Doctors Face and Body (Robert Kotler, M.D. and Stuart Linder, M.D., respectively) noticed that, in the massive glut of news about Heidi Montag’s plastic surgery, two things stood out if you looked closely:
Among eight other minor nips and tucks, Heidi had two major procedures done over, including:
- A revision rhinoplasty
- A breast augmentation revision
Revision surgeons go back and repair cosmetic plastic surgeries that weren’t done correctly the first time.
Dr. Kotler (who blogs as Dr. Face) and his erstwhile colleague, Dr. Linder (who blogs as Dr. Body) are both board-certified Beverly Hills cosmetic plastic surgery revision specialists.
As you might guess from their blogging names, Dr. Kotler performs surgeries of the face while Dr. Linder handles many breast and body cosmetic plastic surgery.
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Dr. Face: (Dr. Kotler) Of the breast surgery revisions you do, doctor, is there a common mistake the doctor before you has made in the first surgery? And how many breast surgery revisions are you doing these days?
Dr. Body: (Dr. Linder) Yesterday was typical; of the six initial consultations, three patients wanted breast surgery revision because the first, second or even the third were not done correctly. I saw one woman several days ago whose breasts had been operated on five times – and all five were poorly performed! Overall, I would say half of my patients ask for breast revisions.
Dr. Face: What seems to be the problem with the surgeries before you perform your corrections?
Dr. Body: I see several problems. Daily, I see patients from all over the world whose previous surgeon started the procedure with an incision in the belly button or in the arm pit. The idea is to hide the resulting scar but the surgeon is starting too far away from the breast to create a good pocket and place the breast implants correctly.
Dr. Face: Do you see other common patterns that result in unhappy patients?
Dr. Body: I see quite a few “double bubble” patients. That happens when the implants break through the skin near the breast bone and roll together. Conversely, I also see many patients whose implants are so far apart, the patient has no cleavage. After healing, their breast augmentation looks like two grapefruit halves stuck to their chests.
Dr. Face: Well, what incision do you use to get good results and repair these bungled breast augmentations?
Dr. Body: I start with an incision in the areola region, the dark area surrounding the nipple. I favor that approach because I’m working and standing right over the breast and can more easily center and balance the implants to provide natural looking results. Additionally, the important structures in the chest – directly beneath the breasts — that must be operated on for a complete, proper placement of the implants are only two inches away. I can clearly see everything relating to the internal anatomy of the breast and chest.
Dr. Face: I also see many patients for a rhinoplasty revision surgery to provide a better looking nose and to make sure their breathing is good. The most common mistake I see? Previous surgeons taking away too much nasal tissue and, often, too much of the bones and cartilage inside the nose.
Dr. Body: You have such a small area to work in doctor; it must be like watch making or building ships in bottles!
Dr. Face: The situation is close to that, but there is another factor at work — it takes many years to realize how the passing years can affect a nose job. It’s almost like there are three people involved in a rhinoplasty – the patient, the surgeon and Mother Nature whose healing process can change or complement what I’ve done in surgery.
Dr. Body: Well, how do you account for what the healing process is going to do?
Dr. Face: One, by being conservative during the surgery. I can always go back later and perform some refinement, if necessary. Two, if there are very minor imperfections surprisingly delivered by Mother Nature, we can often correct them in the office using filler injections instead of another surgery. I have read that as many as 25 percent of rhinoplasty patients across the board are not satisfied with their nose jobs. That explains why we are seeing a record number of patents requesting we re-do the work first done first elsewhere by more inexperienced surgeons.
Dr. Body: Being that the nose is a three-dimensional structure, some of the bones and cartilage inside the nose must be the equivalent of weight-bearing walls in a house.
Dr. Face: That’s correct — the same thing can happen to a nose as to a house. If you remove too much of the weight bearing walls, the structure can collapse or partially cave in.
Dr. Body: Then what do you do?
Dr. Face: If it’s very serious, I can take donor tissue from the rib area or an ear and recreate the wall. But sometimes, if only a divot or scooped out area shows on the outside of the nose, I can avoid surgery altogether and, again, use injections of facial fillers to make the nose aesthetically pleasing once more.
Dr. Body: If you were a patient, what would you do to make sure your nose or breast augmentation was done correctly the first time?
Dr. Face: In addition to reading everything about a surgeon’s training and experience, I would check their websites for the number and type of revision surgeries performed. Because the surgeon who repairs the work of other surgeons surely knows how and where the mistakes are made and how to get it right the first time. So patients are well served to always search for the cosmetic plastic surgeon who is the most specialized and has the longest run of experience.
Look at Dr. Kotler’s before and after rhinoplasty revision photos.
View Dr. Linder’s before and after breast augmentation revision pictures.
