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Cosmetic procedures and their outcomes can be influenced by how the body responds to the traumatic insult of surgery and the unpredictable forces induced by wound healing. As a result, undesired aesthetic outcomes can occur. This may necessitate the need or desire for revision plastic surgery.

In plastic surgery, the occurrence of complications presents different issues from most other types of surgical disciplines. Unlike more typical postoperative problems such as infection or bleeding, the healing of the surgical site in a cosmetic procedure may be perfect but the desired appearance of the operated area less than desired. The development of a suboptimal appearance exposes the cosmetic surgery patient and the surgeon to the potential need or desire for revisional surgery.

Since appearance was the primary objective of undergoing the surgery, the rate of revisional surgery is going to change based on a patient’s perception of the outcome. While the actual need for revisional surgery varies amongst the type of cosmetic procedure performed,  it has been estimated that it averages in the range of 10% to 15%.  Certain procedures, usually those that involves implants, can be substantially higher. Conversely, many other procedures manipulate one’s own natural tissues to create their effect and, as a result, their revisional rate is in the low single digits.

While revisions of cosmetic surgery results may often be relatively minor, and usually way less than the original surgery, their risk of occurrence is most certainly not rare. Any cosmetic surgery patient needs to understand that the risk of revision plasticl surgery is real and not to make the assumption that such things just happen to others and they are somehow immune to this possibility.

When postoperative complications develop and the need for revisional surgery becomes apparent, it is not a moment of happiness for either the patient or the surgeon. The cosmetic patient is dissatisfied as they never really anticipated that this might happen, no matter how well disclosed this risk was before surgery. Surgical problems are often thought of as ‘something that happens to other patients’ or are the result of some type of ‘surgical negligence’…neither of which is rarely true.

The cosmetic patient is understandably focused on the potential benefits of the operation, not the statistical risks of revisional surgery. This thought process has been unintentionally fostered by plastic surgeons themselves with the many promotional advertisements promising ‘weekend facelifts’, ‘scarless surgery’, and many unrealistic outcomes or recovery times.  As a result, cosmetic surgery is often not seen as the very real surgery that it is with its many potential risks.

Like the patient, the surgeon is equally not enthused about the need for revisional surgery either. There are many reasons surgeons can feel that way, from knowing that the patient is disapppointed,  a perceived failure of their own abilities and as to how this may reflect on their own reputation and image. As a result of these opposing perspectives and even potentially conflicting agendas, a discrepancy may develop between the patient and surgeon as to the need and advisability of revisional surgery.

When needed, however, surgical revisions should be done in the proper setting and under the appropriate circumstances. Certain minor revisions can be reasonably performed under local anesthesia in the office. This approach is simple and avoids the use of the operating room. Many times, however, this office approach to surgery is ‘overused’ in an effort to save the patient further expense. Many revisions are best done in the operating room under an anesthetic that provides a more comfortable experience for the patient and also allows the surgeon to more adequately perform the revision plastic surgery.

Dr. Barry Eppley

Indianapolis, Indiana

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