Revision
Surgery

Cosmetic surgery is often referred to as “surgery for the mind”.

This form of plastic surgery can be life changing, allowing patients to feel better about themselves both physically and emotionally, and increasing their confidence significantly. That said, all surgery carries risk; both medical, and in the case of plastic surgery, cosmetic. Wouldn’t it be wonderful if all cosmetic surgery procedures were devoid of risk, no-one had scars post operatively and everyone was delighted with the results! The reality, unlike what is so often depicted on so-called “reality TV”, is that complications do occur from time to time, and some of these complications will result in the need for further corrective surgery. Early complications may include bleeding, infection, skin damage, nerve damage etc. as detailed elsewhere on the website.

A certain percentage of patients will be dissatisfied with the results of their surgery despite there having been no “medical” complications. We are not made of plasticine that can simply and predictably be molded to its final shape. Occasionally, for a variety of reasons, the cosmetic result is less than what was hoped for by both surgeon and patient. Furthermore, given the passage of time, gravity, ageing, smoking, pregnancies, weight fluctuations and so forth may negatively impact on a once good result. There are essentially 2 patient groups that may present for revision plastic surgery – those who were initially satisfied with the result, which then deteriorated over time, and those in whom the result was less-than-ideal from the start.

Revision surgery is almost always more complex than the primary surgery. This is due to the altered anatomy brought about by the prior surgery – tissues may have been unusually thinned, donor material (nasal septal cartilage) may be depleted, scarring may have distorted tissue planes and if the primary surgery was done elsewhere, it may be difficult to establish exactly what was done previously. Furthermore, those patients who were dissatisfied with the result of the first surgery are understandably upset and very dubious about the potential success of any further intervention.

Some surgeons do not like revising their own cases as they may feel that this represents a failure to achieve their original goal. I have the opposite attitude – I am always willing and keen to do revisions on any of my patients, if I agree that the result is less-than-ideal and believe that further surgery will improve the situation. Ultimately, both the patient and I want the best possible result. To this end, I try to make it as easy as possible for the patient to proceed with revision surgery – I generally do not charge a surgeon’s fee for my own revisions, but the patient would be responsible for covering the costs of the facility (hospital / clinic) and the anaesthetist . It is very difficult to achieve a “perfect” result in plastic surgery, and even more so with revision surgery for the reasons alluded to above. Those seeking perfection are likely to be disappointed, but those with realistic expectations seeking an improvement, should benefit from appropriate revision surgery.

All surgeons have revision cases – their own and those where the primary surgery was done elsewhere. Any surgeon who claims that they have never done any of their own revisions, has either not done enough cases, or the patients have gone elsewhere! I have been privileged to visit some of the world leaders in aspects of plastic surgery, and watched them revise their own cases. It is an unfortunate reality that not every result will be ideal and that some patients will need, or at least derive some further benefit, from revision surgery.

In general terms, post operative results take about a year to settle down completely and it is highly unusual to revise procedures much before this time has elapsed. This period is often distressing for the patient, who has to live with the less-than-ideal result, but experience has shown that many aspects improve with time as the tissue softens and not infrequently, given enough time, either no revision is required, or the extent of the revision is less than initially anticipated.

Whilst every effort will always be made to ensure a complication-free and cosmetically excellent result, one must appreciate that occasionally (fortunately infrequently) things do not turn out as one might have hoped. My commitment is to minimize this risk where possible, and to offer a revision surgery to any of my patients in whom the result has been less than anticipated. Your commitment is to be the best patient you can be, by ensuring that you are well, a non smoker (or stop smoking), be an appropriate weight for your height, and follow all the pre- and post operative instructions given to you.

If you have any questions about this, feel free to email me

Member |  International Society of Aesthetic Plastic Surgery (ISAPS)
Fellow  |  College of Surgeons of South Africa (Plastic Surgery)
Member |  International Member of THE American Society of Plastic Surgeons
Fellow  |  Royal College of Surgeons
Member |  Association of Plastic & Reconstructive Surgeons of SA