Plastic surgery revision is one of the unfortunate realities of the cosmetic surgery industry. There are many reasons a patient may seek a corrective operation:
- Complications in healing such as internal or external scarring
- Asymmetrical results
- Adverse or allergic reaction to implants or injected substances
- Incorrect surgical approach for a given procedure
- Too many plastic surgery procedures in too short a time
- Procedure not suited to a particular patient’s anatomy
In this article, we’ll look at some of the most common procedures for which patients request revision. This is only a broad overview. The specific technique used for fixing each of these problems varies on a case-by-case basis.
Rhinoplasty Revision Surgery
The nose job is a very popular cosmetic surgery in the United States, and one for which patients often seek plastic surgery revision, as well. Impaired nasal passageways leading to snoring or mouth breathing are the most common complaint. Other issues include:
- Skin that droops below the nose instead of conforming to the reshaped cartilage underneath
- A nose that looks crooked when viewed from the front
- A nose tip that looks too narrow or asymmetrical
- Collapsed or “pinched” looking nostrils
- A bump on the bridge of the nose
An initial rhinoplasty is challenging enough, but revision is even more complex. A surgeon may have to harvest cartilage from the septum or even from the ear to attempt to rebuild the nose. In some cases, nasal implants or even skin grafting may also be required. The more procedures a patient has on her nose, the worse it may get, so finding a surgeon who can correct the problem the first time is very important.
Breast Implant Revision Surgery
Most breast implant patients will undergo plastic surgery revision as a normal part of their implant maintenance at some point. This is because implant design has not been developed to the point where these devices last a lifetime. However, implant failure is only one reason for revision and replacement. There are also a number of things that can go wrong with the implant surgery.
Capsular contracture is the development of thick, fibrous scar tissue around the implant that contracts and puts pressure on the implant. This tissue can make the implants feel rock hard to the touch and look very distorted. In severe cases, the breast may be painful and tender to the touch. Revision surgery involves removing the implant along with the scar tissue. If the implant was placed subglandularly (under the fatty and glandular tissue), switching to the submuscular placement is usually advised. If capsular contracture occurs under the muscle, reconstructive surgery to repair the muscle may be required.
Malposition is another cosmetic surgery problem with breast implants. Unlike capsular contracture which cannot be predicted, poor implant placement is usually a problem caused by the surgeon. It can happen when the pocket to hold the implant is not created properly or if implants are too large to be supported by the existing tissue. Symmastia occurs when the skin over the sternum lifts away from the underlying tissue creating a “uniboob” effect. Bottoming out occurs when the implant migrates downward.
Both of these problems are linked to over-dissection of the pocket that holds the implant. Fixing this issue involves repairing the torn tissues. Sometimes, this can be accomplished with internal sutures. If the implants used are too large, the surgeon will need to replace them with a more appropriate size. Some plastic surgeons are experimenting with a tissue matrix material called Strattice to repair damaged areas of over-dissection and reduce the likelihood of capsular contracture recurrence.
Facelift Revision Surgery
A patient who has a facelift that is overdone often ends up with a face that looks very flat and tight. The cheeks and mouth may be distorted, as well. However, for most patients the tightness immediately after a procedure is simply due to swelling and the facial skin will look normal after a few months. The most common reason for plastic surgery revision for a facelift is that it didn’t make enough of a change. This occurs when the skin is tightened but the underlying musculature and connective tissue is not addressed. This issue can be corrected by having a full facelift that restructures the face to restore the original placement of tissues. Volume in certain areas may also need to be added with dermal fillers.
Liposuction Revision Surgery
Asymmetry and uneven contours are fairly common problems with liposuction that has been overdone or performed incorrectly. Correction of these issues may involve additional liposuction to even out bumpy areas. A smaller cannula may help produce more even results. In some cases, fat may need to be harvested from elsewhere on the body and then injected into the area that has been too aggressively treated.
Who Should Perform Your Plastic Surgery Revision
Who you choose to perform your plastic surgery revision depends on the reason for revision. It may be acceptable to have your initial surgeon do a revision if:
- You requested a specific breast implant size and ended up wishing you had gone with a different size. It isn’t the surgeon’s fault if you change your mind.
- Your surgeon has a low overall complication rate and you happen to be one of the unlucky patients who has a complication.
- Your surgeon is offering to do the revision free of charge and has experience performing the type of correction needed.
Of course, it doesn’t hurt to get a second opinion even in those situations. You should probably go to a new surgeon â€” perhaps one who specializes in revision surgery â€” if:
- You ended up with a completely different result than what you clearly asked for. This indicates a communication problem.
- You feel the undesirable outcome is due to surgeon error, for example, an incorrect pocket dissection technique.
- You have serious wound healing problems (such as tissue necrosis) or capsular contracture causing structural damage that requires reconstructive surgery rather than additional cosmetic surgery.
Plastic Surgery Revision Has Limitations
Sometimes, patients have cosmetic surgery with unrealistic expectations for the results. This is a particular problem for individuals with body dysmorphic disorder, or a distorted mental image of what their body looks like. These patients are at high risk for repeat surgeries in an attempt to get everything perfect. Unfortunately, there is no such thing as a perfect body or face. After too many procedures, the best outcome many patients can hope for is to relieve pain, heal damaged tissue and look fairly normal again.