New Rep for Revision

New Rep for Revision
Dr. Rady Rahban

They slink into the offices of plastic surgeons – women and men with botched nose jobs, mangled tummy tucks, and other marks of missteps.

They’ve come for a corrective fix, anxious to undo what some other surgeon did wrong.

Little wonder they find their way to Beverly Hills, called the “Plastic Surgery Capital of the World,” in some quarters. The tony town also is home to a growing number of board-certified plastic surgeons who are increasingly busy putting their talents toward repairs in the wake of less skilled doctors and cosmetic surgeons.

Corrective procedures – also called “revision surgeries” – account for anywhere from 25 percent to 40 percent of the work at some Beverly Hills plastic surgery practices these days.

It’s a relatively new trend, physicians say.

“Five to six years ago, I started noticing an uptick in revisionist surgeries across the board – noses, breasts, lipo[suction] – botched, just fundamental errors,” said Dr. Rady Rahban, a Beverly Hills board-certified plastic and reconstructive surgeon. “I’ve got women who come in with humongous breasts, too large. They can’t go to work, they’re so embarrassed. Noses, totally collapsed. People who can’t breathe, nasal cripples.

“We’re at a state of crisis when it comes to plastic surgery.”

The often costly repairs reported by the Beverly Hills plastic surgeons working on body parts damaged by other doctors are borne out by recent medical studies that point to a largely unregulated market for cosmetic surgery.

Some so-called “cosmetic surgeons” can practice with as little as a few weekends of training.

$16 billion

It’s a lucrative market.

Americans spent a record $16 billion on cosmetic plastic surgery in 2016, according to the American Society of Plastic Surgeons. That included 1.8 million plastic surgery procedures, from 290,000 breast augmentations to 255,000 liposuctions, 223,000 nose jobs and 131,000 facelifts.

What’s not clear is the skill levels or certifications of the doctors who performed the surgeries – whether they were done by board-certified plastic surgeons, or by non-certified cosmetic surgeons.

Nor it is clear how many of those 1.8 million surgeries were revisions to previous surgeries gone bad. Or whether they were the latest among the repeat surgeries sought to fix nostrils that had been over-clipped, liposuctions that had been over-suctioned and breasts that had been overdone, plastic surgeons say.

The list of botched surgeries doesn’t include less dramatic damages – poor stitching, infections, festering wounds and scars that can arise from cut-rate plastic surgeries performed by unskilled practitioners at home or overseas.

Patients, many in tears, are then forced to pay qualified surgeons up to 30 percent more than the cost of the original surgery to correct newly disfigured or asymmetrical appendages.

“My business slowly morphed [from standard surgeries] to complex scarred victims, easily a quarter of my operations,” said Rahban, who founded his boutique practice 12 years ago and now takes on around 200 plastic surgery cases a year from across the globe. “I feel bad for the patients who have been wronged. In general, revision outcomes are never as good as if the surgery was done right the first time.”

‘Snake oil’

Recent studies by Northwestern University suggest considerable confusion by the general public as to who may be qualified to perform plastic surgery – especially on social media, now a leading marketing tool for breast augmentations and other work.

A board-certified plastic surgeon is a physician with six to eight years of surgical training, with at least three years devoted to plastic surgery. Many continue their training throughout their careers.

Then there are the numerous practitioners of “cosmetic surgery,” often doctors in other specialties – such as gynecologists, dermatologists or ER physicians – aiming to profit from more lucrative cosmetic work paid for in cash, researchers say.

Training can range from a one-year cosmetic surgery fellowship to a handful of short weekend courses in such areas as liposuction, according to the Chicago-area school. Anyone with a medical license can call themselves a cosmetic surgeon.

One Northwestern Medicine study reported a nearly 300 percent increase in the number of complications for a stomach procedure done by non-plastic surgeons compared with board-certified plastic surgeons.

Another study published last year by Northwestern found that most providers who advertised aesthetic surgery on Instagram were not board-certified plastic surgeons. In addition, businesses from hair salons to dentists to health spas were marketing plastic surgery procedures without any associated physician.

“Sometimes, less scrupulous providers are far better marketers, which goes back to the snake oil salesmen of the Old West,” said Dr. Clark Schierle, director of aesthetic surgery at Northwestern Specialists in Plastic Surgery, in Chicago, and a lead author of the Northwestern study. “This is an alarming trend.

“Since the beginning of the year, one third of the breast surgeries I performed were revision cases.”

The American Society of Plastic Surgeons, which published a similar study, did not respond to requests for comment for this story.

Revisionist history

The average breast alteration last year in the U.S. cost $3,700, according to the American Society of Plastic Surgeons.

It can cost much more in Beverly Hills, which earns its status as the Capital of Plastic surgery with an estimated 500 cosmetic surgeons packed within its four square miles – more than the state of Rhode Island. The Beverly Hills surgeons are behind the fountain of youth that keeps some of the world’s best-known celebrities ready for their close ups, Rhaban said.

Dr. Kevin Brenner opened a private plastic surgery practice in Beverly Hills after two residencies and now specializes in restoring the appearance of the breasts and abdomen. He has published many peer-reviewed articles, as well as numerous chapters in plastic surgery textbooks.

Revision cases, he said, now make up 40 percent of his business.

The worst case, he said, was an exotic dancer who had numerous surgeries to enlarge her breasts – until one doctor ultimately packed in four implants. When one gland became infected, forcing a local hospital to remove the additions, she went decades with a grossly unbalanced chest until she could afford a fix.

A more recent case was a woman who had suffered five revision operations to one breast, then flew in to see Brenner for a sixth.

“The revisions are growing,” Brenner said. “Beverly Hills is a mecca for plastic surgery. Some of the best in the world work here. And when you have a real problem, you go to the best. They end up turning to me, or coming here, because they want it to be the last operation.”

Dr. Andre Panossian, a plastic surgeon who specializes in facial paralysis and nerve disorders, served for years at Children’s Hospital Los Angeles until opening a Beverly Hills practice. He has performed more than 5,000 cosmetic and reconstructive surgeries, and roughly two out of three are revision cases these days, he said.

It can sometimes take between six to eight hours to correct a badly done nose at a cost of between $12,000 and $20,000, he said. And that’s on top of the $6,000 to $10,000 the patient likely paid someone else for the nose job.

One of his worst cases was a woman in her 30s who came in with a “boxer’s nose,” he said, with a collapsed center, which bent left. It was her third corrective surgery.

“I do more revision surgeries than primary surgeries these days. It’s crazy,” Panossian said. “They’re usually people who go to other plastic surgeons in town and it hasn’t turned out so well. Or Mexico.”

Rahban, whose boutique practice on Wilshire Boulevard has drawn patients from around the world, says a quarter of his operations, and a third of his patient inquiries, are revision cases.

Call for transparency

Rahban has joined other plastic surgeons in demanding more transparency in a cosmetic surgery industry marred by misleading qualifications, hyped websites and fake reviews. He said there should be legislation to require doctors to disclose their training.

Some of the most trying cases, he said, are the one’s he’s forced to turn away. That includes a young woman in tears who came to see him after an unskilled doctor had removed much of her nose.

“The surgeon had clipped her nostrils, removed too much,” Rahban said. “She looked unrecognizable – and cut off much of her nostrils. And there was absolutely nothing I could do. It was horrific.”

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