If you’re considering plastic surgery or a cosmetic procedure, there are many things that no doubt factor into your decision. Cost, recovery, and efficacy are always top of mind, as are the quality and safety of the results. Even in the most skilled hands, the risk of complication or an unsatisfying outcome still exists. While revision statistics can be hard to come by, the United States Food and Drug Administration (FDA) estimates 20 to 40 percent of breast augmentation patients and 40 to 70 percent of breast reconstruction patients undergo reoperations in the first eight to 10 years of having implants placed. Meanwhile, studies show between five to 15 percent of rhinoplasty surgeries are revised.
When a procedure requires revision because of complication or undesirable results, what are your options? Should you stick with the same surgeon or look for another practice? How do you decide on next steps? Whether you're considering a procedure and want to know the good, the bad, and the in-between or you’ve already had surgery that didn’t go according to plan, we spoke with top plastic surgeons to learn more about the options that may be available to you.
How to Tell If a Procedure Has ‘Failed’
Let’s get this out of the way up front: This topic is quite nuanced. Exactly what constitutes a ‘failed’ procedure or surgery often depends on who you ask. For some, it’s when complications arise (learn more in our comprehensive overview of cosmetic surgery complications). For others, it’s when they aren’t aesthetically pleased with the outcome. Or maybe it's a combination of the two.
As it relates to the former, your plastic surgeon should educate you on what to expect post-op and the things you should keep an eye on. If you notice anything that doesn’t look or feel quite right, it’s a good idea to check in with your provider. “Complications like hematoma (blood buildup) or seroma (fluid buildup) are not ideal, but they can usually be resolved with a return trip to the operating room,” says Olivia MaDan, MD, a board eligible plastic and reconstructive surgeon in Nashville. Others, like capsular contracture after breast implants, can take months or years to become evident and may require revision.
The more ambiguous type of procedure ‘failure’ is the kind that involves a patient not being satisfied with their results. For starters, it’s important to remember that even though you may be cleared to resume regular activities at two- or three-month post-op mark, it can take a year (or more) for the body to fully heal after cosmetic surgery. The final result is not truly visible until the healing process is complete, but that’s not to say you can’t raise concerns along the way. If you are concerned about how you look after a procedure, tell your surgeon why you’re unhappy. Any reputable provider will talk through your concerns, advise on recovery, and discuss next steps – which leads us to…
How to Proceed After a ‘Failed’ Procedure
We said it before, but it can’t be emphasized enough: “The first step is to allow the body to heal from the first surgery,” explains Jules Walters III, MD, a board certified plastic and reconstructive surgeon in Metairie, LA. “Most revisions can be considered around six months after the original surgery.” There may, however, be exceptions to this rule, which is why it is important to keep in close contact with your surgeon. “When a procedure fails and complications arise, it will be up to your medical provider to help guide you through your recovery process,” says Martin Benjamin, MD, a board certified plastic and reconstructive surgeon in Scottsdale, AZ.
It’s necessary to figure out the root cause of the failure. “The most important issue is to determine why the procedure failed,” Dr. MaDan notes. Medical imaging or other tests may be ordered to precisely establish what has gone wrong and why it happened. Depending on the cause of the post-op complications or cosmetic concerns, there may be different courses of action. “It will be important to discuss what revisions or alternative procedures are available to you in an effort to still achieve your desired results,” Dr. Martin shares. “Make sure that you discuss all personal questions and concerns in efforts to best formulate a plan moving forward.”
What Revision Entails
How you treat or correct a poor procedural outcome depends on your initial surgery. “Discussing the best treatment plan moving forward with the surgeon that performed the procedure is the first option that should be explored,” says Michael Somenek, MD, a double board certified facial plastic and reconstructive surgeon in Washington, DC. “With this, the patient will be maximally informed about their options both surgically and, perhaps, non-surgically.”
Revision procedures are generally considered more complicated than primary procedures because of how the anatomy has been altered, how surgical techniques have evolved over time, how the body healed itself, and more. “Revision surgery is a wholly different field from primary surgery because a surgeon must contend with the patient's distorted anatomy, as well as scar tissue and the other surgeon's subpar result,” says Barry Weintraub, MD, a board certified plastic and reconstructive surgeon in New York City.
Just as no two surgeries are the same, every revision is unique. “All invasive and non-invasive modalities must be explored to produce the superior result the patient truly deserves,” Dr. Weintraub shares. In some cases – like revision rhinoplasty or replacing breast implants – the secondary surgery may bear some resemblance to the original. “Depending on the initial surgery, revision may involve a part of the original treatment,” Dr. MaDan explains. “Alternatives after surgical failure are on a case-by-case basis.”
While it is often recommended to first return to the provider who performed your procedure, you are free (and encouraged) to seek a second opinion. “You must always choose a board certified plastic surgeon, which is the minimum criteria one should look for," Dr. Walters cautions. “Once a patient confirms that the surgeon is board certified, then a patient must make sure the surgeon performs the chosen procedure regularly and can show multiple before and after photos.” That includes doing your due diligence to ensure the provider has extensive experience with revision, Dr. Weintraub adds.
Revising Non-Surgical Procedures
While we’re mostly discussing surgical procedures in this article, it’s important to note that non-surgical procedures can also fail. Last year, supermodel Linda Evangelista opened up about the disfiguring effects she experienced due to paradoxical adipose hyperplasia (PAH) after a series of CoolSculpting® treatments. Correction requires liposuction to remove the hardened fat deposits. Not happy with your hyaluronic acid (HA)-based filler? Hyaluronidase can often be used to dissolve suboptimal results or prevent serious damage in the case of rare complications like vascular occlusion.
Again, consulting with a board certified plastic surgeon or dermatologist who specializes in the treatment and revision of the procedure you had is key to the development of a safe and effective correction plan.
What’s Different About Revision Procedures
There is risk involved with any treatment or surgery, and that’s even more so the case with revision procedures. It’s important to recognize that creating further trauma will leave behind additional scar tissue, and the cumulative scarring may make it difficult to achieve the results a patient desires. There is also an added risk of complications.
Providers who take on revision cases will often take great care to properly manage patient expectations and explain the limitations of treatment. You should discuss how your surgeon plans to perform the revision surgery, whether you will have more scarring, and what to expect from the wound-healing process. Depending on what caused the issues after your initial procedure, there may be extra precautions for you to take both pre- and post-op.
Furthermore, you may find that you struggle more emotionally in the run-up to or in the period after your revision procedure. You likely experienced a certain amount of stress or anxiety as a result of your initial treatment, and it’s perfectly normal for that to influence how you feel about the follow-up. It's important to share these fears with your surgical team and even with your primary care physician, so they can ensure your mental health is well looked after during recovery.
We hope you are thrilled with the result of your cosmetic surgery or procedure and that your recovery is a smooth one, but it’s important to know that things don’t always go as planned. One way to minimize the risk of complications or a suboptimal outcome is to choose a highly skilled, board certified plastic surgeon or dermatologist who specializes in the procedure(s) you are interested in. Look closely at before and after photos, ask about how often they perform the treatment, and seek out patient testimonials to hear first-hand accounts. While this can’t guarantee success, it will go a long way to ensuring your safety should something go wrong.
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