Operating in Reverse: How the Unwanted Plastic Surgery Result Can Be Reversed

Doreen Wu (00:00):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu. And I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is "Operating in Reverse: How the Unwanted Plastic Surgery Result Can Be Reversed." Another intriguing episode title Dr. Bass, when people think of plastic surgery, the word reversible doesn't typically come to mind. So what is this episode going to be about how to fix a complication from plastic surgery?

Dr. Lawrence Bass (00:39):
That's part of it Doreen, fortunately big healing complications are uncommon in plastic surgery, but that's not the only thing that might lead someone to re-operate. Some people just want better symmetry. That's something. I generally advise people not to chase too hard. A big asymmetry is undesirable, but small asymmetries are universal in human appearance and chasing them really hard is a lot of risk for very little reward. Sometimes people re-operate because there's some aspect of their appearance that's not as they desired or not as they expected it to turn out or they want more improvement than they got, or they want to change it in some different way. So that's occasionally a reason for re-operating but this episode is mostly about what happens, not when you want to change or refine a result, but when you want to undo a result, and there are several reasons for that, sometimes you thought better of changing the feature. And you just want to go back to where you started. Once you realize how you'll look with that feature a certain way. You say that doesn't look good on me. I don't like that. Let me just go back where I came from. Sometimes you just need a different look. You're at a different life stage where there's a style or a fashion change in terms of a certain feature you tried to create. And so you'd like to undo the procedure and again, go to a different sort of a look.

Doreen Wu (02:22):
I can already tell this is going to be a nuanced topic. So Dr. Bass, can you break this down for me a little so I'm sure I understand the distinctions.

Dr. Lawrence Bass (02:31):
Sure. There are things like immediate undos. You decide you want bigger cheeks, you get cheek implants. Once you see them in there, you realize you really don't look better with bigger cheeks. So you come back and say, "I hate it. This was a big mistake. Put me back where I started." So that's a, that's an immediate undo. And then sometimes there's a style undo. You wanted a big buttock. You decided to do a Brazilian butt lift, and now you have that bigger buttock, but you didn't realize all the implications, how it was going to change, how large it made your breast look to have wider hips or a bigger buttock, how it was going to change your fit in fashions, how it was going to affect your ability to do sports. Maybe you don't like the reaction you're getting from friends, family, or just from strangers commenting on your appearance or staring at you. So that's a style undo.

Doreen Wu (03:37):
That seems straightforward enough. So what are some common examples of this in the body?

Dr. Lawrence Bass (03:42):
Mostly in the body it's about adding or removing fat for body shape. So it's like what we do in the procedures in the first place, except just going in the opposite direction. So most people like to be thin in America. We're obsessed with being thin and many other nations are as well. But we do have fad shapes and celebrity imitation, and those kind of shapes or appearances are more likely to be undone if they end up being out of style. An example of that again is the Brazilian butt lift, a body shape popularized by Kim Kardashian and others which is very much in style right now, getting people to go to big construction projects with fat grafting, mostly to build a bigger bottom, but at some point that may be out of style and they may want to reverse that.

Doreen Wu (04:47):
And how is that accomplished? What can be done to reverse a BBL?

Dr. Lawrence Bass (04:51):
Basically it's liposuction, as I said, Brazilian butt lift or BBL is mostly done with fat grafting. And so liposuction will take that fat back out and allow a reshaping. You know, you could take it out partially. You could take it out totally. you could just take out enough to focus on a different shape than the one that was obtained. Sometimes prosthetic implants are used, gluteal implants, and there, the implant can simply be removed, which by and large undoes the result.

Doreen Wu (05:32):
But doesn't that mean you just end up back where you started?

Dr. Lawrence Bass (05:36):
Well, you hope you end up back where you started. That's what you're trying to do when you reverse it. But sometimes depending on how much of a size change was involved, you may have loose skin and that may require skin excision. The more traditional type of buttock lift, where a wedge of skin and fat is taken out at the top of the buttock to boost and shape the buttock. You also have lost that fat store which you may want to use somewhere else and maybe needed to create a complimentary shape somewhere else. Particularly if you've done a reduction as the initial procedure, going back and adding back the shape can really only be accomplished if you have fat somewhere else to borrow.

Doreen Wu (06:29):
That makes sense. If you're removing something that was previously there, then there will likely be a cavity where the material was originally taking up space. So it makes sense that reshaping and some restructuring are both likely necessary. So what's another example in the body that you often encounter?

Dr. Lawrence Bass (06:47):
So another typical body shaping or body size area that we work on is of course the breast. So you maybe decide, whether you reduced or you got a breast augmentation, you may decide you're over being a certain size or that a certain size is too big for you currently, particularly if you lost weight elsewhere in the body, you may now look unbalanced. So in that case, we take breast implants out if someone feels they're larger than they want to be, but there, much more commonly, especially if a number of years have passed and if the augmentation was significant in size, it's fairly common to require a breast lift at that point, if we really want to maintain ideal breast shape. So some people may decide they they're just done with the implants or they're done being a certain size and they may just go ahead and do it other times.

Dr. Lawrence Bass (07:56):
They pursue adjusting the size when it's time to do some other surgery. So they got capsular contracture or they're thinking about a breast lift and this is, or the implants fail. And this is the chance for them to jump in and, and take advantage of that needed surgery to make that, that reversal in the size selection that they made at the outset with their original procedure. Sometimes people decide they're really over it. They do a full reverse, just pull the implants out and downsize. Or some people who want to maintain some of the size will pull implants out and switch to fat grafting for breast augmentation, usually at a more modest size and without a lot of delayed consequences of having a breast implant, an artificial implant, inside the body. Some people decide they're, they're not that worried about the size, but they they're worried about the implants. They're just tired of thinking about them or they're concerned about what they might do in the future. So they decide to remove the implants without any problem occurring. And I've had two or three patients in my nearly 30 years of practice who have come back and said, "I just don't like the idea of thinking about these implants, just take them out." So it doesn't happen very often, but it does occasionally happen.

Doreen Wu (09:40):
Let's switch gears and talk about the face. What kinds of procedures are targets for reversal on the face?

Dr. Lawrence Bass (09:47):
Well, the first thing is implants. So cheek implants, chin implants, jawline, or jaw angle implants, which are frequently used to alter face shape, may be too big, or someone just doesn't like the look or it's not what they expected. So they decide to take the implants out undo the procedure. Occasionally someone likes it, but wants to go up in size. So they double down on the augmentation. So they're not really reversing, they're kind of taking it one step further. An analogous thing happens with injectable fillers. So some people wind up with too much filler and their shape is distorted. This can be avoided by just building up incrementally, but, you know, sometimes it sneaks up some on people and they need to undo some of that filler, or they've had too many different kinds of fillers in too many treatment sessions.

Dr. Lawrence Bass (11:03):
And as that different population of fillers, both different in type and age, start absorbing a lot of unpredictable shapes can emerge as those fillers come out. And so we decide to reverse the fillers, take them out all at once to avoid having to experience that protracted period of peculiar shape change. And sometimes the tissues just need rest. We want the fillers out of there so that the tissues can rest and not continue to go through injection sessions. Sometimes again, people didn't get what they expected out of a filler, or they look and they say, "okay, you filled in my fold or you gave me bigger cheeks, but that doesn't look like me." So it doesn't fit their self image. And they'll decide to try to reverse that. And a lot of times we reverse filler before we do surgery in the face.

Dr. Lawrence Bass (12:05):
If we're going to do a brow lift or an eyelid plasty or a facelift, we want to know exactly where to put things, exactly what the baseline bone structure is. And so sometimes people will come a few weeks before the surgery, have all the filler reversed so we can proceed. And so this is done by injecting an enzyme that melts the fillers, which in the United States, because almost all fillers we use are hyaluronic acid fillers. The hyaluronidase enzyme breaks that down and allows us to undo the fillers. So with fillers, we kind of have a magic eraser that lets us take a mistake or adjust a decision to change direction or change course, and take away the old choices, the old filler and start fresh. The same kind of thing sometimes happens with fat grafting. People either get too much it winds up someplace that they didn't intend and they have a funny shape and that can be taken down with kind of like a baby liposuction-like procedure.

Doreen Wu (13:22):
Sounds like some of these reversals can be pretty involved. Are there additional consequences for these reversals?

Dr. Lawrence Bass (13:29):
Well, the nice thing is usually the answer to that is no, but it's possible depending on the magnitude of the size change and how long the size change was maintained. So again, a big size change, particularly in the awkward direction. If the person went a lot bigger and now they're taking that back to go to a smaller size, having loose skin or empty skin is more likely, and that might require something bigger in terms of undoing.

Doreen Wu (14:07):
And now what about the nose? Do people often reverse their rhinoplasties?

Dr. Lawrence Bass (14:12):
That's a great question. And, you know, that's more of a gray area. Sometimes it's a liquid what's called a liquid rhinoplasty. That's done with injectable filler and there people may decide they don't want that shape anymore. They want a slightly different look. And we undo the filler again with the injectable enzyme, but where it's surgical rhinoplasty, it's not so much a question of reversing, but in many Caucasian rhinoplasty, the essential step that's taking place is essentially a reductive rhinoplasty. We're reducing the size of the bones, the cartilages, and taking overbuilt sharp or angular shapes and trying to soften and harmonize them.

Dr. Lawrence Bass (15:10):
So, and we're also trying to take out width very often in the nose. So in a lot of secondary rhinoplasty, it relates to building back structure in the nose to restore shape. If the change is deemed too much or if the nose is collapsing with age or with excessive surgery, it's building back that support structure and projection. So in a sense, it's undoing, but really what we're doing is going in and constructing a new artificial support for the nose to replace the initial support that was lost over the course of surgery. Rhinoplasty in Asian noses and black people's noses is more often about narrowing the contour of the nose and augmenting the projection of the dorsum, or the bridge of the nose. And that's sometimes done with a prosthetic implant. And if that was done too much, or the person wants to undo it and have a more authentic ethnic look the implant can be removed, but a lot of secondary procedures in the nose for everybody of all ethnicities is really aimed at refining rather than reversing the result.

Doreen Wu (16:37):
All right, let's recap the episode for our listeners. What are the key takeaways about procedure reversal?

Dr. Lawrence Bass (16:43):
Well, the first thing is careful planning, thinking through your wishes and desires and careful imaging and simulation maximizes your understanding of the likely results that you're realistically going to obtain. So you can decide if that's a good look for you or not. So that you're less likely to end up with something you don't like that you want to reverse, never decide on doing a procedure in haste that will also reduce the chances you have to reverse or undo a procedure when it comes to fads and trends in appearance. I mean, that's okay for fashion. That's okay for makeup. But it's not ideal for aesthetic treatments. And I personally feel it's a bad idea for surgical procedures. But again, there is reversing potentially even with surgery. It's always better though, to avoid an unwanted appearance than to have to undo an unwanted appearance separate from that.

Dr. Lawrence Bass (17:58):
There are some things we know we're going to be going back eventually to rework them, not so much to reverse them, for example, a facelift or a breast lift. I mean, aging always continues. It never stops. And so eventually we'll have to relift and that gives a chance to readjust other aesthetic concerns. At the same time, the same idea with breast implants, sooner or later, those implants are likely to wear out. And so, you know, sooner or later, you're likely to be back in the operating room. And that gives you a chance to take aesthetic concerns and adjustments you'd like to make that are not major and urgent that you can live with for a while, but are not ideal. And rework them at that time when you need to be in the operating room anyway. So overall, if you made a mistake and you need to reverse something, usually a lot can be done, but don't seesaw. Don't do something, undo it, redo it, undo it. Be kind to your body tissues. And remember that perfect is the enemy of good.

Doreen Wu (19:18):
Being kind to your body and maintaining realistic expectations are definitely important lessons to keep in mind when it comes to plastic surgery. I, for one, am very happy to know that I have a lot of options if I'm not in love with my surgery results or an outcome after particular procedure. Thank you to all of our listeners for joining us today, to hear about what you can do to achieve your desired results. I hope you found this episode as intriguing and informative as I did. If you think of other exciting developments or trends in plastic surgery that you would like us to discuss in upcoming episodes, please reach out by email or Instagram. We'll see you next time. This is Doreen Wu thanking you for joining Dr. Bass and me for this discussion of procedure reversal and plastic surgery. Be sure to tune in next time. And don't forget to subscribe to our podcast, to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (20:08):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass, Park Avenue, plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor-patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.