For those of you who have seen the recent television show, Botched which is the latest offering from Hollywood to the world of plastic surgery on the reality TV platform, I would have to say that this is the first reality TV show on plastic surgery I have applauded since it showcases two board certified surgeons, one in plastic surgery, and one in facial plastic surgery, who responsibly go about assisting those people who have unfortunately undergone misguided procedures at the hands of either non-certified physicians or surgeons who now lost their way even though they were certified.
Dr. Nassif and Dr. Dubrow are both well respected surgeons within their community and thus far have done a good job of demonstrating to their audience how responsible surgeons should go about taking care of these patients. The first evening that the show aired, my nurse, Beth called me the next day and asked me if I had seen the show and I told her that indeed I had. She remarked to me how we had seen and done all the surgeries that had been showcased on the show for botched patients right here in Alabama.
Indeed for a number of reasons, our practice seems to be one where we perform re-operative surgery after patients have been elsewhere. While the reasons for this are complex, I feel the most common reason is because many patients don’t understand the necessary steps to finding a plastic surgeon which has low complication rates and good aesthetic outcomes. The current world of internet marketing is very confusing and many patients find these internet websites to be full of a lot of hype, which is very misleading.
I have previously mentioned in other blogs, the proper degree of importance, patients should place on certain issues in regard to finding their surgeons, but it seems that a great many number of patients seem to miss the mark in this category. Many times when we see patients that have been “botched” their comments are, “well, his internet site makes him seem so great and he had a lot of great reviews, and he seems to do a lot of cases, and he wasn’t very expensive”.
We hear this scenario a lot and the first thing I can say is that the patient needs to be very careful about something that appears bargain basement because you tend to get what you pay for no matter what it is. Surgeons who run very high volume centers do so because they are cheap, so keep in mind that a bargain basement price in a high volume center will put you in a situation where the surgeon has to complete a good many more cases to meet the overhead that he has to pay to afford the surgical center and/or office setting. Therefore, your surgeon is essentially under the gun to complete as many cases as they can in a day because they have lowered the price to attract more volume. We feel that this is a scenario that has a direct negative impact on patient interests.
The best interest of the patient is obviously to have the best possible outcome and the best possible outcome occurs when the surgeon has the freedom to take the necessary time to perform a detailed and careful operation, especially in the re-operative setting; therefore, a bargain basement scenario does not lend itself to the situation. In regards to performing procedures that have been previously botched, even more time is necessary except the first part of the procedure requires undoing what has been done wrong and also finding what anatomy is still present that can be utilized to correct the situation.
In addition, patients need to understand that their expectations for correcting a botched procedure need to be different than the original expectations since the second surgeon is now handicapped in regards to the anatomy of the operative site, as well as residual scarring. While many botched procedures can be corrected to a point, at which the patient is very satisfied, on the other hand, some expectations are essentially unrealistic. It is so unfortunate that these botched procedures even occur. The reasons that they occur are due to several possibilities. The first and most likely cause for a botched procedure is that it was done by a non-certified person who was not trained in plastic surgery.
The only type of surgeon that people should be performing plastic surgery is a board certified plastic surgeon. There are a number of other societies, which have created their own boards and these boards are not approved by the American Board of Medical Specialties and they try to promote themselves as qualified surgeons in the cosmetic arena. The standards for these boards are much lower in that they only require one year of training under another surgeon who is usually non-certified by the American Board of Plastic Surgery. They state as their rationale for acceptance that their fellows perform a great number of cosmetic procedures in that one year. In fact, they use old data from the American Society of Plastic Surgery to show that their fellows actually perform more cosmetic procedures than residents in the American Board of Plastic Surgery Residency program. This is a twist on the facts because what they are leaving out is that the residents in the American Board of Plastic Surgery are highly trained in the foundational principles of plastic surgery in the first year of training and residents in the American Board of Plastic Surgery are usually already fully trained in another field of surgery such as general surgery or ENT or orthopedic surgery.
Leaving out of the foundational principles of plastic surgery is simply teaching a physician to perform 6-8 different cosmetic procedures would be the same as admitting a student to college and teaching them to perform 8-10 experiments in the lab without giving them the entire educational basis prior to doing so. The proof of this is the fact that without fail, the overwhelming majority of cosmetic procedures over the last 50 years has been invented by board certified plastic surgeons and these new and innovative procedures are based on the foundational principles necessary to understand and create the world of aesthetic surgery.
Therefore the idea that someone without the foundational principles can enter into a 1-year program and learn 6-8 procedures is erroneous in terms of justifying that person as a qualified surgeon in the aesthetic arena. Another reason that botched cases occur is because properly certified physicians may not always develop a good aesthetic eye or they themselves may have had a long background in reconstructive surgery and only recently entered into the aesthetic arena. Aesthetic surgery is an art form, which requires not only foundational principles of training and training in aesthetic procedures, but also requires an artistic eye and unfortunately not all surgeons have that. Another source of botched cases come from surgeons who for whatever reason do not have a high level of concern about the outcomes and therefore perform procedures in a very fast and careless manner. Fortunately, this last category is exceedingly rare, but we do encounter it in some of the patients that have come to our office.
One last category is that category of patients who may appear to be “botched”, but on the other hand have simply encountered a complication from a procedure that has been performed by a highly qualified surgeon. An example in case is a patient I saw a number of years ago who came to me after having a rhinoplasty elsewhere and after the rhinoplasty had lost a significant portion of the tip of her nose. The surgeon that performed the procedure was a very well-known and respected plastic surgeon who was a member of the American Association of Plastic Surgeons which is the world honor society in plastic surgery, which contains only about 300 members worldwide with these members being peer selected by other plastic surgeons. Therefore, I knew that the surgery had been carried out properly by a highly qualified physician, yet here was a patient who had gone in for a routine rhinoplasty and yet had lost to the tip of her nose and was now facing major reconstruction.
However upon delving into the case further and upon dealing with the patient myself, it became obvious that the patient was a habitual chain smoker and drug addict and after surgery she did not follow instructions in that she essentially the smoked the end of her nose off. This patient was essentially inoperable and we wound up not proceeding with reconstructing it and referring her for a nasal prosthesis. Therefore, every case that appears to be “botched” may not be so and in fact can be a result of a complication such as this or a wound infection or another untoward situation. Be that as it may, we do seem to see a fair number of reoperative patients in our practice at Core Plastic Surgery in Birmingham.
If you are a patient who has had an untoward result from a complication or if you feel you have been “botched” then we will be happy to see you and evaluate you for a revision procedure. Many surgeons do not want to see patients who have had complications elsewhere, but at Core Plastic Surgery, we feel it is our mission to assist these patients and try to return them to normal as much as possible. If you would like to schedule a consultation for a previous botched procedure, please call Regina Windham @ 205-397-2104.