By Angela Bronner, AOL Black Voices

In what used to be the domain of the rich or famous, the nip tuck has gone mainstream. Like that knock-off Prada bag, plastic, cosmetic or elective surgery has trickled down to the masses.

The results are everywhere – from celebs with perky noses smeared across your favorite magazines, to the girl at the perfume counter with perfect Ds, to scads of TV shows that take the mystery out cosmetic surgeries (even if they are hard to stomach.)

In 2006, nearly 12 million surgical and non surgical procedures (like Botox and laser hair removals) were performed in the United States, an increase of almost 446 percent in the last decade. Breast augmentation recently surpassed liposuction as the number one cosmetic surgical procedure, with more than 380,000 performed last year.

Even African Americans, who historically have been out of the loop (no nose jobs at 13 or face lifts at 55 here), are undergoing the knife in droves. From 2004 to 2005, there was a 67% increase in elective surgeries for blacks. And especially now that plastic surgeons are becoming more educated about the nuances of black skin, including keloids, uneven coloration, light and dark spots, this trend can be expected to continue.

The news was awash this week with the tragic death of Dr. Donda West, mother of rapper Kanye West, who reportedly died after a "cosmetic surgical procedure." The doctor who performed her surgery was not board certified, as many doctors are not, in their zeal to get a piece of this multi-billion dollar juggernaut which can make them independent of insurers who do not pay for cosmetic surgery.

"You do have to be a doctor to do plastic surgery," explains Dr. Daniel Ronel, a plastic surgeon who practices in Sante Fe, New Mexico, of the business that cleared $11.5 billion last year, "but you can be a gynecologist, you can be a pediatrician. A lot of people take a weekend course and say they're a 'trained plastic surgeon.' It's really scary."

Dr. Ronel advises that you look for a plastic surgeon certified by the American Board of Plastic Surgery, which he labels the gold standard. "If you're board certified by the American Board of Plastic Surgery, you have to train for five to seven years."

In addition to death, the most heinous outcome, scarring, blod clots, bleeding, sensory loss, tissue damage and more superficial injury like discoloration and keloids (especially with African Americans), are all possibilities, if plastic surgery goes awry.

Though most plastic surgeons would not label their work "dangerous," they do acknowledge that some procedures pose more risks than others.

"I think plastic surgery is safe if it's done safely," notes Dr. Kimlyn Long, a Howard University educated Medical doctor and plastic surgeon. "But if we're doing large volume liposuction – and large volume is more than 5 liters of fat and fluid -- we would not do that on an outpatient basis."

Anesthesia, especially, which is common in most popular procedures such as liposuction, tummy tucks and some breast augmentations, increase your risk.

"Anesthesia is a big factor -- the level of anesthesia, the length of anesthesia," explains Dr. Long. "They're putting the patient to sleep, they're giving the patient medication, and it all depends on how the patient responds to that is really the most critical thing."

"When you're having a surgery in the operating room, the anesthesiologist is sort of taking control of your body systems," furthers Dr. Ronel, who also says that you need to be in a monitored recovery center afterwards. "You look for bleeding, you look for breathing problems. That's why people stay in the recovery room after the surgery, you can't just go right home."

Both doctors say that they turn away between 10-25% of patients who come in for counseling, because it's not all about the money.

"As a doctor, you have to have that patient's best interest at heart," says Dr. Long. "Sometimes you say, I don't think I can give you what you're looking for. Sometimes you have to say no."