionally scarred from the situation,” Lay says in Behind the Mirror. “It makes me feel so frustrated and ashamed [to know] that I participated in and fed into the world’s view of beauty.”

Dr. Haworth is less contrite in the film. “I think The Swan did a pretty good job at trying to show the ‘warts and all’ of the process,” he says. Though he acknowledges that “some of the Swans did struggle with the aftercare.”

As the documentary wraps up, a tearful Kristy Garza, watching snippets from season one, says she feels sorry for that version of herself—a young girl just desperate to be pretty. Season two’s sisters, Gina and Kari (the one who nearly died), tell us that despite all they went through, The Swan experience didn’t sour their opinion of plastic surgery. “What people expect us to regret the most is the surgery—that was the taboo or bad part,” says Gina. “I don’t regret the surgeries. I just regret that the process…tore us down quite a bit.”

To read more about plastic surgery:

• Denise Richards Opens Up About Her Facelift
• I Got a Nose Job Eight Years Ago—and This Is How I Feel About It Today
• Would You Get a Fat Transfer With Someone Else's Fat?