Some athletes are choosing to go under the knife, here’s what you need to know.

Carter Wheeler was proud of how far he’d come. He’d lost more than 100 pounds and become an incredible athlete—feared on many a local cycling group ride—in the process. He’d changed his diet, becoming a vegan, and he felt better than ever. “I have so much energy now, my recovery time is great and I only sleep like five or six hours a night,” he says.

After an almost two-year-long journey, Wheeler had a lot to be proud of. But he also wasn’t totally satisfied. He looked great when he had his clothes on, but when he walked around shirtless at the beach, he still couldn’t help but feel self-conscious about his body.

Here’s one thing that no one will tell you about being fit: Sometimes, no matter how hard you work, there are still things you don’t like about your body. Maybe it’s a result of a massive body transformation or a medical condition like breast cancer, and you’ve got excess skin or parts of your breasts missing. And maybe it’s a genetic thing—say a predisposition to carrying your weight on your thighs, which no amount of spot training is going to help. Indeed, “spot weight loss” is a myth. A study done by the University of Connecticut in 2007 found that after 12 weeks of exercising one arm but not the other, there was no difference in subcutaneous fat levels on participants’ arms. You can build muscle in a trouble spot, but shrinking fat cells will only happen through weight loss. And if you’ve already hit a healthy weight, but fat still lingers on your hips, belly or thighs, it’s hard not to feel totally frustrated by your efforts.

In cases like these, many athletes contemplate plastic surgery—but no one wants to talk about it. “I don’t want people saying, ‘she only looks like that because she had a tummy tuck and lipo,’” says one reader who asked to have her identity withheld. “I worked my ass off and I work my ass off every day in the gym,” she adds. As an ironman athlete, competitive triathlete and a mom, our unnamed source worried that others would think she cheated, when the reality is that she lost 60 pounds through diet and exercise before going under the knife.

“Is it cheating? No. Who would you be cheating? You’re not competing against anyone, you’re just trying to be your best self,” explains Dr. Kent V. Hasen, of Aesthetic Plastic Surgery of Naples.

“I have what I have, I did what I did, I don’t see why anyone should have a problem with that,” says Wheeler. “But I’m not the kind of person who judges what other people do with their bodies.”

So could plastic surgery be right for you? Dr. Hasen says it depends.

Hasen says that he generally really likes working with athletes because they tend to understand that cosmetic procedures are not a quick fix. That without maintaining a proper diet and exercise, any results achieved through liposuction or the new, non-surgical CoolSculpting procedure would quickly be erased. Athletes get that. However, athletes are also generally more self-critical and impatient with long recovery times.

For Wheeler, that was one of the toughest things about his procedure. “The first week you can do things at one mile an hour, the second week at two miles an hour, then three miles an hour. I just started back by walking around the neighborhood, very, very slowly. I was in considerable pain, the pain was really unbearable,” he remembers.

Depending on the procedure, Hasen says that athletes should be prepared to take as least a few months off from hard training. You can be back to racing in six to eight months, but be prepared for longer downtimes—everyone heals at a different rate. The extreme downtime—and athletes’ collective loathing of sitting still—is one reason Hasen really advocates for non-surgical procedures when possible.

“Athletes are ideal candidates for CoolSculpting and now we have the Vanquish Fat Removal System, these are treatments for people who aren’t really fat and there’s literally no downtime,” says Hasen. Both systems—CoolSculpting cools fat cells to a point where they die off while Vanquish heats fat cells until they die—offer about a 25 percent reduction in fat cells. Liposuction, meanwhile, can remove more fat but has a much longer recovery time. “It’s a single treatment but it’s incredibly painful for how small the incision is,” says Hasen.

As for removing extra skin, reconstructing breasts or tightening and lifting tummies, often athlete’s only real options are surgical. Still Wheeler says he’d recommend his procedure to others.

“I felt like an athlete but I wanted to look like what I had earned,” he says adding “Plus, every time I ran, things would move around so much, it was uncomfortable and annoying. I promised myself that when I got down to a weight that my body felt happy at, I would consider doing something about it.”

Wheeler’s surgery also had one other effect that he hadn’t anticipated: even more confidence. As the weeks of recovery passed and Wheeler was finally able to get out on his bike again, he found he had a renewed commitment to fitness. Finally he both looked like an athlete and felt like one too.

“What you can’t expect is that when it’s all done, you’re going to be perfect. Everyone will always have things they don’t like,” Wheeler advises, “but for me, this was the end of this journey, and my scar from the surgery is a reminder of what I did, everything I accomplished.”

Thinking about going under the knife? Consider these things first:

Plan for downtime
Look at your race or competition schedule and choose a time when you’ve got at least six months to recover. Planning your procedure for after a major goal event will help alleviate that feeling that you should be out training when instead you’re stuck inside recovering.

Research your doctor
Items like CoolSculpting are being offered by everyone from opthamologists to dermatologists. Hasen says that your best bet, however, is to work with a board certified plastic surgeon, who can talk you though all of your options. “An opthomologist isn’t going to tell you that maybe your a better candidate for liposuction when it’s clearly in his best interest to have to do CoolSculpting,” he says.

And before you even sit down for a consultation, do your research. Ask friends for reccomendations and look into a doctor’s lawsuit history.

Be flexible about your recovery
“I knew I was going to be out for a couple of weeks but after four weeks I went back in and the doctor said, I don’t think you’re ready to run yet,” says our unnamed source. “I had to wait two more weeks, but it really was the right thing to do.”