Health history plays a big part in a surgery's success.

Q: I really enjoyed your last article about overdone plastic surgery operations. Out of curiosity, what can be done if a patient has a bad plastic surgery outcome?

-Jill F Mission Viejo, CA

A: The answer to this question depends on the cause and extent of the bad outcome. First and foremost, all physicians have taken the old Hippocratic oath when we became doctors, and one of the primary elements of that oath is that first, we will do the patient no harm. Every step must be taken to avoid complications and to insure patient safety. This begins with the very first patient visit, when an extensive health history form is filled out and reviewed.

Sometimes patients with minor issues, for example, someone wishing Botox or removal of a small skin lesion, question why they have to take ten minutes to fill out a thorough health questionnaire. The reason for this is that a patient may not connect the significance of a prior illness, allergy, or family condition which may affect the outcome of a future treatment. We have to know if a patient is on diet pills (most contain a form of speed and this could react with anesthetic medications given to a patient), vitamins or herbs (some increase the chance of bleeding and other complications), smoking history (smokers have a higher incidence of skin loss following a tummy tuck, breast reduction or face lift) or illegal drug use (many interfere with medications, could destabilize the heart or other organs, after administration of an otherwise appropriate medication).

Once we are sure that no significant health issues exist, we as physicians must evaluate each patients concerns and decide if a treatment is appropriate and safe, and to go over the various options with each patient. Before surgery is contemplated, more laboratory tests are ordered to make sure the patient is a fit candidate for the procedure. And finally, every precaution must be taken during the operation itself to insure patient safety and sound surgical judgments. Given this approach, complications should be few and far between, but the surgeon must be prepared to deal with them if they occur.

For example, patients who have a bleeding problem after surgery may have to return to surgery to stop the bleeder and to evacuate accumulated blood; if done promptly and properly, the patient should heal well without any side effects. But ignoring such a problem, or delaying proper diagnosis or treatment could result in skin loss, infections or other major complications. Any surgeon who operates for many years will see his share of complications, but the trick is to recognize them and to treat them appropriately.

Below I will show you a series of photos of a young lady whose rhinoplasty did not go as the original surgeon had planned. This 22-year old female, who still had a rather significant nasal deformity, came to see me after having had had two rhinoplasties by an ear nose and throat surgeon in Northern California.

The first was to correct a breathing problem and to remove the dorsal hump. The nose “did not turn out right” and the breathing problem was worse. A second procedure by the same surgeon corrected the breathing problem but the external deformity was not corrected.

Aside from the inconvenience of requiring a third operation, fortunately, this lady did not endure any long term harm as I was able to correct her deformity with another rhinoplasty, but ideally, this result would have been achieved the first time around.

(Before photos following two prior rhinoplasties performed by another surgeon. After photos following reconstruction performed by Dr. Bunkis, your results may vary.)

In summary, much can be achieve regardless of how bad the initial complication is, but every effort should be taken to avoid complications, and if they do occur, to treat them right away and appropriately. If you would like to set up a complimentary consultation, please feel free to contact Dr. Bunkis at Orange County Plastic Surgery 949.888.9700.