Why don't Plastic surgeons like to do TT revisions?? Is it because you don't like to "fix" other doctors' botch jobs?

Question

What's in the minds behind plastic surgeons who has to fix or clean up what some other doctors messed up?? The real truth if possible:) I manage a successful dental office and often tell patients the hard truth bc I sincerely care, not to scare them but sometimes as professionals, you can foresee the results, based on your experiences. So why isn't there as many PS out there who will fix botch jobs??

Ronald J. Edelson, MD · Answer

Each case is differrnt.  I have performed revisions of other surgeons' tummy tuck.  It really depends on whether anything worthwhile can actually be done and that varies from case to case.

Payman Danielpour, MD, FACS · Answer

I guess it depends who you are asking.  Some surgeons love doing revisions and dont mind going into an operated field and somoe dont feel as comfortable.  With that said, each case is different and really depends on what truly needs to be done.  Perhaps tummy tuck revisions are a bit more challenging because the excess skin is usually already removed. Its important to sometimes think outside the box and use technology as well to assist us in revision surgery.

Anita Patel, MD, FACS · Answer

Many of us choose to do revision work and enjoy it. We enjoy tackling an advanced problem and making things better for the patient. The word "botched" is not a word most plastic surgeons like to use. It can mean different things to different people, anywhere from a slightly irregular scar to an all out disaster result, but it inherently implies the surgeon did something wrong. In some cases this is true, and the results are due to poor judgement or skill by the surgeon. However, in many cases it is not due to surgeon error, but rather a failure to meet the patient's expectations. Just as with primary surgery, with revision surgery it is important to determine if the patient is a good candidate and if the anticipated results will meet the patient's expectations. Also, what was done in the first surgery may pose limitations on what can be done in the revision surgery. In some cases where a patient has come to me for a revision of so-called "botched" surgery, the results are in fact within the normal range for the procedure, though the the specific complaints are valid (such as asymmetry, or poorly positioned scar, etc). In some cases patients bring intense anger and heated emotions when presenting for a revision, and most surgeons feel that patient is not yet emotionally ready for a revision surgery. There has to be trust between surgeon and patient, and that goes both ways. In order for it to be a good fit, the patient has to trust the surgeon is able to correct the problem and will do her/his best to do so, while also understanding the limitations of surgery, and the surgeon has to trust the patient will comply with postoperative instructions and trust the process and allow time to heal before judging the new results. The surgeon in a sense "inherits" all of the problems or complaints the patient has, and they become theirs now rather than the initial surgeon, and that may be more than someone wants to take on for a result that wasn't their doing. Also, even if the surgeon feels technically able to improve a patient's results, if the patient does not seem able to be pleased, the surgeon will likely decline. Alternatively, if a surgeon thinks they can make the results better but not to the degree required to please the patient, that is another reason a surgeon would decline.

Zoran Potparic, MD · Answer

Revision of any surgical procedure may be significantly more challenging then original surgery, ultimately more expensive and with inferior result then if primary procedure ended without complications. It is very hard to explain that fact to a patient and promise improvement but still inferior result then she (he) initially expected. Patients frequently have difficulties to understand and accept the fact that evary commplication and less then expected result of surgical procedure does not have to be a mistake of a surgeon; very frequently comorbidities (obesity, smoking, chronic deasease, non-compliance, etc.) may contribute to a poor surgical outcome. Faced with a complexity of surgery and patient mental status, many surgeons would avoid doing revisional surgery or delay it for a longer period based on individual evaluation.

Gerald Minniti, MD, FACS · Answer

Hello,There are many surgeons like myself who do a lot of revision surgery. Go visit a few ABPS certified/ASAPS member surgeons who specialize in body contouring surgery. If there is something we can do to make it better, I think most of us would be willing to take the challenge. Best of luck!

John P. Di Saia, MD · Answer

This is pretty simple really:
(1) Prior surgeons may do things in ways that a new surgeon finds limiting. Surprises at any operation are not welcome in the vast majority of cases. 
(2) Revision patients tend to be unhappy and spread that unhappiness to the new surgeon. 
(3) Revision patients are harder to operate and have less wonderful results in general. 
(4) Revision patients have often spent a good deal of money with their former surgeon and feel that despite the difficulty of the problem, they should pay very little for the revision.
(5) Some revision patients from other surgeons sue the new surgeon.
In essence revising another surgeon's work has the tendency to constitute a good deal of poorly compensated liability which smart surgeons avoid like the plague. Most of us carefully screen such patients trying to determine the good risks before accepting such a case. . 
Best Regards,

John Di Saia MD

Tim Sayed, MD, MBA, FACS · Answer

I am among those surgeons who actually enjoys the challenge of revision surgery.The biggest problems, and part of the reason you may be experiencing reluctance by some plastic surgeons to engage in revising a result, may be:1. The result is not, in fact, a "botched" result but simply one that is not what the patient expected and without being present for the prior consult and operative processes, the new plastic surgeon is faced with trying to piece together the best plan to course correct for the patient. The fact that a patient thinks another plastic surgeon's work is "botched" may give a new surgeon pause as to whether this is a patient easily satisfied if a revision is undertaken, or the changes the new surgeon can propose don't seem substantial enough for the patient to feel they will be getting value from revision.2. The result is actually good and the patient has totally unreasonable expectations, or worse, Body Dysmorphic Syndrome and the new surgeon will now "own" the result if a new operation is done on a patient with unreasonable expectations.3. There are risk factors that contributed to the suboptimal result that are not under the surgeon's control - obesity, diabetes, smoking, etc. - that may not be different the second time around4. The patient expects the new surgeon to offer discounted services to correct or improve the result or is unwilling to accept the surgeon's fee schedule, having already spent considerable money on the original surgery, and the original surgeon may very well be able to deliver an improvement on the result at a more cost effective basis if the patient would only continue to trust that surgeon. Of course, sometimes the original surgeon's work or bedside manner or office personnel have left the patient with diminished faith and a fresh set of eyes and hands are indicated.Be careful about surgeons out there who tell you they are constantly fixing the "errors" or "bad work" of other surgeons. All plastic surgeons have occasional complications or imperfect results, and most of us are perfectly capable of and willing to revise our own work  within reason to make a patient happy. Similarly, we all occasionally give second opinions or revise the work of others and most of us do this knowing that some of our own patients may be out there getting revisions by others, and collegiality in our community is generally the norm.

Fara Movagharnia, DO, FACOS · Answer

My goal is always to make someone feel better about themselves.  If that is something I can accomplish with revising another doctor's surgery, then I will.  However, revisions are not always appropriate in every case.  It depends on the reason for the patient's concern, their medical status, realistic expectations and whether or not I can make an improvement.  Every case is different.

Curtis Wong, MD · Answer

but the reluctance comes when there 'botched job' is that really that botched and that the patients expectations may be unrealistic.  Also, once you agree to take on a botched job from someone else, you now inherit all the emotions and angst that has prevailed during that time.  If I know I can make an outcome better, I have no problems taking on an unhappy patient from someone else.  But the results are not that bad and perfection is expected, I will not want to assume the responsibility and baggage that come with that patient as anything less than perfect is not good enough.

Why don't Plastic surgeons like to do TT revisions?? Is it because you don't like to "fix" other doctors' botch jobs?

Answers (9)

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