What Was That Question Again?
There's an oft-overlooked question which every potential cosmetic surgery patient should ask before signing on the dotted line to go under the knife:
Excuse me, Dr. Cutsalot, but what is your revision policy?
If you surgeon acts like he doesn't know what you mean, or seems reluctant to give a direct answer, try prodding him or her along by mentioning a hypothetical cosmetic scenario (like uneven breasts, a still-too-large nose, etc.) that scares you. Then ask what would happen if you were unhappy with the outcome: Does he or she offer reduced fees or even waive the surgeon's fee completely for a revision (or "touch up", as some surgeons call it)? What about anesthesia fees and facility (operating room) fees? How long do you have to wait before the surgeon will perform the revision surgery?
The Revision Expert
New York plastic surgeon, Andrew Jacono, MD, dedicates 35% of his practice to revision surgery on patients who were unhappy with the results delivered by other doctors. He has been featured on several national television news programs, and his expertise is sought after in the toughest facial cosmetic surgery revision cases. According to him, 10% of all cosmetic procedures performed in the U.S. are revision procedures. Although the revision rate in Dr Jacono’s own practice is a very low 1%, he does waive his surgical fee for any revision surgery required by one of his patients. As is the case with most surgeons, anesthesia and operating room costs are separate and are the responsibility of the patient, a fact which Dr. Jacono discloses to all his patients before the initial surgery.
Dr. Jacono believes that revision surgery should wait until at least one year after the first surgery, as there can be dramatic changes which occur within the first year after surgery as part of the healing process. This may vary slightly from one type of surgery to another, and different doctors have different guidelines as to when they will operate again.
Who Will Perform Your Revision Surgery
By the numbers above, it appears that many patients who are unsatisfied with their surgical outcome are choosing not to go to the original surgeon for their revision surgery. Some may not know about the surgeon’s revision policy (and perhaps never even thought to ask). Others simply may not trust the person who they believe “messed up” in the first place. This is a valid concern, although it is important to understand that not all poor outcomes are the surgeon’s fault. Sometimes, poor aftercare by the patient (i.e., failing to follow the surgeon’s instructions for wound care and post-op activity level) is to blame. In other instances, the patient has failed to communicate clearly with the doctor about his or her wishes. Occasionally, things just go wrong with the surgery in ways that are out of the surgeon’s control.
Are you Seeing Things Realistically?
It is important to remember that perfection is not a realistic expectation. One person’s “beautiful” may be another person’s “good enough to get by”, and still another’s “unacceptable”. Your surgeon may truly feel that you came out with the best possible result. In that case, there’s not much chance that he or she will offer a free re-do. Keep in mind as well that each person’s bone structure, build, and other individual traits present certain limitations. In other words, all the plastic surgery in the world will not turn you into the starlet whose proportions you covet. The goal of cosmetic surgery is to look like you, only better.
Furthermore, a patient’s problem is sometimes not really on the outside, but rather is in his or her own head. A psychological condition called body dysmorphic disorder causes some patients to see physical flaws that simply are not there (or to greatly exaggerate those that do exist). If you or your surgeon feel that this could be the case with you, you may want to consider seeking help from a qualified psychiatrist who specializes in this type of disorder.
On the other hand, if the result of your surgery is truly unsatisfactory, you should know ahead of time what your options are for revision (if needed). Even the best plastic surgeon cannot guarantee a great outcome, but the good ones will work with you to make sure it all comes out okay in the end.
An About.com Reader’s Story
Recently, a poster on our plastic surgery forum asked what she should do about the fact that her breast implant surgery left her with one breast significantly larger than the other. The truth is that no face or body is perfectly symmetrical, and asymmetry is one of the most common plastic surgery risks. However, this patient explained that her surgeon had filled one implant 100cc more than the other (leaving it noticeably larger), and there had been no previous discussion of this possibility. I asked her if she knew her surgeon's revision policy, and she did not.
So readers, I admonish you to learn something from her situation. There is no such thing as a stupid question. What is stupid is to not ask questions. Make sure you understand all the details of your surgery ahead of time. Ask your surgeon about his or her contingency plans if something unexpected comes up during the surgery. Ask every question you can think of, including this one about your surgeon's revision policy. (bonus points if you can get the answer in writing) To that end, you may also want to check out this list of the Top 11 Questions to Ask Your Plastic Surgeon. Also, take the time to talk to others who are considering or have undergone plastic surgery. Join the discussion on our plastic surgery message boards.
Interview with Andrew Jacono, MD; New York, NY; conducted on October 28, 2008