Revision Plastic Surgery

Medical literature suggests the revision otoplasty rate has a wide variance, from 0.6 percent to 11 percent. Nevertheless, most patients who need it only require minor corrections involving asymmetry (i.e., “noticeable” difference in the projection between the two sides), under-correction, and scarring.


However, there are various ways to achieve long-lasting and more predictable results from otoplasty and thus minimize the revision otoplasty rate.


revision otoplasty

Leading Los Angeles plastic surgeon Dr. Tarick Smiley has explained his techniques that help him achieve high patient satisfaction.


  • Remove the “offending” cartilage


Some surgeons simply excise some skin and rely heavily on internal sutures to pin back the ears. Dr. Smiley says this “approach” may not provide long-lasting results because the cartilage—a firm but flexible tissue that holds and determines the ear shape—has a rather “strong memory.”


To achieve results that can persist long term, Dr. Smiley highlights the importance of removing and/or “weakening” a small amount of cartilage, in addition to the use of correct suturing techniques.


  • Wait until ear growth is near complete


While otoplasty can be performed as early as two years of age, waiting until the patient reaches five offers some unique advantages since during this period ear growth is near complete (about 90 percent). This makes it easier for surgeons to assess the ideal projection of the ear, and deliver results that will most likely last a lifetime.


  • Importance of scar placement and wound closure


The incision must lie precisely at the ear-scalp junction for optimal scar concealment. Furthermore, it should be closed in several layers so the skin surface will receive no or very little tension, leading to more “favorable” scarring.


Medical literature suggests that a good number of patients seeking revision otoplasty want to hide or at least improve the appearance of their scars.


  • Avoid infection


Poor scarring from otoplasty is sometimes linked to infection, which can be avoided by taking antibiotics, performing proper wound care, avoiding tobacco products and aspirin (and other blood thinners), and reaching one’s optimal health prior to surgery.

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Revision BBL, which is an acronym for Brazilian butt lift, poses unique challenges although with proper patient selection, correct timing, meticulous surgical execution, and 100 percent patient participation (e.g., avoiding direct sitting at least three weeks postop), good results can be achieved.


Renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate the challenges of revision BBL and the corresponding ways to “counteract” them, ultimately delivering an improved “backside” in terms of shape and size.


revision bbl

The female patient shown in the video not just complained about the minimal improvement of the buttocks from the two previous BBLs, but also the indentations around the abdomen, which was previously used as a donor site.


In BBL, the donor sites refer to areas treated by liposuction to collect the “unwanted” fats, which are later purified and re-injected into the patient’s backside.


Dr. Smiley said the visible indentations in the abdomen were caused by a combination of under- and over-liposuction.


In the video, the celebrity plastic surgeon was shown using a microcannula, a stainless steel tube with an outside diameter less than 2.5 mm, allowing him to remove smaller bits of fats. Large cannulas, meanwhile, were not ideal for revision liposuction because they give little control as they suction out fats in larger chunks, he explained.


Aside from using microcannulas, Dr. Smiley was also seen injecting a small amount of fat to further smooth out the indentations in the patient’s abdomen.


Dr. Smiley said it is of critical importance to maintain enough fats beneath the skin during liposuction to preserve a smooth surface and avoid “surgical stigmata” usually in the form of dents, bumps, and sagging appearance.


After removing the excess fats through microcannula liposuction, and making sure that all the abdominal indentations from the previous surgeries were eliminated, Dr. Smiley then proceeded with the revision BBL.


With proper purification and re-injection of the “best and healthiest” fats, Dr. Smiley said that up to 70 percent of injected volume is expected to survive long term in the buttocks.

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Facelift revision cost will vary depending on the amount of correction one needs. Also, revisions do not always deal with botched results due to technical errors during surgery; occasionally, issues may arise because of poor healing and continuous aging.


Nonetheless, major revisions are rarely an issue when the surgery is performed by a board-certified facial plastic surgeon who conducts facelift and its ancillary procedures on a regular basis.


facelift revision cost

Due to differences in healing, some facelift patients may need minor revisions. Oftentimes, surgeons revise their own work for minimal fees, some even waive their professional fees, although they will still charge for the anesthesia and the operating room.


A good number of facelift revisions deal with improving the appearance of scars. It is important to note that the incision lines must curve around the ear’s contours and remain hidden behind the hairline. While scars generally fade and stay hidden, due to unexpected healing a few patients may have their scars slightly revised.


However, major revisions are almost always caused by poor surgical execution. For this reason, a prudent patient should select her plastic surgeon based on experience, training, and other relevant qualifications, as opposed to shopping around to get the cheapest bargain deals.


As of this writing, the average cost of facelift is $6,000-$7,000, although it could be more expensive when combined with other procedures such as fat transfer, eyelid surgery, etc.


When one charges way below the “standard price,” it is almost always a sign that patient safety has been compromised—i.e., the surgery is not performed at an accredited surgical facility, the anesthesia is not administered by a licensed anesthesiologist, etc.


Leading Los Angeles plastic surgery expert Dr. Tarick Smiley warns patients that “non-specialists” offering facelift has high “major” revision rate, while board certified plastic surgeons have very low complication rate, a “trend” which has been shown by several studies.


Facelift revision cost can be more expensive when it deals with major corrections—e.g., pleating along the jawline, overly tight mid face, “flattened” cheeks, and other types of facial distortion.


Occasionally, facelift revision could simply mean non-surgical touch-ups in the form of dermal fillers and Botox.


Standard fillers such as Restylane and Juvederm can address soft tissue shrinkage that causes hollowed eyes, deep tear trough, and gaunt cheeks. They typically cost between $600 and $800, depending on the injection sites.


The average cost of Botox, meanwhile, is $300-$500.

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Revision rhinoplasty nose tip, aka, secondary or correction nose surgery involving the tip, is a highly customized procedure to ensure high patient satisfaction, according to California Surgical Institute website.


While rhinoplasty is supposed to provide near permanent results, medical literature has suggested that 10-15 percent of patients will require some type of revision. Contrary to popular belief, technical error is not always the culprit; unexpected changes during healing and other factors that are beyond the surgeon’s control do occur and may warrant a corrective surgery.


revision rhinoplasty nose tip

Furthermore, not every revision rhinonplasty nose tip is an extensive one. Some patients just require minor correction, which typically entails a shorter downtime.


For patients who require minor corrections, the closed technique is generally favorable; this uses incisions that are placed within the inner lining of the nostrils, thus avoiding the risk of visible scars.


However, patients who have severe deformity or require a great deal of work will generally need the open rhinoplasty technique that offers their surgeons better visibility as it allows them to lift the “roof” of the nose by cutting the strip of tissue between the nostrils.


It is important to note that open rhinoplasty results in more bleeding, surgical trauma, and “disturbance” that it typically entails longer recovery than the closed method.


The specific surgical maneuver during a revision rhinoplasty nose tip will largely depend on the patient’s cosmetic concerns, underlying anatomies, gender, and ethnicity. In this procedure, there might be a need to change the angle of tip rotation, its projection or vertical height, and/or its width.


In female rhinoplasty, it is ideal to create a slightly upturned tip appearance (about 95 to 108 degrees angle of rotation), while in men a straighter profile (or even a minimal droop) is deemed more appropriate.


Aside from gender, one’s ethnicity will also dictate the ideal tip appearance. For instance, patients of African and Asian background should not have their tip significantly narrowed lest the results would appear ethnically inconsistent with their facial features.


Of course, good patient-doctor communications will also play a critical role in achieving results that will satisfy both parties.

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A secondary tummy tuck is generally more challenging than the initial surgery due to the presence of scarring of variable extent, the tissue planes are less defined, and there is some type of deformity—e.g., wide belly button, residual bulges that lead to unnatural contour of the waistline, and abrupt transition between the lower abdomen and pubic hairline.


Despite the aforementioned challenges, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that good results from secondary tummy tuck remain achievable with “proper patient selection” and careful evaluation of the underlying anatomies.


secondary tummy tuck

In Dr. Smiley’s recent Snapchat video post, he has shown one female patient seeking a secondary tummy tuck because “she was unhappy with the residual skin laxity and stretch marks, and the less than optimal scar placement” from the initial surgery.


The patient shown in the video was particularly concerned about her “high riding scar” that made it difficult to hide beneath her underwear or two-piece bikini.


To hide the hip-to-hip scar, Dr. Smiley has created a new incision pattern in which the resulting scar would lie very close to the pubic hairline. It has been dropped by about 4 cm from its previous location, he explains.


Furthermore, his wound closure technique is expected to promote favorable scarring in which it would appear fine, thin, and faded.


Despite varying views on the best wound closure technique among surgeons, the consensus is to remove most of the tension on the skin so the scar will not spread, thicken, or migrate, he says.


In the video, the celebrity plastic surgeon has also removed the residual excess skin and ultimately a good portion of the stretch marks. Contrary to popular belief, tummy tuck is not about removing optimal amount of tissue, but more on preserving enough of this to allow for proper wound closure.


Dr. Smiley warns that removing too much skin and/or fat can destroy the feminine contours of the waistline and result in an abrupt, unnatural transition between the lower abdomen and the mons pubis.


To further create a natural-looking result, Dr. Smiley has also revised the belly button—i.e., its size was slightly reduced and its shape improved (more vertically oriented). This seemingly “subtle” improvement has a large impact on the overall result of tummy tuck given that the navel is the “focal point” of the abdomen.


Dr. Smiley says that a poorly shaped navel is the most obvious sign of tummy tuck and therefore any good surgeon will give this anatomy the much-needed attention.

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Breast lift and implants revision is inherently a tricky combo procedure. First and foremost, patients seeking it have breast and skin tissue that is susceptible to the effects of gravity and stretching.


Nonetheless, breast lift and implants revision can still provide good results, provided that proper implant selection, strict patient selection, and correct surgical maneuvers are all present.


breast lift and implants revision

Before and After Photos of a Patient Who Have Had Breast Lift and Implants Revision


Depending on the patient’s goal and cosmetic concern, the revision surgery may involve replacing the implants with something smaller or bigger.


While large implants can give additional fullness in the upper breast pole, the added weight to the breast increases the stress on skin thus reversing the effects of breast lift. For this reason the underlying anatomies, particularly their limitations, must always be respected and recognized.


Tissue-based planning system is one way to lower the complication and revision rate in breast implant surgery, with or without simultaneous breast lift, according to a study published by journal Plastic and Reconstructive Surgery.


Tissue-based planning system involves careful evaluation of the underlying anatomies of the breast, particularly its soft tissue thickness, dimension, and skin quality, to identify the breast implant size range that will have no or very little detrimental impact on the long-term appearance of the breast.


Simply put, tissue-based planning system aims to prevent or at least minimize implant rippling and palpability and inadvertent shifting.


Aside from proper implant size selection, the breast lift technique will also have a large effect on the surgery’s longevity, as suggested by Los Angeles plastic surgery experts. Internal adjustment of the entire tissue with the use of sutures to support the new contour can lead to a better shape that can withstand the effects of aging for many years.


In any type of breast lift, the fascial layer beneath the skin is closed and sutured in several layers; this technique not only results in additional strength but also promotes better scars as the skin receives no or very little tension.


Despite reshaping the breast tissue, sometimes it remains weak and thus sagging will occur much sooner. For this reason some patients will need reconstructive tissue matrix or surgical mesh (e.g., Strattice), which is used beneath the skin to further reinforce the tissue.


The use of biological tissue matrix helps plastic surgeons address common challenges involved in breast lift and implants revision such as malposition, rippling, and capsular contracture.

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