I agree. If it is needed, or "needed" (As in not medically, but are left horribly disfigured, or the like) yeah, go nuts....but the people who go Whacko Jacko are not cosure in my books. People should have to undergo psychoanalysis before they undergo these changes, to determine if they either:
a.) Really want to change something, and leave it at that, or
b.) Want to log frequent hacking miles, getting their body chewed and hacked to fill some void.

As for the costs between "reality" TV and formal shows, that's the thing, and that's why so many networks are picking them up. They're dirt cheap! No actors, no writers, just a bunch of schlubs clamouring for camera time, and a reward that's a fraction of what is typically made by the companies who produce these shows.