Botched Plastic Surgery Jobs: Who Causes Them?

I saw the v. helpful answers doctors posted on discount plastic surgery, and wondered, gosh, how often do you see botched surgeries (like Dr rand mentions) becs I am worried about a breast implant plan. I hope you are comfortable sharing this.

1) What is your estimate of % of patients that come in with a botched job;

2) Of these, how often are they from overseas work done,

3) or, how often from unqualified doctors,

4) or, how often from qualified doctors?

Just wanted a gut check on this... thx!!

Doctor Answers 11

Who does "botched plastic surgery?"

There are only 3 surgeons who don't have re-do surgeries:

     1)  The dead surgeon.
     2)  The retired surgeon.
     3)  and the liar.

The best surgeons (those who have the fewest complications or re-do operations) are those who obtain excellent training, obtain board certification by real (not bogus) boards, keep up their continuing education, do a lot of the kind of surgery you are contemplating, and have a humble nature that allows them to admit their failings and learn from their mistakes or less-than-ideal outcomes. Educators, whether in academic or private practices, who like to teach other doctors are generally more up-to date, and those who provide charitable surgery for people in less fortunate circumstances tend to be better at their craft, and constantly strive for improvement regardless of their years of experience.

Unfortunately, some surgeons who are on a salary may have less incentive to do better than those whose income depend on their patients' satisfaction and ongoing referrals, but the latter may also be more prone to puffery and self-promotion.

Less than 3% of the 500-700 operations I perform per year require revision surgery, and those are not to fix "botched" surgery, but to improve results, deal with bleeding, place larger implants, or other similar adjustment. Truly unhappy patients with what I would call "botched" results are significantly less than 1% overall, but I do see them. Fortunately, they are very rarely my own patients, and there's a reason for that!

Those "botched surgeries" that I have seen recently: a breast augmentation that was attempted under local anesthesia by a Dermatologist (who called himself a cosmetic surgeon) and only one implant was able to be placed because of patient pain so severe he had to stop halfway through the operation. He tried again the next day (also under local, since he had no hospital privileges and was doing this in an exam room in his clinic) and failed again. Ten days later, the patient still had severe pain in the implanted breast, scars on both sides but an implant missing on one side, and she came to me for help. I took the patient to surgery (under general anesthesia)  to remove the one implant the Dermatologist "cosmetic surgeon" did get in--I found bleeding and possible early infection. Lawsuit pending.

Case two: (an American patient who had surgery in Singapore)--facelift, forehad lift, eyelid surgery patient whose "surgical tourist" operation was not done improperly or "botched" at all, just didn't give her the improvement she (reasonably) wished for. Compared to her pre-op photos, there was really NO improvement, so I include this in the "botched" category. I redid everything, so her overseas cost "savings" really was a huge unnecessary expense and additional risk (she was lucky there were no complications other than a poor result).

Even properly-trained, board-certified plastic surgeons have complications or poor results; those with less training have more bad outcomes, or may be more successful at selecting patients who are "easy" cases, or less well informed as to what constitutes a good outcome. Foreign plastic surgeons can be superb surgeons, but there is a higher proportion of substandard training or practices in some foreign countries. You may be lucky enough to choose the best surgeon in a distant locale, but what happens if there IS a problem or complication?

If you are just concerned, good for you for asking these questions! If your gut is telling you to be concerned about who you are seeing, get a second or third opinion! Remember, the bitterness of poor quality remains long after the sweetness of low price is forgotten.

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Cosmetic surgery and complications.

Despite the many advertisements and "promises" displayed in many print and media advertisements, cosmetic surgery is actual surgery. It should be approached with the same seriousness as any other operation.  It is the perception that cosmetic surgery is simply a product -> pay money and receive your result which leads people to believe it is without risk and consequence. The American Society of Plastic Surgeons has spent countless resources attempting to educate the public in the importance of researching your surgeon and their board certification.

Each plastic surgery practice is different in its scope of patients as well as how much revision or redo operations they perform. I practice in South Florida, and it is not uncommon to see patients who have had cosmetic procedures performed in Latin or South America. Many times, they have had uneventful surgeries and great results. The difficulty is that when a patient travels to have an operation at a cheaper cost, they often cannot return to that surgeon if they have a complication. Thus, treating the complication may cost several thousands of dollars more than what they paid for the original surgery.

Every surgeon has complications, and if they say they do not, I would avoid them. Surgical outcomes are a combination of the surgeon's experience, planning, the patient's anatomy, and the patient's own unique health situation. The key is to find a board certified plastic surgeon with whom you feel comfortable. You should understand the procedure, the risks of the procedure, any alternatives, and what to expect afterwards (including treatments for any complications). If you are worried about your breast implant plan, why not see a few more plastic surgeons? Having a surgeon that you respect and trust is one of the most important components of having cosmetic surgery.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Many Factors Contribute To Poor Aesthetic Results

When you take all the factors into account that go into an aesthetic surgery and the results, there are a number of things that can lead to bad results.   Sometimes the patient themselves is at fault by not following pre-and post-op instructions, going to unqualified or overseas surgeons due to discounted prices, or having unrealistic expectations.  Other times, it can be a surgeon who promises too much, is not qualified to be doing certain surgeries, or is not technically sufficient to give someone the desired results.  Throw in tissue healing characteristics and luck, and you can target alot of different areas that can lead to a poor outcome.  Any surgeon who says they have no revisions just means that they send the patients elsewhere.  Even at our best, surgeons are still human and sometimes just cannot acheive that perfect outcome.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 73 reviews

Botched Plastic Surgery Jobs: Who Causes Them?

GREAT question. The # 1 answer is YOU the patients who go to unqualified PS's. Yes there can be poor results in anyones hands but in general the non PS or poorly trained PS's are the problem because YOU (the public) tries to get something for nothing in fees. "Discount Plastic Surgery or Out of Country Plastic surgery" allows the public to be fooled in that they are ALWAYS getting truly qualified surgeons. As a way to fight these mills many of us will try to "match" written fee quotes in order to at least help protect you from bad surgery. From MIAMI Dr. Darryl J. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Botched Surgery?

Great question... Most surgeons would like to believe that they are the best.  It is the nature of a competitive field.  But the reality is even the most famous, most published, and busiest of plastic surgeons have complications.  The best that I've heard this described is that surgeons are human, and so are their patients.  So imperfections must occur.  And despite the common opinion, there are good and bad surgeons overseas just as there are here.  The difference is that surgeons here must maintain malpractice insurance.  This protects both surgeons and patients on domestic soil.  Additionally, when your surgery is performed by a surgeon you trust locally, all of your follow up will be performed locally.  And all outcome, good and bad, will have a local physician to be held accountable.  Plastic surgeons rely and bank on their reputations.  A personal referral is the best.  If this is unavailable, then do your research and take your time. 

As far a horrendous outcomes, I have seen those both locally and from offshore surgery.  It just depends on your surgeon's training and devotion.  Good luck!!

Jason Hess, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

"Botched" Surgeries

We have a unique situation here in south Texas because of our proximity to Mexico and the cheaper surgery available down there.  Patients will call local surgeons after they return from Mexico seeking advice or care.  The majority of problems I have seen are not so much from unskilled surgery, but from little or no aftercare, especially after larger cases like tummy tuck.

This is why the surgery is cheaper doen there, but  it can result in things like fluid collections and infections that require more surgery or even hospitalization.  Had those issues been detected by the operating surgeon in time, they would not have been so serious in many cases.

Even expert plastic surgeons are going to have the occassional unfavorable outcome for various reasons...but as the other posters have mentioned, your best path is to choose a board-certified plastic surgeon who will stay with you every step of the way.

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 270 reviews

Plastic Surgery and "Botched" Jobs

I still remember the words of wisdom imparted to me during my years of training, "if you don't have any complications, you haven't performed enough surgery".  In fact, part of surgical residencies involve a specific excercise known as Morbidity and Mortality conference or "M&M" to discuss these issues.  So, as any ethical Facial Plastic Surgeon will tell you, complications can and do happen.  What differentiates an average Surgeon from an excellent Surgeon is how he/she treats the complications that occur.  Generally, what most would describe as "botched surgery is a complication that was performed by a Surgeon (or unfortunately a non-Surgeon) who was unwilling or unable to handle the problems that occurred.  Having surgery abroad does not necessarily condemn a patient to a terrible result, but it does hinder their ability to have complications solved should they occur.  Likewise, going along with an infomercial based company that advertises a "revolutionary" procedure doesn't mean you will be "botched", but most of these companies place profit high above patient care.  In these circumstances, problems that do occur are not always handled to a patient's satisfaction.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

Who causes Botched Plastic Surgery Jobs?

We have all seen those images of celebrities and wondered, who on Earth did THAT?  These are the rich and powerful, and if they turned out like THAT what chance do I have of getting a good result?  The answer to the question is not straightforward, since complications happen even to the best of surgeons.  The difference is how the problems are dealt with if and when they arise.  Getting discount surgery is not a good idea for obvious reasons.  Going off shore for surgery is also a poor choice because how can problems be dealt with if they arise? For more details, check out my blog.

Claudio DeLorenzi, MD
Toronto Plastic Surgeon
4.2 out of 5 stars 8 reviews

"Botched" Plastic Surgery

There are some steps patients can take to significantly increase the likelyhood that their surgery will be safe and successful.

1) Select a board-certified plastic surgeon
2) Look for a member of ASAPS (these plastic surgeons have expertise in aesthetic plastic surgery
3) Be sure surgery is performed in an accrediated facility (Joint Commission or AAAASF certified, or dual certification)
4) Be sure a board-certified anesthsiologist adminsiters anesthesia
5) Check the training of your plastic surgeon carefully. Where did they attend medical school? Where did they receive surgical training? Did they have a plastic surgery fellowship? How many years of formal surgical training did they receive?
6) Check out your plastic surgeon on the state medical board website. 
7) Ask who else will be in the OR. Typically a first assitant, circulating nurse(s) pre-op and post op nurse(s) and a certified sterile processing tech to sterilize all instruments
8) carefully review before and after images. Each patient should be photgraphed from three angles font, side and oblique. Lighting and distance from the camera should be consistent. Many photos should be available. 
9) Ask to see the OR, or at least view multipe photos of OR, pre-op, recovery room, sterile processing room
10) Be sure a pre-operative appt. is a comprehensive appt. where you are given careful instructions about pre-operative and post-operative care
11) Post-operative appts. should be made at the pre-operative appt. Be at all appointments
12) Follow instructions provided by your doctor and report and concerns
13) Don't rush into surgery, or feel pressured to schedule. If something is telling you the surgeon you are considering isn't right for you, listen. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Chances of Good Results Increased With BC Plastic Surgeons

I too am  unable to answer your questions specifically.  All surgeries are accompanied by certain risks, but you do increase your chances of obtaining good results if you use a Board-certified Plastic Surgeon.  There are other board certifications out there (some valid and some bogus), but there is only one Amer. Board of Plastic Surgery.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.