Nov. 29, 2022
Operating in Reverse: How the Unwanted Plastic Surgery Result Can Be Reversed
If you have had a cosmetic procedure and wish it could be undone, or if you are considering a cosmetic procedure but afraid you'll regret it, there are options for going back. There are options available if you don't love the outcome after most procedures.
Implants and fillers can be changed, and it is possible to rework other cosmetic procedures. Brazilian butt lifts and other fat grafting shaping procedures can be treated with liposuction like techniques to go in reverse. Trends in appearance are okay for fashion and makeup, but not ideal for aesthetic treatments, especially plastic surgery.
Thinking through your procedure decisions and planning properly is the key to good outcomes. Carefully plan and think through your wishes and desires before getting a cosmetic procedure with tools like visual imaging and computer simulation to understand the results you might see.
It's always better to avoid an unwanted result than have to undo it, but there are ways to rework procedures, if not necessarily reverse. And be kind to your body tissues – perfect is the enemy of good.
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
1
00:00:00,840 --> 00:00:04,810
Welcome to another episode of
Park Avenue Plastic Surgery Class,
2
00:00:05,150 --> 00:00:08,810
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:08,811 --> 00:00:11,490
surgery. I'm your co-host Doreen Wu.
4
00:00:11,491 --> 00:00:15,890
And I'm excited to be here
with Dr. Lawrence Bass,
Park Avenue plastic surgeon,
5
00:00:16,570 --> 00:00:18,090
educator, and technology innovator.
6
00:00:18,710 --> 00:00:22,010
The title of today's episode
is "Operating in Reverse:
7
00:00:22,310 --> 00:00:25,330
How the Unwanted Plastic Surgery
Result Can Be Reversed." Another
8
00:00:27,490 --> 00:00:31,090
intriguing episode title Dr. Bass,
when people think of plastic surgery,
9
00:00:31,510 --> 00:00:33,690
the word reversible doesn't
typically come to mind.
10
00:00:34,150 --> 00:00:38,490
So what is this episode going to be about
how to fix a complication from plastic
11
00:00:38,491 --> 00:00:39,324
surgery?
12
00:00:39,630 --> 00:00:41,050
That's part of it Doreen,
13
00:00:42,160 --> 00:00:46,570
fortunately big healing complications
are uncommon in plastic surgery,
14
00:00:47,310 --> 00:00:50,610
but that's not the only thing that
might lead someone to re-operate.
15
00:00:52,120 --> 00:00:55,010
Some people just want better
symmetry. That's something.
16
00:00:55,210 --> 00:00:58,730
I generally advise people
not to chase too hard.
17
00:00:59,690 --> 00:01:01,850
A big asymmetry is undesirable,
18
00:01:02,870 --> 00:01:07,450
but small asymmetries are
universal in human appearance and
19
00:01:07,560 --> 00:01:11,730
chasing them really hard is a lot
of risk for very little reward.
20
00:01:12,910 --> 00:01:17,730
Sometimes people re-operate because
there's some aspect of their appearance
21
00:01:17,731 --> 00:01:22,450
that's not as they desired or not
as they expected it to turn out
22
00:01:23,700 --> 00:01:27,600
or they want more
improvement than they got,
23
00:01:28,420 --> 00:01:31,120
or they want to change
it in some different way.
24
00:01:31,620 --> 00:01:36,400
So that's occasionally a reason for
re-operating but this episode is mostly
25
00:01:36,530 --> 00:01:37,400
about what happens,
26
00:01:38,780 --> 00:01:42,720
not when you want to
change or refine a result,
27
00:01:42,900 --> 00:01:46,040
but when you want to undo a result,
28
00:01:47,300 --> 00:01:49,560
and there are several reasons for that,
29
00:01:49,561 --> 00:01:52,320
sometimes you thought better
of changing the feature.
30
00:01:52,500 --> 00:01:54,800
And you just want to go
back to where you started.
31
00:01:55,510 --> 00:01:58,480
Once you realize how you'll look
with that feature a certain way.
32
00:01:58,540 --> 00:02:01,200
You say that doesn't look
good on me. I don't like that.
33
00:02:01,860 --> 00:02:05,040
Let me just go back where I came from.
34
00:02:05,750 --> 00:02:08,000
Sometimes you just need a different look.
35
00:02:08,001 --> 00:02:12,680
You're at a different life stage where
there's a style or a fashion change
36
00:02:13,060 --> 00:02:16,080
in terms of a certain
feature you tried to create.
37
00:02:16,580 --> 00:02:19,080
And so you'd like to undo
the procedure and again,
38
00:02:19,860 --> 00:02:21,680
go to a different sort of a look.
39
00:02:22,890 --> 00:02:26,770
I can already tell this is going
to be a nuanced topic. So Dr. Bass,
40
00:02:26,910 --> 00:02:29,690
can you break this down for me a
little so I'm sure I understand the
41
00:02:29,930 --> 00:02:30,763
distinctions.
42
00:02:31,360 --> 00:02:32,193
Sure.
43
00:02:32,860 --> 00:02:36,570
There are things like immediate undos.
44
00:02:37,830 --> 00:02:41,210
You decide you want bigger
cheeks, you get cheek implants.
45
00:02:41,240 --> 00:02:42,650
Once you see them in there,
46
00:02:42,750 --> 00:02:46,250
you realize you really don't
look better with bigger cheeks.
47
00:02:46,830 --> 00:02:50,090
So you come back and say, "I
hate it. This was a big mistake.
48
00:02:51,400 --> 00:02:55,540
Put me back where I started." So
that's a, that's an immediate undo.
49
00:02:56,080 --> 00:02:59,920
And then sometimes there's a style undo.
50
00:03:01,140 --> 00:03:06,040
You wanted a big buttock. You
decided to do a Brazilian butt lift,
51
00:03:07,060 --> 00:03:09,240
and now you have that bigger buttock,
52
00:03:09,260 --> 00:03:12,840
but you didn't realize all the
implications, how it was going to change,
53
00:03:13,580 --> 00:03:17,800
how large it made your breast look to
have wider hips or a bigger buttock,
54
00:03:18,220 --> 00:03:20,440
how it was going to change
your fit in fashions,
55
00:03:20,460 --> 00:03:23,080
how it was going to affect
your ability to do sports.
56
00:03:24,080 --> 00:03:28,600
Maybe you don't like the reaction
you're getting from friends, family,
57
00:03:28,700 --> 00:03:33,400
or just from strangers commenting on
your appearance or staring at you.
58
00:03:34,480 --> 00:03:36,320
So that's a style undo.
59
00:03:37,940 --> 00:03:39,550
That seems straightforward enough.
60
00:03:40,050 --> 00:03:42,430
So what are some common
examples of this in the body?
61
00:03:42,970 --> 00:03:47,670
Mostly in the body it's about
adding or removing fat for body
62
00:03:47,840 --> 00:03:52,630
shape. So it's like what we do in
the procedures in the first place,
63
00:03:52,730 --> 00:03:55,310
except just going in
the opposite direction.
64
00:03:55,890 --> 00:03:59,990
So most people like to be thin in America.
65
00:03:59,991 --> 00:04:04,790
We're obsessed with being thin
and many other nations are
66
00:04:04,930 --> 00:04:05,763
as well.
67
00:04:06,330 --> 00:04:10,630
But we do have fad shapes and celebrity
68
00:04:10,631 --> 00:04:11,464
imitation,
69
00:04:12,090 --> 00:04:16,710
and those kind of shapes
or appearances are more
70
00:04:16,770 --> 00:04:21,030
likely to be undone if they
end up being out of style.
71
00:04:21,031 --> 00:04:24,670
An example of that again
is the Brazilian butt lift,
72
00:04:24,910 --> 00:04:29,830
a body shape popularized by
Kim Kardashian and others which
73
00:04:29,831 --> 00:04:32,070
is very much in style right now,
74
00:04:32,071 --> 00:04:36,990
getting people to go to big
construction projects with
75
00:04:37,290 --> 00:04:40,270
fat grafting, mostly to
build a bigger bottom,
76
00:04:41,480 --> 00:04:46,260
but at some point that may be out of
style and they may want to reverse that.
77
00:04:47,700 --> 00:04:50,720
And how is that accomplished?
What can be done to reverse a BBL?
78
00:04:51,860 --> 00:04:54,390
Basically it's liposuction, as I said,
79
00:04:54,860 --> 00:04:59,470
Brazilian butt lift or BBL is
mostly done with fat grafting.
80
00:05:00,770 --> 00:05:05,390
And so liposuction will
take that fat back out and
81
00:05:05,440 --> 00:05:08,870
allow a reshaping. You know,
you could take it out partially.
82
00:05:08,871 --> 00:05:09,710
You could take it out totally.
83
00:05:11,270 --> 00:05:15,870
you could just take out enough
to focus on a different shape
84
00:05:16,140 --> 00:05:18,070
than the one that was obtained.
85
00:05:19,020 --> 00:05:23,390
Sometimes prosthetic implants
are used, gluteal implants,
86
00:05:24,090 --> 00:05:27,510
and there, the implant
can simply be removed,
87
00:05:27,680 --> 00:05:31,630
which by and large undoes the result.
88
00:05:32,530 --> 00:05:35,110
But doesn't that mean you just
end up back where you started?
89
00:05:36,260 --> 00:05:38,710
Well, you hope you end up
back where you started.
90
00:05:39,850 --> 00:05:42,390
That's what you're trying
to do when you reverse it.
91
00:05:42,490 --> 00:05:46,630
But sometimes depending on how
much of a size change was involved,
92
00:05:47,370 --> 00:05:51,870
you may have loose skin and
that may require skin excision.
93
00:05:52,530 --> 00:05:54,950
The more traditional type of buttock lift,
94
00:05:55,000 --> 00:05:59,840
where a wedge of skin and fat is
taken out at the top of the buttock to
95
00:05:59,850 --> 00:06:02,040
boost and shape the buttock.
96
00:06:03,860 --> 00:06:08,720
You also have lost that fat store which
97
00:06:08,721 --> 00:06:13,360
you may want to use somewhere else and
maybe needed to create a complimentary
98
00:06:13,650 --> 00:06:14,720
shape somewhere else.
99
00:06:15,840 --> 00:06:20,440
Particularly if you've done
a reduction as the initial
100
00:06:20,441 --> 00:06:21,250
procedure,
101
00:06:21,250 --> 00:06:25,800
going back and adding back
the shape can really only be
102
00:06:25,801 --> 00:06:28,720
accomplished if you have fat
somewhere else to borrow.
103
00:06:29,780 --> 00:06:33,150
That makes sense. If you're removing
something that was previously there,
104
00:06:33,380 --> 00:06:38,030
then there will likely be a cavity where
the material was originally taking up
105
00:06:38,031 --> 00:06:42,670
space. So it makes sense that reshaping
and some restructuring are both likely
106
00:06:42,671 --> 00:06:46,630
necessary. So what's another example
in the body that you often encounter?
107
00:06:47,430 --> 00:06:52,330
So another typical body
shaping or body size area that
108
00:06:52,331 --> 00:06:55,930
we work on is of course the
breast. So you maybe decide,
109
00:06:56,830 --> 00:07:00,410
whether you reduced or you
got a breast augmentation,
110
00:07:00,490 --> 00:07:05,370
you may decide you're over being
a certain size or that a certain
111
00:07:05,440 --> 00:07:08,210
size is too big for you currently,
112
00:07:08,211 --> 00:07:12,570
particularly if you lost
weight elsewhere in the body,
113
00:07:13,110 --> 00:07:17,770
you may now look
unbalanced. So in that case,
114
00:07:17,950 --> 00:07:22,490
we take breast implants out if someone
feels they're larger than they want to
115
00:07:22,491 --> 00:07:26,290
be, but there, much more commonly,
116
00:07:26,291 --> 00:07:30,330
especially if a number of years have
passed and if the augmentation was
117
00:07:30,331 --> 00:07:31,610
significant in size,
118
00:07:32,280 --> 00:07:36,530
it's fairly common to require
a breast lift at that point,
119
00:07:37,110 --> 00:07:40,730
if we really want to
maintain ideal breast shape.
120
00:07:43,590 --> 00:07:46,010
So some people may decide
121
00:07:47,560 --> 00:07:51,970
they they're just done with the implants
or they're done being a certain size
122
00:07:51,990 --> 00:07:55,500
and they may just go ahead
and do it other times.
123
00:07:56,180 --> 00:08:01,100
They pursue adjusting
the size when it's time
124
00:08:01,240 --> 00:08:02,940
to do some other surgery.
125
00:08:03,320 --> 00:08:08,220
So they got capsular contracture or
they're thinking about a breast lift
126
00:08:08,280 --> 00:08:10,460
and this is, or the implants fail.
127
00:08:10,560 --> 00:08:13,900
And this is the chance
for them to jump in and,
128
00:08:15,240 --> 00:08:20,100
and take advantage of that
needed surgery to make that,
129
00:08:20,330 --> 00:08:25,260
that reversal in the size selection
that they made at the outset with
130
00:08:25,261 --> 00:08:26,460
their original procedure.
131
00:08:27,690 --> 00:08:32,020
Sometimes people decide they're really
over it. They do a full reverse,
132
00:08:32,170 --> 00:08:35,020
just pull the implants out and downsize.
133
00:08:36,800 --> 00:08:41,100
Or some people who want to
maintain some of the size
134
00:08:41,650 --> 00:08:45,620
will pull implants out
and switch to fat grafting
135
00:08:46,780 --> 00:08:48,240
for breast augmentation, usually
136
00:08:50,620 --> 00:08:54,480
at a more modest size and
without a lot of delayed
137
00:08:54,840 --> 00:08:59,720
consequences of having a breast
implant, an artificial implant,
138
00:08:59,980 --> 00:09:00,880
inside the body.
139
00:09:04,090 --> 00:09:07,660
Some people decide they're, they're
not that worried about the size,
140
00:09:07,760 --> 00:09:10,100
but they they're worried
about the implants.
141
00:09:10,101 --> 00:09:14,460
They're just tired of thinking about
them or they're concerned about what they
142
00:09:14,620 --> 00:09:15,700
might do in the future.
143
00:09:16,620 --> 00:09:20,680
So they decide to remove the implants
without any problem occurring.
144
00:09:21,180 --> 00:09:25,880
And I've had two or three
patients in my nearly 30 years of
145
00:09:26,160 --> 00:09:27,800
practice who have come back and said,
146
00:09:28,000 --> 00:09:32,270
"I just don't like the idea of
thinking about these implants,
147
00:09:33,300 --> 00:09:37,110
just take them out." So it
doesn't happen very often,
148
00:09:37,170 --> 00:09:38,910
but it does occasionally happen.
149
00:09:40,200 --> 00:09:42,510
Let's switch gears and
talk about the face.
150
00:09:42,980 --> 00:09:46,190
What kinds of procedures are
targets for reversal on the face?
151
00:09:47,290 --> 00:09:52,180
Well, the first thing is
implants. So cheek implants,
152
00:09:52,660 --> 00:09:57,460
chin implants, jawline,
or jaw angle implants,
153
00:09:58,180 --> 00:09:59,013
which are
154
00:10:00,580 --> 00:10:05,340
frequently used to alter
face shape, may be too big,
155
00:10:05,740 --> 00:10:10,140
or someone just doesn't like the
look or it's not what they expected.
156
00:10:11,660 --> 00:10:14,500
So they decide to take the implants out
157
00:10:16,060 --> 00:10:20,060
undo the procedure.
Occasionally someone likes it,
158
00:10:20,460 --> 00:10:22,540
but wants to go up in size.
159
00:10:23,700 --> 00:10:28,660
So they double down on the augmentation.
So they're not really reversing,
160
00:10:29,500 --> 00:10:31,060
they're kind of taking
it one step further.
161
00:10:32,660 --> 00:10:37,540
An analogous thing happens
with injectable fillers. So
162
00:10:39,770 --> 00:10:44,610
some people wind up with too
much filler and their shape is
163
00:10:45,290 --> 00:10:50,170
distorted. This can be avoided by just
building up incrementally, but, you know,
164
00:10:50,650 --> 00:10:55,450
sometimes it sneaks up some on people and
they need to undo some of that filler,
165
00:10:56,210 --> 00:11:01,130
or they've had too many different
kinds of fillers in too many
166
00:11:01,730 --> 00:11:06,510
treatment sessions. And as that
different population of fillers,
167
00:11:06,790 --> 00:11:08,470
both different in type and age,
168
00:11:09,510 --> 00:11:14,350
start absorbing a lot of
unpredictable shapes can emerge
169
00:11:15,390 --> 00:11:19,990
as those fillers come out. And so
we decide to reverse the fillers,
170
00:11:20,670 --> 00:11:25,670
take them out all at once to
avoid having to experience that
171
00:11:26,590 --> 00:11:30,350
protracted period of
peculiar shape change.
172
00:11:31,430 --> 00:11:33,470
And sometimes the tissues just need rest.
173
00:11:33,790 --> 00:11:38,270
We want the fillers out of there so that
the tissues can rest and not continue
174
00:11:38,710 --> 00:11:42,710
to go through injection
sessions. Sometimes again, people
175
00:11:44,480 --> 00:11:48,960
didn't get what they expected out of a
filler, or they look and they say, "okay,
176
00:11:49,160 --> 00:11:51,680
you filled in my fold or
you gave me bigger cheeks,
177
00:11:51,840 --> 00:11:52,920
but that doesn't look like me."
178
00:11:54,520 --> 00:11:59,320
So it doesn't fit their self image. And
they'll decide to try to reverse that.
179
00:12:00,830 --> 00:12:05,310
And a lot of times we reverse filler
before we do surgery in the face.
180
00:12:05,930 --> 00:12:10,550
If we're going to do a brow lift
or an eyelid plasty or a facelift,
181
00:12:10,610 --> 00:12:13,630
we want to know exactly
where to put things,
182
00:12:14,060 --> 00:12:16,990
exactly what the baseline
bone structure is.
183
00:12:17,330 --> 00:12:20,910
And so sometimes people will come
a few weeks before the surgery,
184
00:12:21,100 --> 00:12:24,990
have all the filler
reversed so we can proceed.
185
00:12:25,530 --> 00:12:30,110
And so this is done by injecting
an enzyme that melts the
186
00:12:30,111 --> 00:12:32,430
fillers, which in the United States,
187
00:12:32,540 --> 00:12:37,310
because almost all fillers
we use are hyaluronic acid
188
00:12:37,311 --> 00:12:38,430
fillers. The hyaluronidase enzyme
189
00:12:41,010 --> 00:12:45,470
breaks that down and allows us to
undo the fillers. So with fillers,
190
00:12:45,530 --> 00:12:50,270
we kind of have a magic eraser
that lets us take a mistake
191
00:12:50,890 --> 00:12:51,830
or adjust a decision
192
00:12:53,410 --> 00:12:55,950
to change direction or change course,
193
00:12:56,850 --> 00:13:00,070
and take away the old choices,
194
00:13:00,410 --> 00:13:02,710
the old filler and start fresh.
195
00:13:02,711 --> 00:13:07,390
The same kind of thing sometimes
happens with fat grafting.
196
00:13:07,391 --> 00:13:08,790
People either get too much
197
00:13:10,650 --> 00:13:15,190
it winds up someplace that they
didn't intend and they have a funny
198
00:13:15,320 --> 00:13:19,690
shape and that can be taken
down with kind of like a baby
199
00:13:20,080 --> 00:13:21,570
liposuction-like procedure.
200
00:13:22,810 --> 00:13:25,670
Sounds like some of these
reversals can be pretty involved.
201
00:13:26,290 --> 00:13:28,870
Are there additional
consequences for these reversals?
202
00:13:29,580 --> 00:13:34,430
Well, the nice thing is usually
the answer to that is no,
203
00:13:34,970 --> 00:13:39,750
but it's possible depending on the
magnitude of the size change and
204
00:13:39,770 --> 00:13:43,990
how long the size change was
maintained. So again, a big size change,
205
00:13:44,630 --> 00:13:47,390
particularly in the awkward direction.
206
00:13:48,410 --> 00:13:53,270
If the person went a lot bigger
and now they're taking that back to
207
00:13:53,271 --> 00:13:54,710
go to a smaller size,
208
00:13:55,450 --> 00:14:00,150
having loose skin or empty skin is
209
00:14:00,500 --> 00:14:01,470
more likely,
210
00:14:01,650 --> 00:14:06,550
and that might require something
bigger in terms of undoing.
211
00:14:07,560 --> 00:14:11,500
And now what about the nose? Do people
often reverse their rhinoplasties?
212
00:14:12,210 --> 00:14:16,350
That's a great question. And, you
know, that's more of a gray area.
213
00:14:16,700 --> 00:14:21,500
Sometimes it's a liquid what's
called a liquid rhinoplasty.
214
00:14:21,501 --> 00:14:26,140
That's done with injectable
filler and there people
215
00:14:26,320 --> 00:14:28,980
may decide they don't
want that shape anymore.
216
00:14:28,981 --> 00:14:30,740
They want a slightly different look.
217
00:14:31,840 --> 00:14:36,380
And we undo the filler again
with the injectable enzyme,
218
00:14:36,440 --> 00:14:38,980
but where it's surgical rhinoplasty,
219
00:14:40,450 --> 00:14:44,420
it's not so much a question of reversing,
220
00:14:45,160 --> 00:14:48,220
but in many Caucasian rhinoplasty,
221
00:14:49,120 --> 00:14:53,240
the essential step that's taking place is
222
00:14:54,160 --> 00:14:56,720
essentially a reductive rhinoplasty.
223
00:14:56,721 --> 00:15:00,400
We're reducing the size of
the bones, the cartilages,
224
00:15:00,401 --> 00:15:05,200
and taking overbuilt sharp or angular
225
00:15:05,201 --> 00:15:08,360
shapes and trying to
soften and harmonize them.
226
00:15:10,380 --> 00:15:14,000
So, and we're also trying to take
out width very often in the nose.
227
00:15:15,300 --> 00:15:18,120
So in a lot of secondary rhinoplasty,
228
00:15:18,420 --> 00:15:23,120
it relates to building back structure
in the nose to restore shape.
229
00:15:23,980 --> 00:15:28,520
If the change is deemed
too much or if the nose is
230
00:15:28,610 --> 00:15:32,280
collapsing with age or
with excessive surgery,
231
00:15:32,670 --> 00:15:36,640
it's building back that support
structure and projection.
232
00:15:37,500 --> 00:15:39,360
So in a sense, it's undoing,
233
00:15:39,500 --> 00:15:44,480
but really what we're doing is
going in and constructing a new
234
00:15:45,570 --> 00:15:50,560
artificial support for the nose to
replace the initial support that was lost
235
00:15:50,630 --> 00:15:51,960
over the course of surgery.
Rhinoplasty in Asian
236
00:15:55,680 --> 00:16:00,310
noses and black people's
noses is more often
237
00:16:00,400 --> 00:16:05,310
about narrowing the contour of the
nose and augmenting the projection of
238
00:16:05,311 --> 00:16:07,150
the dorsum, or the bridge of the nose.
239
00:16:09,090 --> 00:16:12,870
And that's sometimes done
with a prosthetic implant.
240
00:16:12,970 --> 00:16:14,710
And if that was done too much,
241
00:16:14,730 --> 00:16:18,590
or the person wants to undo
it and have a more authentic
242
00:16:19,490 --> 00:16:22,750
ethnic look the implant can be removed,
243
00:16:24,240 --> 00:16:28,820
but a lot of secondary procedures
in the nose for everybody of all
244
00:16:29,050 --> 00:16:33,940
ethnicities is really
aimed at refining rather
245
00:16:34,010 --> 00:16:35,860
than reversing the result.
246
00:16:35,860 --> 00:16:39,960
All right, let's recap the
episode for our listeners.
247
00:16:40,350 --> 00:16:43,000
What are the key takeaways
about procedure reversal?
248
00:16:43,930 --> 00:16:47,420
Well, the first thing is careful planning,
249
00:16:48,820 --> 00:16:53,780
thinking through your wishes
and desires and careful imaging
250
00:16:54,260 --> 00:16:55,180
and simulation
251
00:16:57,220 --> 00:17:01,740
maximizes your understanding of the
likely results that you're realistically
252
00:17:02,100 --> 00:17:02,933
going to obtain.
253
00:17:03,860 --> 00:17:07,700
So you can decide if that's
a good look for you or not.
254
00:17:08,500 --> 00:17:13,260
So that you're less likely to end up
with something you don't like that
255
00:17:13,620 --> 00:17:14,700
you want to reverse,
256
00:17:15,940 --> 00:17:20,700
never decide on doing a procedure
in haste that will also reduce the
257
00:17:21,220 --> 00:17:24,380
chances you have to
reverse or undo a procedure
258
00:17:26,220 --> 00:17:30,460
when it comes to fads and
trends in appearance. I mean,
259
00:17:30,740 --> 00:17:33,700
that's okay for fashion.
That's okay for makeup.
260
00:17:35,180 --> 00:17:38,100
But it's not ideal for
aesthetic treatments.
261
00:17:38,740 --> 00:17:43,140
And I personally feel it's a bad
idea for surgical procedures.
262
00:17:44,460 --> 00:17:48,180
But again, there is reversing
potentially even with surgery.
263
00:17:49,520 --> 00:17:50,360
It's always better though,
264
00:17:50,560 --> 00:17:55,280
to avoid an unwanted appearance than
to have to undo an unwanted appearance
265
00:17:57,600 --> 00:17:58,360
separate from that.
266
00:17:58,360 --> 00:18:03,280
There are some things we know we're
going to be going back eventually to
267
00:18:03,800 --> 00:18:07,280
rework them, not so much to
reverse them, for example,
268
00:18:07,920 --> 00:18:12,600
a facelift or a breast lift. I
mean, aging always continues.
269
00:18:12,840 --> 00:18:13,680
It never stops.
270
00:18:14,800 --> 00:18:19,320
And so eventually we'll have to
relift and that gives a chance to
271
00:18:20,080 --> 00:18:22,600
readjust other aesthetic
concerns. At the same time,
272
00:18:23,560 --> 00:18:27,720
the same idea with breast
implants, sooner or later,
273
00:18:28,480 --> 00:18:33,480
those implants are likely to wear out.
And so, you know, sooner or later,
274
00:18:34,240 --> 00:18:36,480
you're likely to be back
in the operating room.
275
00:18:37,440 --> 00:18:42,000
And that gives you a chance
to take aesthetic concerns and
276
00:18:42,600 --> 00:18:47,000
adjustments you'd like to make
that are not major and urgent
277
00:18:48,200 --> 00:18:51,800
that you can live with for
a while, but are not ideal.
278
00:18:52,440 --> 00:18:56,680
And rework them at that time when you
need to be in the operating room anyway.
279
00:18:59,040 --> 00:19:03,400
So overall, if you made a mistake
and you need to reverse something,
280
00:19:03,830 --> 00:19:07,160
usually a lot can be
done, but don't seesaw.
281
00:19:07,161 --> 00:19:10,800
Don't do something, undo
it, redo it, undo it.
282
00:19:10,800 --> 00:19:12,800
Be kind to your body tissues.
283
00:19:13,380 --> 00:19:16,760
And remember that perfect
is the enemy of good.
284
00:19:18,300 --> 00:19:22,210
Being kind to your body and maintaining
realistic expectations are definitely
285
00:19:22,211 --> 00:19:26,130
important lessons to keep in mind when
it comes to plastic surgery. I, for one,
286
00:19:26,131 --> 00:19:30,010
am very happy to know that I have a lot
of options if I'm not in love with my
287
00:19:30,011 --> 00:19:33,090
surgery results or an outcome
after particular procedure.
288
00:19:33,700 --> 00:19:36,010
Thank you to all of our
listeners for joining us today,
289
00:19:36,030 --> 00:19:38,730
to hear about what you can do
to achieve your desired results.
290
00:19:39,410 --> 00:19:42,610
I hope you found this episode as
intriguing and informative as I did.
291
00:19:43,230 --> 00:19:46,530
If you think of other exciting
developments or trends
in plastic surgery that
292
00:19:46,531 --> 00:19:48,730
you would like us to discuss
in upcoming episodes,
293
00:19:48,830 --> 00:19:52,370
please reach out by email or
Instagram. We'll see you next time.
294
00:19:54,400 --> 00:19:58,210
This is Doreen Wu thanking you for joining
Dr. Bass and me for this discussion
295
00:19:58,230 --> 00:20:02,050
of procedure reversal and plastic
surgery. Be sure to tune in next time.
296
00:20:02,070 --> 00:20:03,810
And don't forget to
subscribe to our podcast,
297
00:20:04,070 --> 00:20:07,250
to stay up to date with all of the
exciting content that is coming your way.
298
00:20:08,460 --> 00:20:12,770
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
299
00:20:12,900 --> 00:20:17,450
Class podcast with Dr. Lawrence
Bass, Park Avenue, plastic surgeon,
300
00:20:18,250 --> 00:20:20,130
educator, and technology innovator.
301
00:20:20,430 --> 00:20:22,930
The commentary in this
podcast represents opinion.
302
00:20:23,120 --> 00:20:25,530
This podcast does not
present medical advice,
303
00:20:25,830 --> 00:20:29,810
but rather general information about
plastic surgery that does not necessarily
304
00:20:29,910 --> 00:20:33,130
relate to the specific conditions
of any individual patient.
305
00:20:33,470 --> 00:20:38,170
No doctor-patient relationship
is established by listening
to or participating
306
00:20:38,310 --> 00:20:39,143
in this podcast,
307
00:20:39,400 --> 00:20:43,450
consult your physician to advise you
about your individual healthcare.
308
00:20:43,710 --> 00:20:45,090
If you enjoyed this episode,
309
00:20:45,270 --> 00:20:49,480
please share it with your friends and
be sure to subscribe to our podcast on
310
00:20:49,481 --> 00:20:53,360
Apple Podcasts, Google, Spotify, Stitcher,
311
00:20:53,660 --> 00:20:55,960
or wherever you listen to podcasts.
00:00:00,840 --> 00:00:04,810
Welcome to another episode of
Park Avenue Plastic Surgery Class,
2
00:00:05,150 --> 00:00:08,810
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:08,811 --> 00:00:11,490
surgery. I'm your co-host Doreen Wu.
4
00:00:11,491 --> 00:00:15,890
And I'm excited to be here
with Dr. Lawrence Bass,
Park Avenue plastic surgeon,
5
00:00:16,570 --> 00:00:18,090
educator, and technology innovator.
6
00:00:18,710 --> 00:00:22,010
The title of today's episode
is "Operating in Reverse:
7
00:00:22,310 --> 00:00:25,330
How the Unwanted Plastic Surgery
Result Can Be Reversed." Another
8
00:00:27,490 --> 00:00:31,090
intriguing episode title Dr. Bass,
when people think of plastic surgery,
9
00:00:31,510 --> 00:00:33,690
the word reversible doesn't
typically come to mind.
10
00:00:34,150 --> 00:00:38,490
So what is this episode going to be about
how to fix a complication from plastic
11
00:00:38,491 --> 00:00:39,324
surgery?
12
00:00:39,630 --> 00:00:41,050
That's part of it Doreen,
13
00:00:42,160 --> 00:00:46,570
fortunately big healing complications
are uncommon in plastic surgery,
14
00:00:47,310 --> 00:00:50,610
but that's not the only thing that
might lead someone to re-operate.
15
00:00:52,120 --> 00:00:55,010
Some people just want better
symmetry. That's something.
16
00:00:55,210 --> 00:00:58,730
I generally advise people
not to chase too hard.
17
00:00:59,690 --> 00:01:01,850
A big asymmetry is undesirable,
18
00:01:02,870 --> 00:01:07,450
but small asymmetries are
universal in human appearance and
19
00:01:07,560 --> 00:01:11,730
chasing them really hard is a lot
of risk for very little reward.
20
00:01:12,910 --> 00:01:17,730
Sometimes people re-operate because
there's some aspect of their appearance
21
00:01:17,731 --> 00:01:22,450
that's not as they desired or not
as they expected it to turn out
22
00:01:23,700 --> 00:01:27,600
or they want more
improvement than they got,
23
00:01:28,420 --> 00:01:31,120
or they want to change
it in some different way.
24
00:01:31,620 --> 00:01:36,400
So that's occasionally a reason for
re-operating but this episode is mostly
25
00:01:36,530 --> 00:01:37,400
about what happens,
26
00:01:38,780 --> 00:01:42,720
not when you want to
change or refine a result,
27
00:01:42,900 --> 00:01:46,040
but when you want to undo a result,
28
00:01:47,300 --> 00:01:49,560
and there are several reasons for that,
29
00:01:49,561 --> 00:01:52,320
sometimes you thought better
of changing the feature.
30
00:01:52,500 --> 00:01:54,800
And you just want to go
back to where you started.
31
00:01:55,510 --> 00:01:58,480
Once you realize how you'll look
with that feature a certain way.
32
00:01:58,540 --> 00:02:01,200
You say that doesn't look
good on me. I don't like that.
33
00:02:01,860 --> 00:02:05,040
Let me just go back where I came from.
34
00:02:05,750 --> 00:02:08,000
Sometimes you just need a different look.
35
00:02:08,001 --> 00:02:12,680
You're at a different life stage where
there's a style or a fashion change
36
00:02:13,060 --> 00:02:16,080
in terms of a certain
feature you tried to create.
37
00:02:16,580 --> 00:02:19,080
And so you'd like to undo
the procedure and again,
38
00:02:19,860 --> 00:02:21,680
go to a different sort of a look.
39
00:02:22,890 --> 00:02:26,770
I can already tell this is going
to be a nuanced topic. So Dr. Bass,
40
00:02:26,910 --> 00:02:29,690
can you break this down for me a
little so I'm sure I understand the
41
00:02:29,930 --> 00:02:30,763
distinctions.
42
00:02:31,360 --> 00:02:32,193
Sure.
43
00:02:32,860 --> 00:02:36,570
There are things like immediate undos.
44
00:02:37,830 --> 00:02:41,210
You decide you want bigger
cheeks, you get cheek implants.
45
00:02:41,240 --> 00:02:42,650
Once you see them in there,
46
00:02:42,750 --> 00:02:46,250
you realize you really don't
look better with bigger cheeks.
47
00:02:46,830 --> 00:02:50,090
So you come back and say, "I
hate it. This was a big mistake.
48
00:02:51,400 --> 00:02:55,540
Put me back where I started." So
that's a, that's an immediate undo.
49
00:02:56,080 --> 00:02:59,920
And then sometimes there's a style undo.
50
00:03:01,140 --> 00:03:06,040
You wanted a big buttock. You
decided to do a Brazilian butt lift,
51
00:03:07,060 --> 00:03:09,240
and now you have that bigger buttock,
52
00:03:09,260 --> 00:03:12,840
but you didn't realize all the
implications, how it was going to change,
53
00:03:13,580 --> 00:03:17,800
how large it made your breast look to
have wider hips or a bigger buttock,
54
00:03:18,220 --> 00:03:20,440
how it was going to change
your fit in fashions,
55
00:03:20,460 --> 00:03:23,080
how it was going to affect
your ability to do sports.
56
00:03:24,080 --> 00:03:28,600
Maybe you don't like the reaction
you're getting from friends, family,
57
00:03:28,700 --> 00:03:33,400
or just from strangers commenting on
your appearance or staring at you.
58
00:03:34,480 --> 00:03:36,320
So that's a style undo.
59
00:03:37,940 --> 00:03:39,550
That seems straightforward enough.
60
00:03:40,050 --> 00:03:42,430
So what are some common
examples of this in the body?
61
00:03:42,970 --> 00:03:47,670
Mostly in the body it's about
adding or removing fat for body
62
00:03:47,840 --> 00:03:52,630
shape. So it's like what we do in
the procedures in the first place,
63
00:03:52,730 --> 00:03:55,310
except just going in
the opposite direction.
64
00:03:55,890 --> 00:03:59,990
So most people like to be thin in America.
65
00:03:59,991 --> 00:04:04,790
We're obsessed with being thin
and many other nations are
66
00:04:04,930 --> 00:04:05,763
as well.
67
00:04:06,330 --> 00:04:10,630
But we do have fad shapes and celebrity
68
00:04:10,631 --> 00:04:11,464
imitation,
69
00:04:12,090 --> 00:04:16,710
and those kind of shapes
or appearances are more
70
00:04:16,770 --> 00:04:21,030
likely to be undone if they
end up being out of style.
71
00:04:21,031 --> 00:04:24,670
An example of that again
is the Brazilian butt lift,
72
00:04:24,910 --> 00:04:29,830
a body shape popularized by
Kim Kardashian and others which
73
00:04:29,831 --> 00:04:32,070
is very much in style right now,
74
00:04:32,071 --> 00:04:36,990
getting people to go to big
construction projects with
75
00:04:37,290 --> 00:04:40,270
fat grafting, mostly to
build a bigger bottom,
76
00:04:41,480 --> 00:04:46,260
but at some point that may be out of
style and they may want to reverse that.
77
00:04:47,700 --> 00:04:50,720
And how is that accomplished?
What can be done to reverse a BBL?
78
00:04:51,860 --> 00:04:54,390
Basically it's liposuction, as I said,
79
00:04:54,860 --> 00:04:59,470
Brazilian butt lift or BBL is
mostly done with fat grafting.
80
00:05:00,770 --> 00:05:05,390
And so liposuction will
take that fat back out and
81
00:05:05,440 --> 00:05:08,870
allow a reshaping. You know,
you could take it out partially.
82
00:05:08,871 --> 00:05:09,710
You could take it out totally.
83
00:05:11,270 --> 00:05:15,870
you could just take out enough
to focus on a different shape
84
00:05:16,140 --> 00:05:18,070
than the one that was obtained.
85
00:05:19,020 --> 00:05:23,390
Sometimes prosthetic implants
are used, gluteal implants,
86
00:05:24,090 --> 00:05:27,510
and there, the implant
can simply be removed,
87
00:05:27,680 --> 00:05:31,630
which by and large undoes the result.
88
00:05:32,530 --> 00:05:35,110
But doesn't that mean you just
end up back where you started?
89
00:05:36,260 --> 00:05:38,710
Well, you hope you end up
back where you started.
90
00:05:39,850 --> 00:05:42,390
That's what you're trying
to do when you reverse it.
91
00:05:42,490 --> 00:05:46,630
But sometimes depending on how
much of a size change was involved,
92
00:05:47,370 --> 00:05:51,870
you may have loose skin and
that may require skin excision.
93
00:05:52,530 --> 00:05:54,950
The more traditional type of buttock lift,
94
00:05:55,000 --> 00:05:59,840
where a wedge of skin and fat is
taken out at the top of the buttock to
95
00:05:59,850 --> 00:06:02,040
boost and shape the buttock.
96
00:06:03,860 --> 00:06:08,720
You also have lost that fat store which
97
00:06:08,721 --> 00:06:13,360
you may want to use somewhere else and
maybe needed to create a complimentary
98
00:06:13,650 --> 00:06:14,720
shape somewhere else.
99
00:06:15,840 --> 00:06:20,440
Particularly if you've done
a reduction as the initial
100
00:06:20,441 --> 00:06:21,250
procedure,
101
00:06:21,250 --> 00:06:25,800
going back and adding back
the shape can really only be
102
00:06:25,801 --> 00:06:28,720
accomplished if you have fat
somewhere else to borrow.
103
00:06:29,780 --> 00:06:33,150
That makes sense. If you're removing
something that was previously there,
104
00:06:33,380 --> 00:06:38,030
then there will likely be a cavity where
the material was originally taking up
105
00:06:38,031 --> 00:06:42,670
space. So it makes sense that reshaping
and some restructuring are both likely
106
00:06:42,671 --> 00:06:46,630
necessary. So what's another example
in the body that you often encounter?
107
00:06:47,430 --> 00:06:52,330
So another typical body
shaping or body size area that
108
00:06:52,331 --> 00:06:55,930
we work on is of course the
breast. So you maybe decide,
109
00:06:56,830 --> 00:07:00,410
whether you reduced or you
got a breast augmentation,
110
00:07:00,490 --> 00:07:05,370
you may decide you're over being
a certain size or that a certain
111
00:07:05,440 --> 00:07:08,210
size is too big for you currently,
112
00:07:08,211 --> 00:07:12,570
particularly if you lost
weight elsewhere in the body,
113
00:07:13,110 --> 00:07:17,770
you may now look
unbalanced. So in that case,
114
00:07:17,950 --> 00:07:22,490
we take breast implants out if someone
feels they're larger than they want to
115
00:07:22,491 --> 00:07:26,290
be, but there, much more commonly,
116
00:07:26,291 --> 00:07:30,330
especially if a number of years have
passed and if the augmentation was
117
00:07:30,331 --> 00:07:31,610
significant in size,
118
00:07:32,280 --> 00:07:36,530
it's fairly common to require
a breast lift at that point,
119
00:07:37,110 --> 00:07:40,730
if we really want to
maintain ideal breast shape.
120
00:07:43,590 --> 00:07:46,010
So some people may decide
121
00:07:47,560 --> 00:07:51,970
they they're just done with the implants
or they're done being a certain size
122
00:07:51,990 --> 00:07:55,500
and they may just go ahead
and do it other times.
123
00:07:56,180 --> 00:08:01,100
They pursue adjusting
the size when it's time
124
00:08:01,240 --> 00:08:02,940
to do some other surgery.
125
00:08:03,320 --> 00:08:08,220
So they got capsular contracture or
they're thinking about a breast lift
126
00:08:08,280 --> 00:08:10,460
and this is, or the implants fail.
127
00:08:10,560 --> 00:08:13,900
And this is the chance
for them to jump in and,
128
00:08:15,240 --> 00:08:20,100
and take advantage of that
needed surgery to make that,
129
00:08:20,330 --> 00:08:25,260
that reversal in the size selection
that they made at the outset with
130
00:08:25,261 --> 00:08:26,460
their original procedure.
131
00:08:27,690 --> 00:08:32,020
Sometimes people decide they're really
over it. They do a full reverse,
132
00:08:32,170 --> 00:08:35,020
just pull the implants out and downsize.
133
00:08:36,800 --> 00:08:41,100
Or some people who want to
maintain some of the size
134
00:08:41,650 --> 00:08:45,620
will pull implants out
and switch to fat grafting
135
00:08:46,780 --> 00:08:48,240
for breast augmentation, usually
136
00:08:50,620 --> 00:08:54,480
at a more modest size and
without a lot of delayed
137
00:08:54,840 --> 00:08:59,720
consequences of having a breast
implant, an artificial implant,
138
00:08:59,980 --> 00:09:00,880
inside the body.
139
00:09:04,090 --> 00:09:07,660
Some people decide they're, they're
not that worried about the size,
140
00:09:07,760 --> 00:09:10,100
but they they're worried
about the implants.
141
00:09:10,101 --> 00:09:14,460
They're just tired of thinking about
them or they're concerned about what they
142
00:09:14,620 --> 00:09:15,700
might do in the future.
143
00:09:16,620 --> 00:09:20,680
So they decide to remove the implants
without any problem occurring.
144
00:09:21,180 --> 00:09:25,880
And I've had two or three
patients in my nearly 30 years of
145
00:09:26,160 --> 00:09:27,800
practice who have come back and said,
146
00:09:28,000 --> 00:09:32,270
"I just don't like the idea of
thinking about these implants,
147
00:09:33,300 --> 00:09:37,110
just take them out." So it
doesn't happen very often,
148
00:09:37,170 --> 00:09:38,910
but it does occasionally happen.
149
00:09:40,200 --> 00:09:42,510
Let's switch gears and
talk about the face.
150
00:09:42,980 --> 00:09:46,190
What kinds of procedures are
targets for reversal on the face?
151
00:09:47,290 --> 00:09:52,180
Well, the first thing is
implants. So cheek implants,
152
00:09:52,660 --> 00:09:57,460
chin implants, jawline,
or jaw angle implants,
153
00:09:58,180 --> 00:09:59,013
which are
154
00:10:00,580 --> 00:10:05,340
frequently used to alter
face shape, may be too big,
155
00:10:05,740 --> 00:10:10,140
or someone just doesn't like the
look or it's not what they expected.
156
00:10:11,660 --> 00:10:14,500
So they decide to take the implants out
157
00:10:16,060 --> 00:10:20,060
undo the procedure.
Occasionally someone likes it,
158
00:10:20,460 --> 00:10:22,540
but wants to go up in size.
159
00:10:23,700 --> 00:10:28,660
So they double down on the augmentation.
So they're not really reversing,
160
00:10:29,500 --> 00:10:31,060
they're kind of taking
it one step further.
161
00:10:32,660 --> 00:10:37,540
An analogous thing happens
with injectable fillers. So
162
00:10:39,770 --> 00:10:44,610
some people wind up with too
much filler and their shape is
163
00:10:45,290 --> 00:10:50,170
distorted. This can be avoided by just
building up incrementally, but, you know,
164
00:10:50,650 --> 00:10:55,450
sometimes it sneaks up some on people and
they need to undo some of that filler,
165
00:10:56,210 --> 00:11:01,130
or they've had too many different
kinds of fillers in too many
166
00:11:01,730 --> 00:11:06,510
treatment sessions. And as that
different population of fillers,
167
00:11:06,790 --> 00:11:08,470
both different in type and age,
168
00:11:09,510 --> 00:11:14,350
start absorbing a lot of
unpredictable shapes can emerge
169
00:11:15,390 --> 00:11:19,990
as those fillers come out. And so
we decide to reverse the fillers,
170
00:11:20,670 --> 00:11:25,670
take them out all at once to
avoid having to experience that
171
00:11:26,590 --> 00:11:30,350
protracted period of
peculiar shape change.
172
00:11:31,430 --> 00:11:33,470
And sometimes the tissues just need rest.
173
00:11:33,790 --> 00:11:38,270
We want the fillers out of there so that
the tissues can rest and not continue
174
00:11:38,710 --> 00:11:42,710
to go through injection
sessions. Sometimes again, people
175
00:11:44,480 --> 00:11:48,960
didn't get what they expected out of a
filler, or they look and they say, "okay,
176
00:11:49,160 --> 00:11:51,680
you filled in my fold or
you gave me bigger cheeks,
177
00:11:51,840 --> 00:11:52,920
but that doesn't look like me."
178
00:11:54,520 --> 00:11:59,320
So it doesn't fit their self image. And
they'll decide to try to reverse that.
179
00:12:00,830 --> 00:12:05,310
And a lot of times we reverse filler
before we do surgery in the face.
180
00:12:05,930 --> 00:12:10,550
If we're going to do a brow lift
or an eyelid plasty or a facelift,
181
00:12:10,610 --> 00:12:13,630
we want to know exactly
where to put things,
182
00:12:14,060 --> 00:12:16,990
exactly what the baseline
bone structure is.
183
00:12:17,330 --> 00:12:20,910
And so sometimes people will come
a few weeks before the surgery,
184
00:12:21,100 --> 00:12:24,990
have all the filler
reversed so we can proceed.
185
00:12:25,530 --> 00:12:30,110
And so this is done by injecting
an enzyme that melts the
186
00:12:30,111 --> 00:12:32,430
fillers, which in the United States,
187
00:12:32,540 --> 00:12:37,310
because almost all fillers
we use are hyaluronic acid
188
00:12:37,311 --> 00:12:38,430
fillers. The hyaluronidase enzyme
189
00:12:41,010 --> 00:12:45,470
breaks that down and allows us to
undo the fillers. So with fillers,
190
00:12:45,530 --> 00:12:50,270
we kind of have a magic eraser
that lets us take a mistake
191
00:12:50,890 --> 00:12:51,830
or adjust a decision
192
00:12:53,410 --> 00:12:55,950
to change direction or change course,
193
00:12:56,850 --> 00:13:00,070
and take away the old choices,
194
00:13:00,410 --> 00:13:02,710
the old filler and start fresh.
195
00:13:02,711 --> 00:13:07,390
The same kind of thing sometimes
happens with fat grafting.
196
00:13:07,391 --> 00:13:08,790
People either get too much
197
00:13:10,650 --> 00:13:15,190
it winds up someplace that they
didn't intend and they have a funny
198
00:13:15,320 --> 00:13:19,690
shape and that can be taken
down with kind of like a baby
199
00:13:20,080 --> 00:13:21,570
liposuction-like procedure.
200
00:13:22,810 --> 00:13:25,670
Sounds like some of these
reversals can be pretty involved.
201
00:13:26,290 --> 00:13:28,870
Are there additional
consequences for these reversals?
202
00:13:29,580 --> 00:13:34,430
Well, the nice thing is usually
the answer to that is no,
203
00:13:34,970 --> 00:13:39,750
but it's possible depending on the
magnitude of the size change and
204
00:13:39,770 --> 00:13:43,990
how long the size change was
maintained. So again, a big size change,
205
00:13:44,630 --> 00:13:47,390
particularly in the awkward direction.
206
00:13:48,410 --> 00:13:53,270
If the person went a lot bigger
and now they're taking that back to
207
00:13:53,271 --> 00:13:54,710
go to a smaller size,
208
00:13:55,450 --> 00:14:00,150
having loose skin or empty skin is
209
00:14:00,500 --> 00:14:01,470
more likely,
210
00:14:01,650 --> 00:14:06,550
and that might require something
bigger in terms of undoing.
211
00:14:07,560 --> 00:14:11,500
And now what about the nose? Do people
often reverse their rhinoplasties?
212
00:14:12,210 --> 00:14:16,350
That's a great question. And, you
know, that's more of a gray area.
213
00:14:16,700 --> 00:14:21,500
Sometimes it's a liquid what's
called a liquid rhinoplasty.
214
00:14:21,501 --> 00:14:26,140
That's done with injectable
filler and there people
215
00:14:26,320 --> 00:14:28,980
may decide they don't
want that shape anymore.
216
00:14:28,981 --> 00:14:30,740
They want a slightly different look.
217
00:14:31,840 --> 00:14:36,380
And we undo the filler again
with the injectable enzyme,
218
00:14:36,440 --> 00:14:38,980
but where it's surgical rhinoplasty,
219
00:14:40,450 --> 00:14:44,420
it's not so much a question of reversing,
220
00:14:45,160 --> 00:14:48,220
but in many Caucasian rhinoplasty,
221
00:14:49,120 --> 00:14:53,240
the essential step that's taking place is
222
00:14:54,160 --> 00:14:56,720
essentially a reductive rhinoplasty.
223
00:14:56,721 --> 00:15:00,400
We're reducing the size of
the bones, the cartilages,
224
00:15:00,401 --> 00:15:05,200
and taking overbuilt sharp or angular
225
00:15:05,201 --> 00:15:08,360
shapes and trying to
soften and harmonize them.
226
00:15:10,380 --> 00:15:14,000
So, and we're also trying to take
out width very often in the nose.
227
00:15:15,300 --> 00:15:18,120
So in a lot of secondary rhinoplasty,
228
00:15:18,420 --> 00:15:23,120
it relates to building back structure
in the nose to restore shape.
229
00:15:23,980 --> 00:15:28,520
If the change is deemed
too much or if the nose is
230
00:15:28,610 --> 00:15:32,280
collapsing with age or
with excessive surgery,
231
00:15:32,670 --> 00:15:36,640
it's building back that support
structure and projection.
232
00:15:37,500 --> 00:15:39,360
So in a sense, it's undoing,
233
00:15:39,500 --> 00:15:44,480
but really what we're doing is
going in and constructing a new
234
00:15:45,570 --> 00:15:50,560
artificial support for the nose to
replace the initial support that was lost
235
00:15:50,630 --> 00:15:51,960
over the course of surgery.
Rhinoplasty in Asian
236
00:15:55,680 --> 00:16:00,310
noses and black people's
noses is more often
237
00:16:00,400 --> 00:16:05,310
about narrowing the contour of the
nose and augmenting the projection of
238
00:16:05,311 --> 00:16:07,150
the dorsum, or the bridge of the nose.
239
00:16:09,090 --> 00:16:12,870
And that's sometimes done
with a prosthetic implant.
240
00:16:12,970 --> 00:16:14,710
And if that was done too much,
241
00:16:14,730 --> 00:16:18,590
or the person wants to undo
it and have a more authentic
242
00:16:19,490 --> 00:16:22,750
ethnic look the implant can be removed,
243
00:16:24,240 --> 00:16:28,820
but a lot of secondary procedures
in the nose for everybody of all
244
00:16:29,050 --> 00:16:33,940
ethnicities is really
aimed at refining rather
245
00:16:34,010 --> 00:16:35,860
than reversing the result.
246
00:16:35,860 --> 00:16:39,960
All right, let's recap the
episode for our listeners.
247
00:16:40,350 --> 00:16:43,000
What are the key takeaways
about procedure reversal?
248
00:16:43,930 --> 00:16:47,420
Well, the first thing is careful planning,
249
00:16:48,820 --> 00:16:53,780
thinking through your wishes
and desires and careful imaging
250
00:16:54,260 --> 00:16:55,180
and simulation
251
00:16:57,220 --> 00:17:01,740
maximizes your understanding of the
likely results that you're realistically
252
00:17:02,100 --> 00:17:02,933
going to obtain.
253
00:17:03,860 --> 00:17:07,700
So you can decide if that's
a good look for you or not.
254
00:17:08,500 --> 00:17:13,260
So that you're less likely to end up
with something you don't like that
255
00:17:13,620 --> 00:17:14,700
you want to reverse,
256
00:17:15,940 --> 00:17:20,700
never decide on doing a procedure
in haste that will also reduce the
257
00:17:21,220 --> 00:17:24,380
chances you have to
reverse or undo a procedure
258
00:17:26,220 --> 00:17:30,460
when it comes to fads and
trends in appearance. I mean,
259
00:17:30,740 --> 00:17:33,700
that's okay for fashion.
That's okay for makeup.
260
00:17:35,180 --> 00:17:38,100
But it's not ideal for
aesthetic treatments.
261
00:17:38,740 --> 00:17:43,140
And I personally feel it's a bad
idea for surgical procedures.
262
00:17:44,460 --> 00:17:48,180
But again, there is reversing
potentially even with surgery.
263
00:17:49,520 --> 00:17:50,360
It's always better though,
264
00:17:50,560 --> 00:17:55,280
to avoid an unwanted appearance than
to have to undo an unwanted appearance
265
00:17:57,600 --> 00:17:58,360
separate from that.
266
00:17:58,360 --> 00:18:03,280
There are some things we know we're
going to be going back eventually to
267
00:18:03,800 --> 00:18:07,280
rework them, not so much to
reverse them, for example,
268
00:18:07,920 --> 00:18:12,600
a facelift or a breast lift. I
mean, aging always continues.
269
00:18:12,840 --> 00:18:13,680
It never stops.
270
00:18:14,800 --> 00:18:19,320
And so eventually we'll have to
relift and that gives a chance to
271
00:18:20,080 --> 00:18:22,600
readjust other aesthetic
concerns. At the same time,
272
00:18:23,560 --> 00:18:27,720
the same idea with breast
implants, sooner or later,
273
00:18:28,480 --> 00:18:33,480
those implants are likely to wear out.
And so, you know, sooner or later,
274
00:18:34,240 --> 00:18:36,480
you're likely to be back
in the operating room.
275
00:18:37,440 --> 00:18:42,000
And that gives you a chance
to take aesthetic concerns and
276
00:18:42,600 --> 00:18:47,000
adjustments you'd like to make
that are not major and urgent
277
00:18:48,200 --> 00:18:51,800
that you can live with for
a while, but are not ideal.
278
00:18:52,440 --> 00:18:56,680
And rework them at that time when you
need to be in the operating room anyway.
279
00:18:59,040 --> 00:19:03,400
So overall, if you made a mistake
and you need to reverse something,
280
00:19:03,830 --> 00:19:07,160
usually a lot can be
done, but don't seesaw.
281
00:19:07,161 --> 00:19:10,800
Don't do something, undo
it, redo it, undo it.
282
00:19:10,800 --> 00:19:12,800
Be kind to your body tissues.
283
00:19:13,380 --> 00:19:16,760
And remember that perfect
is the enemy of good.
284
00:19:18,300 --> 00:19:22,210
Being kind to your body and maintaining
realistic expectations are definitely
285
00:19:22,211 --> 00:19:26,130
important lessons to keep in mind when
it comes to plastic surgery. I, for one,
286
00:19:26,131 --> 00:19:30,010
am very happy to know that I have a lot
of options if I'm not in love with my
287
00:19:30,011 --> 00:19:33,090
surgery results or an outcome
after particular procedure.
288
00:19:33,700 --> 00:19:36,010
Thank you to all of our
listeners for joining us today,
289
00:19:36,030 --> 00:19:38,730
to hear about what you can do
to achieve your desired results.
290
00:19:39,410 --> 00:19:42,610
I hope you found this episode as
intriguing and informative as I did.
291
00:19:43,230 --> 00:19:46,530
If you think of other exciting
developments or trends
in plastic surgery that
292
00:19:46,531 --> 00:19:48,730
you would like us to discuss
in upcoming episodes,
293
00:19:48,830 --> 00:19:52,370
please reach out by email or
Instagram. We'll see you next time.
294
00:19:54,400 --> 00:19:58,210
This is Doreen Wu thanking you for joining
Dr. Bass and me for this discussion
295
00:19:58,230 --> 00:20:02,050
of procedure reversal and plastic
surgery. Be sure to tune in next time.
296
00:20:02,070 --> 00:20:03,810
And don't forget to
subscribe to our podcast,
297
00:20:04,070 --> 00:20:07,250
to stay up to date with all of the
exciting content that is coming your way.
298
00:20:08,460 --> 00:20:12,770
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
299
00:20:12,900 --> 00:20:17,450
Class podcast with Dr. Lawrence
Bass, Park Avenue, plastic surgeon,
300
00:20:18,250 --> 00:20:20,130
educator, and technology innovator.
301
00:20:20,430 --> 00:20:22,930
The commentary in this
podcast represents opinion.
302
00:20:23,120 --> 00:20:25,530
This podcast does not
present medical advice,
303
00:20:25,830 --> 00:20:29,810
but rather general information about
plastic surgery that does not necessarily
304
00:20:29,910 --> 00:20:33,130
relate to the specific conditions
of any individual patient.
305
00:20:33,470 --> 00:20:38,170
No doctor-patient relationship
is established by listening
to or participating
306
00:20:38,310 --> 00:20:39,143
in this podcast,
307
00:20:39,400 --> 00:20:43,450
consult your physician to advise you
about your individual healthcare.
308
00:20:43,710 --> 00:20:45,090
If you enjoyed this episode,
309
00:20:45,270 --> 00:20:49,480
please share it with your friends and
be sure to subscribe to our podcast on
310
00:20:49,481 --> 00:20:53,360
Apple Podcasts, Google, Spotify, Stitcher,
311
00:20:53,660 --> 00:20:55,960
or wherever you listen to podcasts.