Web Log – June 2010 – Revision Surgery

Memorial Day Ceremony, Veteran's Cemetery
Memorial Day Ceremony, Veteran’s Cemetery

Revision Surgery, a second ( or more ) surgery to improve the original result, may be a major or minor issue for both patient and surgeon.  Most Plastic Surgeons take ownership of their operative results.  I frequently tell my patients, “That’s not just your nose (or whatever the appropriate body part) anymore, it’s our nose.”  While my desire to have a patient happy with his or her result is primary, my ego driven desire to have a result that I am happy with comes in a close second.

I think that this is a good motivator, provided that my ego stays in second place.  Why is that… Because a patient’s result may at times be improved with another procedure and I must impartially assess the situation.  That is why it’s also almost always emotionally easier to improve another surgeon’s difficulty than my own.

Revision surgeries come in several flavors.  Minor ones may be done in the office setting under a local anesthetic.  Major ones require a return to the operating room.  Early post op period revisions are relatively unusual.  They are to improve an obvious problem or to treat a complication like infection or bleeding.  Intermediate period operations to improve an aesthetic problem are usually at 6 to 12 months out.  The waiting period is necessary as most early issues will improve to a point where another surgery is either no longer needed or the problem is so minor that the down sided of revision do not justify the upsides.  Late revisions are on surgeries which occurred several years ago.  The improvements needed may or may not be related to problems with the original operation.  More often, another operation is needed to treat changes secondary to aging, pregnancy, or breast implant problems.  Most of these operations occur on another surgeon’s patient.  Late revisions are frequently more complicated and costly than the original procedure.  This information is both new and disturbing to most patients.

All surgeons have to do revision surgeries on their own patients.  I certainly try to keep them to a minimum, but if a surgeon tells you that he or she never has any problems, he or she just started operating… or is lying.  Some operations have a high revision rate while others are low.  I try to avoid the high revision rate ones.  So what if a few patients have a potentially big problem?  Well, it doesn’t matter much unless you are the one with the problem.  In the end I want my patients to have as smooth a course as possible, be happy with their results, and know that I am there to help with any problems they may have.  Our office policies for revision surgery are presented in detail on our surgery quotes and on our web site.

Memorial Day Ceremony, Veteran's Cemetery
Memorial Day Ceremony, Veteran’s Cemetery

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