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Understanding 'Re-Do' Procedures in Cosmetic Surgery

Written by Mr Hiroshi Nishikawa, Consultant Plastic Surgeon

Understanding 'Re-Do' Procedures in Cosmetic Surgery

A working definition of ‘re-do’ surgery is an operation carried out in order to rectify a previous procedure that has gone wrong or has not achieved the desired outcome. There are many terms used to describe this type of surgery, such as ‘touch-up’, ‘revision’, ‘adjustment’, ‘secondary surgery’ to name a few. The semantics vary and can imply minor modifications, or more extensive corrective treatment.

Not all secondary surgery denotes failure. It is not uncommon to need to make alterations such as revising scars, removing dog-ears (following abdominoplasty surgery) or carry out further liposuction to improve results. This ‘touch-up’ surgery can reflect that the surgeon really cares and wants to achieve the very best possible result for the patient. It is not the same as a ‘re-do’.

The need for re-do surgery will be different, and will vary according to circumstance. Re-do operations happen in all surgical specialties and unfortunately it is not an infrequent occurrence in cosmetic surgery. One way to avoid this is to make sure that you are certain that cosmetic surgery is really what is needed to improve your quality of life. Of course it is important that you consult with an experienced cosmetic surgeon who can truly listen to you, understand your aims and then give an honest unbiased opinion on what is possible and what is not. The mismatch between what is possible and the patient’s expectations is probably the most common reason for many re-dos in cosmetic surgery. Unlike cardiac surgery where re-do surgery is usually to save life, the reason for re-dos in cosmetic surgery can sometimes be grey because aesthetic outcome measures are very subjective.

One procedure with a high rate of revision surgery is rhinoplasty; the reason for this is complex. The surgery is difficult and exacting so technical errors or small misjudgements during the operation can lead to a poor outcome. Also every individual heals uniquely, and this is a factor that all cosmetic surgeons will have to take into consideration. The tissues that we operate on (skin, bone and cartilage) will have a built-in unpredictability as they heal in their new position, on the surface and within the nose. The nose is such an exposed and critical aesthetic area that small residual post-operative irregularities often lead to the need for touch-ups. It is more infrequent to have to carry out a total re-do after rhinoplasty but sometimes it is essential if surgery has led to a loss of function such as nasal collapse, airway difficulties or structural deviation. The grey area occurs if, after an apparently successful rhinoplasty, the patient is still unhappy about the outcome and this is usually a result of misaligned expectations, as previous mentioned. For this reason, I spend time in my clinic ensuring I have understood what the patient is hoping to achieve, and being honest about what I think is possible. From there we will come to mutual agreement of what we are aiming for.

Facelifts too can have a high disappointment. Gravity and the ageing processes are powerful forces that work against all rejuvenating surgery of the face. The facelift reverses time but does not stop the ageing process; all patients who undergo this procedure must understand this. Stress, drugs, smoking, alcohol and illness are all factors that can accelerate ageing before and after surgery. Genetics will also play a part. Re-do surgery is an option if there has been no change, or the recurrence of facial drooping has been unacceptably fast.

It’s important to note that all re-do surgery is more difficult than the primary surgery and the decision to carry out re-do surgery requires judgement, experience and honesty to the patient. Post-surgical scarring will have damaged the surgical planes and this will affect the ease and outcome of surgery. The surgeon has to judge whether another operation will be safe and that the secondary outcome will be successful; the stakes are even higher the second time round.

All cosmetic surgery is a journey with potential hazards. It will be an informed decision and the surgeon is responsible for deciding that it is a truly safe trip and in the patient’s best interests. The patient needs to be fully aware of all the risks and benefits, prior to making a decision. The understanding and trust between patient and surgeon will never prevent secondary surgery, but will help to ensure that the decision to carry out a re-do, if required, is the correct one. In all types of surgery, the appropriate and correctly counselled patients will experience life changing and enhancing results.

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