Second Chance Surgery

OP. DR. YUNUS DOĞAN

“Everyone deserves a second chance.”

This popular quote might apply to mischievous lovers, naughty children or reformed criminals, but what about plastic surgeons? Plastic surgery is a significant financial, emotional and physical investment. Many patients save for years to afford it, using up accumulated time off from work and test their personal pain thresholds during recovery.

Can and should these sacrifices be repeated?

The answer depends on who you ask. Just as each patient has his/her own financial capabilities and pain tolerance, everyone also has their own reasons and justifications for plastic surgery in the first place, let alone a second round.

The answer also depends on the goal or reason as well as who’s requesting it. Has the Brazilian butt lift (BBL) fallen from glory? Were the breast implants not the best implants and you’re ready to go bigger and go home? Or was the first tummy tuck just the beginning of your massive transformation after bariatric surgery? Sometimes going under the knife twice is part of the plan from the beginning.

Are all revisions bad?

All revisions are not created equal. A second surgery may be justified for a few different reasons. One of the first steps in any qualified plastic surgeon’s process is making a surgical plan with you. He or she should sit down and have a detailed conversation about your goals and expectations. You will be physically examined and your surgeon will determine the best course of treatment.

Sometimes your desired outcome can be achieved in one surgery. Congratulations! A one-and-done surgical plan may include combining multiple surgeries so that all your affected body parts are altered accordingly. You may have heard of the mommy makeover - which typically includes 360 liposuction, breast augmentation and tummy tuck - all performed in a single trip to the operating room. The patient and surgeon have an understanding that all hopes and dreams will come true after one deep sleep.

If a patient opts for a second round after the one-and-done, this is considered a revision. A revision can happen due to: a surgeon’s error, a patient’s unrealistic expectation or the life expectancy of the initial surgery running its course. Maybe the first set of breast implants did not heal symmetrically. Or a patient’s hyperfocus on the tiniest flaw is too overwhelming to ignore, such as a tummy tuck scar that heals in a less-than-aesthetic fashion, leaving the patient wanting a thinner result. Perhaps the 15 year-old rhinoplasty’s outdated shape is leading the patient back to the operating room for an updated look.

Sometimes it takes more than one surgery to completely redefine your physique to its best potential. Your plastic surgeon knows what he or she can accomplish in one surgery and may decide to create an overall plan. You might be directed to return after proper healing for the next planned step in your individualized process. Your surgeon will provide an outline, calculating each surgery regarding intensity and duration. Multi-stage surgeries are especially common for patients with excessive amounts of loose skin caused by bariatric surgery.

When a patient returns for a second surgery after an appropriate recovery time from the first surgery, this is called the second/secondary session/surgery. Because the second session is openly communicated as part of the original surgical plan, there is no fault assumed or blame placed on either the plastic surgeon or the patient. To ensure patient safety, there are limits as to the quantity of fat removed via one session of 360 liposuction as well as the amount of skin excised in a tummy tuck or Fleur-de-lis (FDL.)

So to recap, a revision is performed to correct a real or perceived error or to update an older plastic surgery. A secondary surgery is planned and performed in correct chronological order per the surgeon’s outline. The American Board of Cosmetic Surgery further confirms this distinctness here.

Second verse, same as the first?

Prior to going under the knife again, there are a few important actions that a patient should commit to taking:

• Use your words
• Bide your time
• Know that scar tissue could be an issue

First of all, communication is vital to ensure that the surgeon fully understands the patient’s desired outcome. Some patients provide pictures to illustrate what they envision in their minds, just in case their words fail to completely convey their wishes.

Second, patients need to be… well, patient! Many plastic surgeries require months of healing to see the end result. Some plastic surgeons advise their patients to refrain from additional surgeries for at least a year to give the initial surgery time to come to fruition. It is also wise to use this time to promote healing through nutrition and a healthy lifestyle.

Patients should be aware that their existing scar tissue could hinder additional surgeries that were not part of the original surgical plan. As realself.com points out, scar tissue thickens the skin, possibly interfering with the surgical process and/or distorting the final results.

The last stitch

Plastic surgeons love happy patients. They love creating fantastic results and helping people achieve their dreams. And for the most part, they love sending them out the hospital door and never seeing them again, unless a return trip is part of the initial plan. Remember, some surgeries require more than one session.

And occasionally, some procedures can develop complications or need a little touch up, like breast implants. We covered the basics of re-fluffing those pillows here when we told you about capsular contracture. Rhinoplasty is another procedure with a moderately high rate of revision - around 10% in 2013, per the American Board of Cosmetic Surgery - but your surgeon will most likely discuss these facts with you. If he or she doesn’t, remember that communication is a two-way street and you’re in the driver’s seat!