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Re-Facing the Mistakes

Plastic surgery isn’t just for specialists anymore—but retouching botched nose jobs and other flawed work is

[Originally published in South Florida Business Journal; not in online archive.]

As baby boomers increasingly turn to plastic surgery to keep them looking young, a new business niche has sprung up for doctors who specialize in fixing other surgeons’ mistakes.

Experts say the demand for cosmetic surgery is so high that many doctors are jumping into the market—even if they lack specialized training to do so. As a result, many patients end up with unsatisfactory results. Some even require a second, third, fourth or fifth session under the knife.

“There are more and more physicians trying to carve out a segment of the cosmetic market. Consequently, there are a fair number of patients who come out dissatisfied with the results,” said Dr. Jorge Perez, a Fort Lauderdale plastic surgeon who estimates 30 to 40 percent of his patients come to him for “re-do’s” of previous surgery.

The range of problems is broad. A 76-year-old North Lauderdale man spent $4,600 to have the fat under his neck liposuctioned and wound up with a beautiful computerized photo image taken before the procedure to show him what he was supposed to look like. He came out with a neck that looks like it still needs work. A Miami woman had three operations before she finally got rid of the bump on her nose.

Notebooks of “before” photos in the office of Dr. Carlos Wolf, a Kendall facial plastic surgeon, show patients with bumps on the nose, crooked noses, scarring, bald spots on their temples and earlobes stuck to their faces. All these patients—who comprise 20 to 30 percent of Wolf’s practice—have had previous surgery.

Problems can occur in many kinds of cosmetic work, but doctors mention laser and nasal surgery as areas of particular concern.

“Not only plastic surgeons, but otolaryngologists and even dentists and osteopaths all think they can do rhinoplasty,” said Dr. Ralph Millard, former chief of plastic surgery at the University of Miami and now a fellow there.

“They understand the anatomy of the area, but they do not understand the subtleties of corrective and reconstructive rhinoplasty. With an increase in the number of people doing it who are not really trained, mistakes are made, and then attempts to correct those mistakes by untrained surgeons make even bigger mistakes, until real deformity has occurred.”

Some surgeons are skillful enough to do a good job even without special training, he adds, but they are few and far between.

Nasal surgery normally requires retouching in 3 to 5 percent of cases, according to the American Academy of Cosmetic Surgery in Champaign, IL. But Millard said over half the noses he does are re-do’s.

Since so many doctors are working outside their specialty, patients should find a doctor with qualifications and experience in the specific area where the work will be done. They also need to have a frank discussion about how potential problems will be handles, Wolf said.

Money is the motivation

Why are doctors without specialized training in plastic surgery getting involved in it in the first place?

“Money,” said Millard. “They look to plastic surgery since it’s elective and the patients will have to pay for it themselves.”

Taking on cosmetic patients also helps make up for lowered income in an era of managed care and controlled costs.

Some physicians are spending a few thousand dollars on a laser as their new cash cow.

“They’ve proliferated at such a great degree that you have doctors who never did anything like this using them,” Wolf said.

“Lasers are easy to work: you push a few buttons, you put it on the face, it works.”

That is, it works until the patient complains of redness, scarring or lack of results.

“Laser resurfacing has been way oversold by people who are not plastic surgeons,” said Dr. Nathan Mayl, immediate past president of the Florida Society of Plastic and Reconstructive Surgeons. To be truly effective, the laser should be combined with other types of treatment 90 percent of the time, he said. Often, it isn’t.

Because laser surgery has become popular only in the last few years, 99 percent of physicians were not trained in its use during their residency, said Dr. Guillermo Castillo, president of the American Academy of Cosmetic Surgery. So they have to take special courses.

“Some are good and some are not very good,” he said.

“Bargains” south of the border

Patients unhappy with the results of their surgery often don’t want to return to the original physician and shell out more money someplace else for correction. This happens particularly in the case of patients who go on “package” trips to Costa Rica or Mexico for cosmetic work.

One of Wolf’s patients went to Costa Rica for a neck and eye lift 10 years ago and ended up with a lopsided face. When she went to a Miami surgeon to repair the damage, she wound up with earlobes attached to her face. She suffered with the condition for eight long years, afraid to try again, before finally going to Wolf and correcting the problem.

“The revisions on these patients are very, very high, so much so, I refuse to see them,” Mayl said. “The patient goes down there with limited resources. They come back with complications which their insurance will not cover. The plastic surgeon here has to charge for it, and there’s a tremendous amount of anger that gets thrown back on you.”