If Your Plastic Surgery has “Gone Wrong” There are Several Options Available to You

February 26, 2017

If Your Plastic Surgery has “Gone Wrong” There are Several Options Available to You

It might seem like an uncomfortable thing to talk about, but sometimes a plastic surgery procedure may not turn out as you expected causing great stress and a lack of confidence. Either your surgeon was not as skilled or qualified as you were led to believe, and/or, as the weeks and months wore on after surgery, the outcome was not as satisfactory as you’d hoped.

The good news is that most – if not all – botched plastic surgery procedures can be remedied by a skilled and US board certified plastic surgeon.

What are your options if you have a botched plastic surgery procedure?

If your previous plastic surgery procedure has gone wrong, there are several things you can do. And indeed, taking immediate action will help you feel better about your situation right away, even if you might need to wait for a few weeks or months for your revision surgery.

First, don’t panic. No matter what your situation, there is a good chance that it can be remedied.

Second, it’s good to know that almost 15% of our patients come to us for revision plastic surgery, with the most commonly requested “do over” procedure being rhinoplasty or “nose job” revision surgery.

Revision Plastic Surgeries

A “revision” or “do over” plastic surgery is its own art and science. Typically, there are several plastic surgery procedures that can be revised with great success. Following are some of our most common. (Note: if you don’t see a particular procedure here please call our office.)

Facelift Revision Surgery

One of the more frequent requests at our office is for a revision, or “corrective” facelift. There are many reasons why you may feel dissatisfied with a previous face and/or neck lift:

  • Lack of longevity, early loss of results, or natural ageing: most facelifts have a natural shelf-life of approximately 5-10 years
  • Lack of impact: your facelift didn’t effectively “lift” or rejuvenate
  • Previous surgeon lacked an “artistic eye” causing lack of aesthetic harmony
  • Looking like someone else syndrome: not looking like “you”
  • You’re simply unhappy, or unsatisfied with the previous surgeon’s work

The good news however, is that many facelifts that fell short of their original goals can be improved upon via revision or corrective facelift surgery.

Read more about faceflift revision surgery here.

Rhinoplasty “Nose Job” Revision

Revision rhinoplasty is one of the most common of all “revision” plastic surgeries mainly because it is one of the most difficult of all plastic surgery procedures to begin with, so there is a large demand for corrective, or secondary surgeries.

Reasons for revising a previous “nose job” range from a thoroughly “botched” procedure performed by an unqualified or unskilled surgeon, to unexpected healing issues such as difficulty breathing. But most commonly, our rhinoplasty revision patients are simply unhappy with the appearance of their “new” nose; it doesn’t aesthetically “work” in balance with their other features.

Revision rhinoplasty is actually a very common procedure, and the benefits to your sense of self-image and level of confidence are significant enough to make it worthwhile.

Read more about revision rhinoplasty surgery here.

Eyelid Revision Surgery (Blephorasty Correction)

Blepharoplasty correction or eyelid revision surgery is a surgical procedure intended to correct the results of previously performed eyelid surgery or blepharoplasty with unsatisfactory or unwanted results. However, eyelid revision surgery can often be more challenging than the initial procedure.

There are primarily two types of blepharoplasty correction:

  1. Revision of “under corrected” eyelid surgery where too much extra skin or fat was left behind and you are unsatisfied with the results. Eyelid revision surgery can also correct ptosis or “drooping” eyelids.
  2. Correction of “overdone” eyelid surgery where too much skin and/or fat was removed giving the eyes a misshapen or unnatural appearance, known as ectropion.

Read more about Blepharoplasty correction or eyelid revision surgery here.

Revision Ear Surgery (Otoplasty Correction)

Otoplasty (ear pinning) is commonly performed on children at a young age to correct prominent or “sticking out” ears, and as they grow into teenagers and young adults, it may be necessary to revise the original surgery.

Also, depending on the skill level of the surgeon who performed the original surgery, patients may find that the ears were “over corrected” giving them an unnatural or “pulled back” look. Other common complaints include unnatural-looking creases where the ear meets the skull. Revision ear surgery can correct these issues.

Read more about Revision Ear Surgery (Otoplasty Correction) here.

Fat Transfer Revision

Fat transfer revision surgery can help address issues that appear after a single fat transfer procedure or a series, such as uneven or unnatural appearance, lumps and bumps, dissolution of implants, and facial asymmetry. Unskilled application of fat transfer may also result in the face appearing too puffy, swollen, or symmetrically uneven and lopsided.

Read more about fat transfer revision surgery here.

Asian “V-Line” Revision Jaw Surgery

Asian V-line revision surgery is most often requested by patients who do not feel that the original procedure addressed all their concerns, leaving them unsatisfied with the results. For example, a square jaw or protruding may not be “softened” or V-shaped enough, or an unwanted “double chin” may still be apparent reducing the contouring effect of the V-line procedure.

Read more about Asian V-line revision surgery here.

Revision Chin Surgery

Chin revision surgery may be necessary if you are unhappy with the results of your initial procedure. In fact, chin revision surgery is one of the most common procedures we perform, often because the previous surgeon has inserted a chin implant, and this approach has not been successful and the chin needs correcting.

Read more about revision chin surgery here.

Corrective Jaw Surgery

The term “jaw surgery” refers to the most common jaw surgeries: lower jaw surgery, double jaw surgery, and bite correction. Revision corrective jaw surgery is any type of orthognathic surgery that is used to correct a previous surgical procedure.

Most typically, patients are unsatisfied because they do not like the look of their “new” jaw. It may be too masculine, or too feminine, or aesthetically not complementing the rest of their facial features. The most common reason for a poor aesthetic or cosmetic outcome is that while the previous surgeon may have had the technical skills to perform the jaw surgery, he may have been lacking the aesthetic appreciation for how the altered jaw would appear with the patient’s other facial features.

Read more about corrective jaw surgery here.

Skull Reshaping Revision

If skull reshaping and augmentation is performed by an inexperienced or unqualified surgeon you may experience an unsatisfactory result. Negative results may also occur due to infection or if the body rejects a skull reshaping implant. In fact, revision or correction of skull reshaping surgery is actually quite common — about 15% of all or our skull reshaping procedures are revision surgeries wherein we are asked to correct a previous surgeon’s work.

Read more about skull reshaping revision surgery here.

Facial Feminization Revision Surgery (FFS)

To capture authentic gender expression, your surgeon needs to be able to surgically integrate the subtle science and intrinsic differences between the male vs. female craniofacial skeleton. One of the most common types of facial feminization procedures we perform is to correct another surgeon’s work. The main reason for this is that while a surgeon may know technically what is required for feminization, they may not have a comprehensive understanding of the subtle aesthetic qualities of what makes a face “feminine” versus what makes a face simply “beautiful”.

Read more about facial feminization revision surgery here.

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Virtual Surgical Planning (VSP)

October 16, 2016


Virtual Surgical Planning (VSP)

What is Virtual Surgical Planning?

Virtual Surgical Planning (VSP) is a pre-operative planning method that involves the visualization of a surgical procedure using 3D imaging computer software. The central patient benefit of using VSP is that it assists your surgeon in predefining each step of the surgical procedure including goal planning, bone segment navigation, and ensuring facial symmetry.

VSP utilizes medical image data to accurately plan the surgery so that the surgeon can then transfer that plan to the patient using customized 3D printed surgical guides.

VSP is used in several plastic and craniofacial surgical procedures.

Virtual surgical planning is quickly becoming a best practice standard of care for orthognathics and reconstructive craniofacial (maxillofacial) surgeries. Dr. Deschamps-Braly commonly uses Virtual Surgical Planning to plan the following procedures:

VSP ensures that the customized treatment plan we create for our patients is highly accurate, and results in the best possible patient outcome.

The benefits of VSP for patients.

VSP helps the patient by giving them a means to visualize exactly what the surgeon will be doing in the operating room, resulting in clarity of communication and increased peace-of-mind. Our patients are typically quite fascinated by viewing a 3D rendering of their own jaw or skull, and knowing exactly how the procedure will work.

Other patient benefits include:

  • Fewer ”surprises” and clearer expectations
  • Better outcomes – VSP makes it easier for your surgeon to reconfirm planned operative movements
  • Reduced surgery time – VSP can eliminate hours of orthognathic pre-op planning

What to expect at your VSP imaging session.

If you are a candidate for VSP the first step will be to undertake a comprehensive initial workup session. This session will include taking all 3D facial and intraoral images, measurements, plain films, study models, midline notations, occlusion class notation, a bite registration, and a cone beam CT scan. A cephalometric analysis is then performed to show the spatial relationships between dental and skeletal elements.

How we build your treatment plan using VSP.

The data collection is then digitized and virtual 3D models are created to simulate the planned surgical movements and outlined patient goals based on the pre-op analysis. The VSP software shows different colors for different sections of the skull, making it easy to see what goes where and in what order.

Plastic surgical guides are then fabricated using a 3D printer, allowing your surgeon to perform the virtual plan in the operating room to ensure precise repositioning of the jaw and other skeletal features.

Want to know more about Virtual Surgical Planning and how it may affect your surgical procedure? Please ask your surgeon during your session or call our office on +1.415.624.3922.

Image source: http://www.medicalmodeling.com/ 

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Is Long Format Plastic and Craniofacial Surgery Safe?

August 28, 2016


Long format surgery may take 6-12 hours, is it safe to be “under” for this long?

Sometimes it is recommended to undertake several plastic surgery procedures during one session. This is known as a long format surgery, which may take anywhere from 6-12 hours in duration. Most often we recommend long format plastic surgeries for either Pan Facial Rejuvenation, Facial Masculinization, or Facial Feminization.

These are complex surgeries that involve several procedures that need to be performed together to ensure a successful result. For example, if you need Forehead Feminization, it is ideal to combine this procedure with Hairline Lowering, a Brow Lift, and possibly even a Feminizing Rhinoplasty.

How safe is long format surgery?

One of the great concerns often expressed by our patients is:

How safe is it for me to be under anesthesia for this long?

This is a valid concern, and one we wish to address to dispel any myths or fears around long format plastic and craniofacial surgery.

Two elements are critical to understand:

First, it’s critical that your doctor is board certified, and that the procedure is performed in a hospital or certified ambulatory surgery center setting with a board certified physician anesthesiologist in attendance.

Dr. Deschamps-Braly has a stellar professional reputation and is cross-trained in both general plastic surgery, orthognathic (jaw) surgery, and craniofacial surgery. He works with highly qualified board certified anesthesiologists and has admitting privileges at various hospitals in the Bay Area in the event extended postoperative monitoring is necessary.

Second, the duration of long format surgeries can range from a couple of hours for a single procedure, to 10-12 hours for a multi-procedural surgery. This is why we carefully screen our patient’s health before surgery with lab and other tests to assess their suitability for long surgery. We may require additional input from other healthcare professionals prior to long surgery should anything be irregular on your health screening.

However, while a long format surgery can be safely be done in a single stage, it can also be broken up into parts—typically an ‘upper face’ and ‘lower face’ phase that would encompass a few procedures that closely relate to each other. Phases can be performed as close as two days or as long as several years apart.

Because long format surgery involves general anesthesia for an extended period of time, certain precautions must be taken. While undergoing 6-12 hours of surgery is typically safe, it is best to minimize the amount of anesthesia that is required–to also minimize postoperative sequelae.

Although delirium and confusion are rare after long format surgery, we require admission to the hospital for observation for any cases lasting longer than 5-6 hours. We work with anesthesiologists to tailor your anesthesia in such a way as to minimize any post operative confusion.

What type of anesthesia is needed for long format surgery?

Long format surgery is performed under a very light general anesthesia. We typically limit the amount of narcotics and other agents that circulate in the body for extended periods which also improves the recovery process.

Although staging surgeries into two smaller surgeries is possible, it rarely is necessary to do this way, and often increases costs by creating two separate trips to San Francisco.

Your surgeon will explain to you how much and what level of anesthesia is required for your specific series of surgical procedures.

During preoperative testing and evaluation, Dr. Deschamps-Braly will determine how safe general anesthesia will be for your particular situation, particularly if you have any other medical problems or conditions to consider. Local anesthesia is always combined with general to decrease the amount of general anesthesia medications that are necessary.

Your general health and lifestyle habits are also important predictors of outcome:

  • You should also have clearance from your family doctor to make sure you are healthy enough for a long surgery.
  • You should be put under anesthesia only by a board certified anesthesiologist and plan to spend the night of your surgery in the hospital.
  • You will be observed in the hospital overnight to make sure that you recover as planned.
  • Additionally, you should make sure that your surgeon does everything to ensure you have good circulation throughout long format surgery and during initial recovery time.

Have any major studies been undertaken in terms of long format surgery and patient safety?

Several studies validate that long hours for surgeries are not a higher risk to patient safety. In fact, one study noted considerable improvements in patient safety.

A 1999 study on the complications of long operations determined that reconstructive surgical procedures often take a long time to perform and duration of surgery is frequently cited as a major risk factor for postoperative complications. Yet, the study suggests that duration of surgery alone is not a major determinant of postoperative complications, and that the type of surgery performed and the patient’s general health are more important predictors of outcome.

A new national study published in the New England Journal of Medicine and presented at the Academic Surgical Congress in February of 2016 showed that allowing surgical residents the flexibility to work longer hours did not pose a greater risk to patients. The highly anticipated seminal study was led by Northwestern Medicine.

In addition, we have performed over 1,700 long format cases without a single serious health related complication. We maintain a successful track record through very thoughtful patient selection and screening.

What precautions do you take to ensure patient safety?

Dr. Deschamps-Braly and his team are highly regarded for their surgical expertise and exemplary patient care. Your pre-op planning consultation with Dr. Deschamps-Braly is an ideal time to discuss all the practical and important ways you can prepare yourself for a safe surgery and an optimized recovery, both initially and in the long term.

There are preliminary protections to take well in advance of surgery, the day of, and post-operation which include:

  • Follow all recommended pre-operative recommendations for optimal emotional, psychological, and physical well-being prior to surgery.
  • Specifically, your surgeon will discuss what level of sedation is needed, and will aim to keep the anesthesia as light as possible.
  • Per your surgeon’s instructions, discontinue any medications before and after surgery that could further alter brain activity.
  • Be well hydrated and nourished before surgery, to improve blood flow to the brain. Ensure you drink plenty of water and even electrolytes if you feel dehydrated.

Your safety is always our highest priority and primary concern.

Dr. Deschamps-Braly and his team take every step to ensure your utmost safety so that your entire patient experience is a positive one–that yields you the desired aesthetic outcomes as well as the best postoperative recovery experience possible. If you have any further questions, please don’t hesitate to ask Dr. Deschamps-Braly during your initial consultation.

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