Latest / HKB Uncut | A Cosmetic Surgery Podcast / 20. Not Happy With Your Results? What to Know About Revision Surgery

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20. Not Happy With Your Results? What to Know About Revision Surgery · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_00: I think anytime we get a patient who like wants that I want this perfect result, it's immediate like that word, let's talk about that word, because unfortunately that's not achievable.
• 0:09
  SPEAKER_01: But that's the beauty in individuals and themselves, because I think there's beauty in imperfection.
• 0:14
  SPEAKER_01: That's why I find everybody that we see beautiful in their own right.
• 0:18
  SPEAKER_01: Right.
• 0:18
  SPEAKER_01: And it's like it's our obligation to help them achieve whatever they're looking for.
• 0:28
  SPEAKER_01: Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
• 0:32
  SPEAKER_00: On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance, and what you need to know before you book a procedure.
• 0:42
  SPEAKER_00: I'm Dr.
• 0:42
  SPEAKER_00: Bill Cortesis.
• 0:44
  SPEAKER_00: And I'm Gorov Baharty.
• 0:45
  SPEAKER_00: We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.
• 0:53
  SPEAKER_01: In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you.
• 1:02
  SPEAKER_01: Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week.
• 1:16
  SPEAKER_01: Bill Cortesis.
• 1:17
  SPEAKER_00: We're excited about today's episode.
• 1:19
  SPEAKER_00: It's kind of a cool topic of the concept of revision surgery and kind of um second opinion on other people's work and what our thoughts are on it.
• 1:26
  SPEAKER_00: Bill, how much of a how much of your practice is revision surgical procedures?
• 1:32
  SPEAKER_01: I would say at least uh 20 to 30 percent of what I do as secondary or tertiary surgeries.
• 1:38
  SPEAKER_00: So explain to patients what that means.
• 1:39
  SPEAKER_00: So what does a revision work mean?
• 1:41
  SPEAKER_00: What does secondary tertiary mean?
• 1:43
  SPEAKER_00: Does that always mean that something went wrong?
• 1:45
  SPEAKER_01: No, you know, patients ultimately, you know, one surgical intervention will not last an entire lifetime, right?
• 1:53
  SPEAKER_01: Things happen, body changes, scar may not heal well, they have implants that need to be replaced.
• 1:59
  SPEAKER_01: And so ultimately there's maintenance or secondary procedures that need to happen long term.
• 2:04
  SPEAKER_01: And so they come to us for these procedures, right?
• 2:06
  SPEAKER_01: I may not have done the first surgery, you may not have done the first surgery, but they come to us for their second and third procedures that they're doing.
• 2:13
  SPEAKER_01: So it's very common.
• 2:14
  SPEAKER_01: Now there's revision surgery because somebody it did not go well, and the term out there is it was botched, right?
• 2:21
  SPEAKER_01: Because it was popularized by the TV show.
• 2:24
  SPEAKER_01: And those happen as well, but sometimes they just happen because you know, taste change, your body changes, you know, the device doesn't last as long, so you ultimately need some work done.
• 2:35
  SPEAKER_01: So yeah, we we do a lot of that, so it's a big part of our practice.
• 2:39
  SPEAKER_00: What do you do?
• 2:44
  SPEAKER_01: You know, I never try to incriminate a a another surgeon um unless something was egregious and that you could tell it was egregious and done completely wrong.
• 2:53
  SPEAKER_01: You know, you know, I wasn't there at the time of the initial consultation.
• 2:57
  SPEAKER_01: I don't know what was discussed, what was talked about.
• 2:59
  SPEAKER_01: I I don't know what that person's anatomy was.
• 3:02
  SPEAKER_01: Even if they show us pictures of what they ultimately look like at that point, I'm not there.
• 3:08
  SPEAKER_01: I can only help them at this point in time.
• 3:11
  SPEAKER_01: And um, you know, I I like to look in the good in people and say, you know what, they probably had the best motives at the time when when doing that surgical intervention.
• 3:21
  SPEAKER_01: And um things sometimes just don't go 100% as planned.
• 3:25
  SPEAKER_01: And um, so for me, I I'm not like I I don't I don't point fingers and say that that that's awful and this was done completely wrong.
• 3:34
  SPEAKER_01: Um I I just like to look in the good in people and take care of them for at the level they're at today.
• 3:41
  SPEAKER_00: So what's your recommendation when a patient has an outcome that they don't they're not happy with to come to you for a second opinion?
• 3:47
  SPEAKER_00: How do you what do you what's the first things that you tell them and how do you help them?
• 3:51
  SPEAKER_01: I think number one, I the first thing I ask them is did you have this discussion with your surgeon?
• 3:57
  SPEAKER_01: Right.
• 3:57
  SPEAKER_01: Oftentimes they didn't.
• 3:58
  SPEAKER_01: I'm shocked to find out that they're too scared to have that discussion.
• 4:04
  SPEAKER_01: Um and the first the you know, the first thing I say to patients that come to me that may not be on and may not be entirely happy with what we've may have done, I'm like, thank you for having the courage to talk to me.
• 4:16
  SPEAKER_01: Because a lot of times they're scared about having that conversation.
• 4:20
  SPEAKER_01: Um, just because I think the surgery went well and it looks great might not be exactly what they were looking for, right?
• 4:27
  SPEAKER_01: And so I think first and foremost, have that honest discussion with your surgeon.
• 4:31
  SPEAKER_01: They might not even be aware, they might be clueless as to the fact that you're not happy with that.
• 4:37
  SPEAKER_01: Oftentimes, and a vast majority of times, that surgeon or that provider will do anything to take care of you and make sure that it's okay.
• 4:46
  SPEAKER_01: So, without a doubt, have that discussion first.
• 4:50
  SPEAKER_01: Um, and then I don't think it's bad to go seek out another opinion, right?
• 4:57
  SPEAKER_01: I I'm always in the the camp of even patients come to see me for a consultation.
• 5:02
  SPEAKER_01: I'm like, hey, have you seen anybody else?
• 5:05
  SPEAKER_01: Are you gonna go see anybody else?
• 5:07
  SPEAKER_01: Have I said anything differently than what another provider has talked to you about?
• 5:11
  SPEAKER_01: And if so, I'm happy to kind of tell you why I'm thinking the way I'm thinking.
• 5:17
  SPEAKER_01: And if you go to another place and they tell you something different and you want to come back and chat with us, by all means do it.
• 5:23
  SPEAKER_01: I think the more transparent and open we are and authentic we are with our patients, the better it's ultimately gonna be.
• 5:29
  SPEAKER_01: I mean, do you think any differently or do you have any other you know differences of No?
• 5:34
  SPEAKER_00: I think one of the things that we're we're spoiled at at our organization is that, you know, if there's an issue into someone internally, there's a concern.
• 5:41
  SPEAKER_00: Like I always am like, let me have one of my partners look at you.
• 5:45
  SPEAKER_00: And I'm not gonna tell them anything about you.
• 5:47
  SPEAKER_00: Let's just see what they think, get some input, and they can get, you know, an objective evaluation and have somebody who's who's trusted that I trust also.
• 5:57
  SPEAKER_00: And I think that can help a lot.
• 5:58
  SPEAKER_00: I think getting loading the boat is what Joe Hunstead used to always say, and getting opinions, getting other specialists' opinions, especially when someone's unhappy or something's going wrong, every once in a while things, like you say, don't go exactly as planned.
• 6:10
  SPEAKER_00: And in those situations, we have to pounce on that issue if there's a problem or a concern.
• 6:16
  SPEAKER_00: You know, in regards to I think you were kind of um being really humble about the your approach on revisionary work and secondary work, because you do more secondary work than anybody I know, especially on breast cases, super complex cases that are, you know, that I would put you, you know, as one of the best in the entire country and in the entire world.
• 6:34
  SPEAKER_00: When you see those patients, you see them and they're they're they're downtrodden, they have real issues.
• 6:38
  SPEAKER_00: So when when you see patients who have had you know a very complex situation, let's just use breasts, for example, and they are they've had three or four or five surgeries.
• 6:47
  SPEAKER_00: Are those patients ever gonna get a great result?
• 6:50
  SPEAKER_01: They can.
• 6:51
  SPEAKER_01: You know, um it is difficult, I'm not gonna lie.
• 6:57
  SPEAKER_01: I and I I I'm a firm believer in this because again, I we talk to our fellows about this all the time, and I know you you say it exactly the same way I do, because we think exactly like on this.
• 7:08
  SPEAKER_01: You need to do that operation right the first time, because to fix the problem that comes from bad breast surgery is very difficult to fix, um, especially certain things you do maneuver, so do it right the first time.
• 7:21
  SPEAKER_01: So it makes your second and third surgeries that much easier.
• 7:24
  SPEAKER_01: But yeah, you can do anything, right?
• 7:26
  SPEAKER_01: I mean, it it's pretty amazing right now with the technology we have, advances in implants, um, all the tools we have in regards to potentially fat grafting or off-the-shelf fat, um, different types of lift procedures that we can do.
• 7:41
  SPEAKER_01: We can fix pretty much anything.
• 7:44
  SPEAKER_01: You can take the worst appearance, worst outcome, and provide an aesthetic outcome that is remarkable.
• 7:52
  SPEAKER_01: And that the patients, I I can't tell you the number of times patients come back in tears, never thinking it was gonna look this good.
• 7:59
  SPEAKER_01: Right.
• 7:59
  SPEAKER_00: You know, and and the other thing is too is that I've a I've learned and um you've taught me other um really uh well-respected, you know, people in our space, is you can't patch things either.
• 8:12
  SPEAKER_00: There's not when something's really complicated and has an issue, sometimes you really have to deconstruct that issue, remove all the obstacles, and do the more complex multi-set of interventions to get where you need to be.
• 8:29
  SPEAKER_00: For example, like you were mentioning using different modalities, different device, potentially using fat grafting, potentially doing lifts, potentially doing total capsulectomies, potentially doing different pocket side changes, potentially using mesh soft tissue products, and all those things really get you to where you need to be.
• 8:44
  SPEAKER_00: And it's like if patients are like, I don't know, I don't want to do that, I don't want to use this, all of a sudden you're you're this artist that has you have this canvas, you have all this stuff to a medium to make all these different colors and textures, but then all of a sudden, if you like take half of that artist's stuff away or take one arm away from a handyman.
• 8:59
  SPEAKER_00: So it's like we need to have all those tools to do all those things, and I've learned that that really can be very helpful.
• 9:04
  SPEAKER_00: You know, one of the other things from a secondary standpoint, too, that we do a tremendous amount of is body contouring, specifically secondary liposuction and then uh abdominal plasty.
• 9:16
  SPEAKER_00: You know, walk me through some of those crazy cases and how how those have been.
• 9:20
  SPEAKER_00: What this what did the patient or surgeon do wrong?
• 9:23
  SPEAKER_00: How do you fix them?
• 9:25
  SPEAKER_01: The biggest issue with needing secondary body contouring surgery is the surgeon didn't do the right operation to begin with.
• 9:33
  SPEAKER_01: I.e.
• 9:34
  SPEAKER_01: the patient needed a tummy tuck and they ended up doing liposuction alone.
• 9:38
  SPEAKER_01: Patient needed a full tummy tuck, they got a mini tummy tuck.
• 9:42
  SPEAKER_01: Patient needed a body lift, they ended up getting an extended tummy tuck.
• 9:47
  SPEAKER_01: Um, or they put the scar too high, they didn't make the belly button look natural.
• 9:52
  SPEAKER_01: And the cool thing is those are all things that we can fix, right?
• 9:55
  SPEAKER_01: And anybody who does a lot of body contouring can probably do that, you know.
• 9:59
  SPEAKER_01: Um, and I would encourage every patient that's even listened to this, make sure that if you go to somebody for secondary, tertiary, that they do a lot of it, because that's super important, right?
• 10:08
  SPEAKER_01: Do you do a lot of these procedures?
• 10:10
  SPEAKER_01: It's a little different, right?
• 10:11
  SPEAKER_01: It's it's different, right?
• 10:12
  SPEAKER_01: It's not a one-size-fits-all, it's not like doing a regular kind of tummy tuck.
• 10:16
  SPEAKER_01: Um, and so make sure that's why I like the concept of multiple opinions, you know, in the in the beginning, because you know, a lot of times they went to the first surgeon they they they had a consult with.
• 10:29
  SPEAKER_01: Oh, like, I like this, this is nice, they get it done, and they're like, oh man, this is not what I was hoping for, right?
• 10:35
  SPEAKER_01: And they got the wrong operation.
• 10:37
  SPEAKER_01: Goes back to that story I had about cool sculpting in the patient who needed an arm lift, but instead got cool sculpting on her arms and it did nothing for them, right?
• 10:45
  SPEAKER_01: So getting the right intervention at first can eliminate all that stuff.
• 10:50
  SPEAKER_01: Um, so I think I think that's uh the the big issue.
• 10:55
  SPEAKER_00: I hate the word botch, but I think um unsatisfactory outcomes are extremely common.
• 10:59
  SPEAKER_00: But and here's what I would frame that around, though.
• 11:02
  SPEAKER_00: This is really important.
• 11:04
  SPEAKER_00: What you and I think versus what a patient thinks.
• 11:09
  SPEAKER_00: At the end of the day, it's all about the patient.
• 11:11
  SPEAKER_00: I have seen so many patients that have had all kinds of work done, face work, body work done, breast work done.
• 11:17
  SPEAKER_00: I'm like, what is that?
• 11:18
  SPEAKER_00: And they're just like, yeah, Tommy Tuck, I love it, it's been so good.
• 11:21
  SPEAKER_00: Now I'm ready for my breasts.
• 11:23
  SPEAKER_00: And I'm like, you know, I would be concerned, I would not be happy with that outcome.
• 11:27
  SPEAKER_00: So I have to be careful about talking about what I think.
• 11:30
  SPEAKER_00: And there's some patients who will have some things done that they will just rip themselves apart or rip another surgeon apart.
• 11:35
  SPEAKER_00: And I'm like, man, that result looks pretty good.
• 11:37
  SPEAKER_00: Your scar looks pretty good, man.
• 11:40
  SPEAKER_00: Um, so I think that it's again, it's the the frame of reference and the lens that you're looking through.
• 11:45
  SPEAKER_00: Um, I just don't love that word botched.
• 11:48
  SPEAKER_00: I think, like you said, Bill, like, you don't know what the situation was.
• 11:51
  SPEAKER_00: You don't know what was going on at that time.
• 11:53
  SPEAKER_00: You don't know the patient's health status, you know what the patient gained a bunch of weight, lost a bunch of weight.
• 11:57
  SPEAKER_00: Um, but there are times, every once in a while, you'll see something that seems this doesn't make sense, this is bad, this needs to be addressed.
• 12:06
  SPEAKER_00: It's rare, but it can happen.
• 12:07
  SPEAKER_00: Every once in a while you have some people doing stuff that they should not be doing.
• 12:11
  SPEAKER_00: And we try to get involved then and try to because we don't want a patient to get hurt.
• 12:15
  SPEAKER_01: Right.
• 12:16
  SPEAKER_00: And that's some scary stuff that that has happened we've seen.
• 12:19
  SPEAKER_01: Yeah, out you know, people practicing medicine outside their scope.
• 12:22
  SPEAKER_01: Yeah.
• 12:22
  SPEAKER_01: So be very careful of that in cognizant, right?
• 12:25
  SPEAKER_01: Just because they say they're a plastic surgeon doesn't mean they're a plastic surgeon.
• 12:28
  SPEAKER_01: Right.
• 12:28
  SPEAKER_01: You know, what's their training like?
• 12:30
  SPEAKER_01: What have they done?
• 12:31
  SPEAKER_01: Have they done a lot of this?
• 12:32
  SPEAKER_01: So that you I think you bring up a really good point there in in regards to that.
• 12:36
  SPEAKER_01: I I think honesty is by far your best policy, and like being upfront and honest with patients, let them know what you see, what could have happened, you know, what possibly was the scenario of why this that why this occurred, and let them know, hey, this is not uncommon.
• 12:51
  SPEAKER_01: I've seen this before.
• 12:53
  SPEAKER_01: Right.
• 12:53
  SPEAKER_01: And it can be taken care of, right?
• 12:56
  SPEAKER_01: Complications do occur.
• 12:57
  SPEAKER_01: Right.
• 12:58
  SPEAKER_01: Complications don't mean malpractice.
• 13:00
  SPEAKER_01: Because that's the other common question I always get is like, hey, can I sue the doc?
• 13:04
  SPEAKER_00: Right.
• 13:05
  SPEAKER_01: You know, you and I both do some medical review, and and you know, the it takes a lot to actually say that there there was malpractice performed.
• 13:14
  SPEAKER_01: Um and people assume that it a complication or bad outcome automatically means the doctor screwed up.
• 13:20
  SPEAKER_01: Right.
• 13:20
  SPEAKER_01: Um, bad things can happen, even in the best of hands.
• 13:24
  SPEAKER_01: And so um that's why it goes back to go to a reputable place that you know they're gonna take care of you when that bad thing does happen.
• 13:32
  SPEAKER_00: Right.
• 13:32
  SPEAKER_00: When something is in how somebody wants or doesn't go right, it is it's uh it can be very scary for patients.
• 13:38
  SPEAKER_00: You know, you you and I both know this.
• 13:40
  SPEAKER_00: I mean, it's an emotional roller coaster, even just the act of having surgery.
• 13:44
  SPEAKER_00: I mean, I've had surgery before, um, and you go through a post-surgical depressive phase, it's very common.
• 13:52
  SPEAKER_00: And I think that's one thing that you're facing, and then you see what's going on, and if there's an issue, you immediately are like, oh my god, regret.
• 13:59
  SPEAKER_00: Why did I do this?
• 14:01
  SPEAKER_00: I shouldn't have done this.
• 14:02
  SPEAKER_00: Maybe this wasn't the right doctor.
• 14:04
  SPEAKER_00: I should have gone the other doctor that I went to.
• 14:06
  SPEAKER_00: So part of it, I think, you know, doesn't it?
• 14:08
  SPEAKER_00: There's a there's a continuing, there's a phase of of healing and recovery.
• 14:11
  SPEAKER_00: Every once in a while you get somebody who's like a month, two months, three months out, and you're like, whoa, slow your roll.
• 14:17
  SPEAKER_00: You know, I think, I mean, that's what I we definitely are cautious about trying to get involved.
• 14:23
  SPEAKER_00: And we want to just support, say, hey, these things are normal.
• 14:26
  SPEAKER_00: Have you talked to your you know, provider, have you talked to the support staff?
• 14:29
  SPEAKER_00: I guess what's your approach on it as it gets further along, and you you can see that there is an actual issue.
• 14:36
  SPEAKER_00: What what's the timing, the time frame too that you tell patients?
• 14:39
  SPEAKER_01: You know, I always approach everything with empathy.
• 14:41
  SPEAKER_01: You know, I try to put myself in their shoes and what they're going through, like you said, and um let them know that you know I I feel for them and I understand kind of what they're going through.
• 14:51
  SPEAKER_01: Um and and let them know that it might not be exactly what you want right now, but it can all be fixed.
• 14:57
  SPEAKER_01: You know, be with us, be with your original surgeon, it can be taken care of.
• 15:01
  SPEAKER_01: Right.
• 15:02
  SPEAKER_01: So that kind of helps put them at ease.
• 15:05
  SPEAKER_01: Um I I've rarely seen anything that we couldn't fix.
• 15:10
  SPEAKER_01: Rarely would you say, Oh, this is permanent, you're gonna have to deal with this.
• 15:13
  SPEAKER_01: Most of the time things can be addressed and taken care of or improved upon, right?
• 15:18
  SPEAKER_01: Um, I I hate to use the word fix, but I always say improved upon, right?
• 15:22
  SPEAKER_01: Then we level set expectations and what does that look like?
• 15:27
  SPEAKER_01: Time frame is one of the biggest things is hey doc, when can I go in to have this done?
• 15:34
  SPEAKER_01: The later you wait, the better it is.
• 15:37
  SPEAKER_01: You know, I think the bare minimum is three to four months.
• 15:40
  SPEAKER_01: If something's really egregious and it needs to be addressed right away, I could probably be talked into doing something around that three to four month mark.
• 15:47
  SPEAKER_01: But in a perfect scenario, I usually like to wait nine months to a year to really get something done.
• 15:53
  SPEAKER_01: Um because things change, scarring improves, position of implants changes, all these things will adjust with time.
• 16:03
  SPEAKER_01: And it's amazing how just letting things settle and relax can improve on its own.
• 16:09
  SPEAKER_00: Yeah, and I'll give you a real life example that I'm dealing with now on a on a revision patient that's a it's a it's a tough one, really bad, and and um one that I kind of my heart kind of goes out to that had a procedure done and she's just it's just not did not turn out how it's supposed to.
• 16:24
  SPEAKER_00: Very extraordinarily, it's a breast case, extraordinarily asymmetric.
• 16:28
  SPEAKER_00: Some things done and some operative decisions made that not by me that that really don't make sense, that are very, they just they don't make sense, and she really is in bad shape, looks really bad psychologically in a difficult place, very kind person, reasonable, um, has lost faith in the other provider and just doesn't want to go that direction, wants to be operated on, and like just it's very disfiguring, and and it's just one of those things where, you know, this is really affecting this individual.
• 16:56
  SPEAKER_00: And so I'm I'm somewhat accelerating my time to intervene, but I'm making her wait though, still.
• 17:01
  SPEAKER_00: I'm making her wait for that three to four month period because I need that pocket to stabilize out the scar to soften.
• 17:07
  SPEAKER_00: Um but it is hard to go because sometimes, you know, you we're not like um, you know, unemotional creatures, we care, and you really want to help somebody out, and like she, if we can get, and I've had this clear, clear explanation to her, like, I cannot make this perfect.
• 17:22
  SPEAKER_00: I cannot, but I can absolutely improve it.
• 17:25
  SPEAKER_00: And when patients understand that, you kind of level set their expectations, hopefully you can exceed it, but at least meet it, and that's powerful.
• 17:32
  SPEAKER_00: And I think that you know, that relationship, that's what drives us, it's what drives all of our team at all of our places, and hopefully drives most of the set of providers is like, you know, establishing that trust, building on that trust, helping someone who exposes themselves, you know, to you from a standpoint of like, you know, literally, when you're doing breast surgery, exposing yourself, but like emotionally exposed and like helping them achieve and realize what they're going to do.
• 17:56
  SPEAKER_00: But it's it's one of those things where even every time we decide to embark on that relationship, it exposes us a little bit too.
• 18:03
  SPEAKER_00: And and so I think that's why we we always are try to be careful to identify what a patient wants, what they want to do.
• 18:08
  SPEAKER_00: But every once in a while, a small thing that we do makes this huge change.
• 18:13
  SPEAKER_00: And so that's why, you know, we had talked on another episode about like someone who's had like 30 surgeries, would you operate on them?
• 18:19
  SPEAKER_00: And it's like, it depends, you know, what it is and what you can achieve for them.
• 18:23
  SPEAKER_00: But it's tough.
• 18:24
  SPEAKER_00: And this revisionary work can be can be really tough, but we both, and I think almost everybody we work with, we really enjoy the revisionary work actually.
• 18:32
  SPEAKER_01: We both find it challenging, you know.
• 18:34
  SPEAKER_01: Um and it's great to really help somebody out.
• 18:37
  SPEAKER_00: Yeah.
• 18:38
  SPEAKER_00: And then even for our patients, sometimes our patients, our own patients that we take care of, may not have gotten exactly what they wanted, or they're concerned about something.
• 18:45
  SPEAKER_00: And every once in a while we might be discordant, we may not may not see them directly, but at the end of the day, I think our patients are biggest person.
• 18:51
  SPEAKER_00: And so we actually will do things to where we, you know, might need to tweak something, adjust something.
• 18:56
  SPEAKER_00: But the patients that we take care of and revise of our own, sometimes most of the time end up being our biggest cheerleaders also.
• 19:02
  SPEAKER_00: And so it's part of the things where we have a we have a sense of responsibility towards those people.
• 19:06
  SPEAKER_00: And I think most providers are like that.
• 19:08
  SPEAKER_01: And I look at it as risk reward, right?
• 19:10
  SPEAKER_01: If if the risk is higher than reward on doing the revision, my answer to them is hey, I don't think we should do this for this and this reason.
• 19:18
  SPEAKER_01: But if if the benefit is higher than the risk, by all means, I think it's okay, right?
• 19:22
  SPEAKER_01: If we can improve upon it and with minimal risk, there's no harm in going down that road and doing the revision surgery.
• 19:29
  SPEAKER_01: As you're waiting to have your revision surgery, and you know, let's say your doc says you need to wait three to six months to have this done, there are other interventions that can be done in in the in the meantime.
• 19:41
  SPEAKER_01: For body contouring, right?
• 19:42
  SPEAKER_01: If it's irregularities, you can have some massage, lymphatic drainage stuff.
• 19:47
  SPEAKER_01: So there are certain things that can be done, right?
• 19:49
  SPEAKER_01: If they're if it's a malposition of the breast, you can try some, you know, other techniques to sort of try to fix that malposition.
• 19:58
  SPEAKER_01: So you're not kind of left in the lurch going to fend for yourself during that time period before you have surgery.
• 20:05
  SPEAKER_01: Most of the time there are these minimal things you can do and small interventions along the way that can help.
• 20:11
  unknown: Yeah.
• 20:12
  SPEAKER_00: And I would say that, you know, one of the things that we do personally is uh just see our patients frequently.
• 20:17
  SPEAKER_00: You know, see them.
• 20:18
  SPEAKER_00: If it's something really that's tough we do, it's something just being there to like lend it, lend a hand, be be a therapist.
• 20:24
  SPEAKER_00: It is important to be there and available to talk.
• 20:27
  SPEAKER_00: Um if there's really a concern, every once in a while they need you need some outreach, you know, you need to get their loved one and talk to them if they're if there's really concerns about it.
• 20:35
  SPEAKER_00: The other is, you know, to encourage them to immerse themselves back into life.
• 20:39
  SPEAKER_00: Sometimes people get a little, you get hyper-focused on something.
• 20:42
  SPEAKER_00: I know, like I had um, I had a rhinoplasty in the in the past, and in the immediate period I saw like swelling and an appearance and discomfort, and I was like, oh, it's not right.
• 20:51
  SPEAKER_00: The result's not right.
• 20:52
  SPEAKER_00: It's not right.
• 20:53
  SPEAKER_00: There's an issue.
• 20:54
  SPEAKER_00: And um part of that is just because I knew too much and everything's fine, but it's still hard during that period because you're vulnerable and not sure what's up.
• 21:01
  SPEAKER_00: So I think that you have to s you have to sort of, you know, encourage people to get back to their thing, be physically active, and move forward.
• 21:08
  SPEAKER_00: Because every once in a while someone might become so obsessed about it that it is, it's a it's uh adversely affecting them, and that's like a bad, you know, feed forward um negative loop that you have to get them out of.
• 21:19
  SPEAKER_00: So I'd say communication and support, like they need to hear it.
• 21:22
  SPEAKER_00: And the other is like to be honest, like we have as providers have to counsel them about it before, like, hey, you know, these this is this is our these are our goals, these are the risks.
• 21:34
  SPEAKER_00: If there is an issue, this is kind of what we do, what would happen.
• 21:38
  SPEAKER_00: And um, and patients need to know that too.
• 21:40
  SPEAKER_00: Like, it's you know, everything you do, there's always a risk.
• 21:43
  SPEAKER_00: Always.
• 21:44
  SPEAKER_00: Um, most of the time that risk is minimal, but if if there is an issue, it can be tended to.
• 21:50
  SPEAKER_00: But like you said, sometimes there's a there's a way to do it because if you act too quickly or you do the wrong thing at the wrong time, you're gonna actually have a worse outcome.
• 21:58
  SPEAKER_00: I think once people understand.
• 22:00
  SPEAKER_00: Understand that and get that reassurance, then it's like, okay, I get it.
• 22:03
  SPEAKER_00: I'm good.
• 22:04
  SPEAKER_00: But lastly, you can do what you said, you can get a second opinion.
• 22:08
  SPEAKER_01: You have to show you care.
• 22:09
  SPEAKER_01: Good which, you know, again, any reputable provider is gonna care.
• 22:14
  SPEAKER_01: So you have to showcase that you care.
• 22:16
  SPEAKER_01: And then let them know that you're on their team.
• 22:19
  SPEAKER_01: You want to do what's best for them at their at that time when it's the right time to do it.
• 22:25
  SPEAKER_01: And unfortunately, sometimes it just takes time to get to that point.
• 22:28
  SPEAKER_00: Yeah.
• 22:29
  SPEAKER_00: And I would say the one thing I tell a patient, being it from the provider perspective, is trust and kindness.
• 22:35
  SPEAKER_00: Uh it's a it's a bi-directional process.
• 22:39
  SPEAKER_00: And so the more trust you can have with your provider, and the more that the that pro trust the provider has in you and the ability to communicate is very important.
• 22:47
  SPEAKER_00: If I feel like that's compromised, I don't do well.
• 22:49
  SPEAKER_00: I know you're the same.
• 22:51
  SPEAKER_00: And every once in a while, I might even get your assistance in talking to a patient, or I might just tell the patient, I'm worried about our relationship here.
• 22:58
  SPEAKER_00: We need to rebuild that trust.
• 22:59
  SPEAKER_00: And it's this is one of the things where I just want to be on the same page.
• 23:02
  SPEAKER_00: And that that very rarely happens.
• 23:03
  SPEAKER_00: But every once in a while, you know, someone gets emotionally charged, you just gotta be like, man, let's let's bring this down.
• 23:08
  SPEAKER_00: Let's uh let's keep this keep this relationship strong because like at the end of the day, relationships are very important.
• 23:13
  SPEAKER_01: You know, if somebody had an issue prior and lost trust in another provider, I can see, you know, I come from a place of empathy, I can understand where they're coming from, that they they lack trust right away.
• 23:28
  SPEAKER_01: And so for us, it's like, all right, continue to be your true authentic self.
• 23:33
  SPEAKER_01: Show them that you do care, that regardless you're gonna help them out.
• 23:37
  SPEAKER_01: And that's our that's our motto.
• 23:38
  SPEAKER_01: We're always gonna try to help them out.
• 23:40
  SPEAKER_01: We're not doing this for a sale or to do a surgical procedure.
• 23:44
  SPEAKER_01: We're there to the reason we got into medicine to begin with is to help people.
• 23:48
  SPEAKER_01: So we're in it to help them.
• 23:51
  SPEAKER_01: And you know, and for us, showing them that is half the battle.
• 23:56
  SPEAKER_01: And just coming from a place of empathy, knowing, hey, I understand where you're coming from.
• 24:00
  SPEAKER_00: I'd be distrustful too.
• 24:02
  SPEAKER_00: And I think the biggest is like listening.
• 24:04
  SPEAKER_00: You gotta you gotta get them to explain and talk and and to develop trust.
• 24:08
  SPEAKER_00: And sometimes it's not immediate.
• 24:10
  SPEAKER_00: That doesn't mean you see someone, you sign them up.
• 24:13
  SPEAKER_00: It might need, you know, they need to digest, understand, come back.
• 24:18
  SPEAKER_00: And I think patients are different, and and sometimes that trust is, you know, earned immediately, and other times it's built over time.
• 24:25
  SPEAKER_00: Or like you've we actually were like, you know what, I know the perfect person who can help with this, and then bring them in.
• 24:30
  SPEAKER_00: Like every once in a while I'll refer to to him or to one of our other amazing surgeons because I think they're being better suited for him.
• 24:37
  SPEAKER_00: And every once in a while, there's a personality, there's a personality fit for others, and in addition to their specialty, it's something like personality is an important piece.
• 24:46
  SPEAKER_01: You know, I I think you you brought up a really good point.
• 24:49
  SPEAKER_01: Having patients come back for multiple visits and consultations, seeing the progress of things and letting them know, I yeah, my plan hasn't changed.
• 24:58
  SPEAKER_01: That's what I think we need to do.
• 25:00
  SPEAKER_01: Or if they're unsure as to what to do, I never allow a patient to sign up for surgery if they're unsure of what they want to do.
• 25:07
  SPEAKER_01: I always have them come back for a second or third consultation to make sure.
• 25:11
  SPEAKER_01: I know you do the same way.
• 25:13
  SPEAKER_01: It's like we have to make sure that this is what they want to do and that they have their expectations laid out for what they want.
• 25:21
  SPEAKER_00: Yeah, and I think the other thing too is if you notice something's not right or doesn't seem right or you're not sure, um, I think let let the provider let your teams know, let everybody know, communicate.
• 25:32
  SPEAKER_00: And same thing from a provider standpoint.
• 25:34
  SPEAKER_00: If you're taking care of someone, someone may not be right, you're like kind of maybe worried, and they don't notice, just tell them.
• 25:39
  SPEAKER_00: Like, hey, I'm not sure about this.
• 25:41
  SPEAKER_00: I'm I'm concerned about this.
• 25:42
  SPEAKER_00: This might need to be tweaked.
• 25:44
  SPEAKER_00: Sometimes when patients hear that, a lot of times they just don't want they don't want to mess with stuff either.
• 25:48
  SPEAKER_00: But like it's important to just I think our thing is like talk to a patient like we're talking to a colleague.
• 25:53
  SPEAKER_00: It might be too much information, but it can be really valuable.
• 25:57
  SPEAKER_01: Overcommunicate.
• 25:58
  SPEAKER_01: You said it earlier.
• 26:00
  SPEAKER_01: And let them know, because a lot of times you'll come in, you'll you'll point out and say, hey, we need to watch this little spot right here.
• 26:05
  SPEAKER_01: And they're like, Doc, I do not want to go back to surgery.
• 26:08
  SPEAKER_01: Right.
• 26:08
  SPEAKER_01: You're like, okay, there are other ways we can address this if need be.
• 26:12
  SPEAKER_01: Right.
• 26:13
  SPEAKER_00: And the other thing too is, you know, um, we're lucky we have the right, we have incredible support staff.
• 26:17
  SPEAKER_00: You know, I don't know about you, but I'm a I'm a firecracker and clinic and just run around because I just like to run around.
• 26:22
  SPEAKER_00: But every once in a while, you know, we might notice that someone needs some more time.
• 26:26
  SPEAKER_00: We've got to slow it down, got to adjust.
• 26:29
  SPEAKER_00: And so I would just remind um patients that, you know, if you're if you don't understand something, you're worried about something, communicate and and just express that and make sure it's known because at the end of the day, people are good.
• 26:41
  SPEAKER_00: People want you to have the best result, best outcome, and um you have to convey that.
• 26:46
  SPEAKER_00: Bill, what are the most common procedures that people come for secondary or tertiary or quaternary rounds?
• 26:51
  SPEAKER_01: So I do a lot of breast surgery.
• 26:53
  SPEAKER_01: Um, you know, implants don't last forever, so I do a lot of implant exchanges.
• 26:57
  SPEAKER_01: Um I wish lifts um lasted forever.
• 27:00
  SPEAKER_01: You know, there's no anti-gravity machine quite yet.
• 27:03
  SPEAKER_01: So I have to redo lifts.
• 27:05
  SPEAKER_01: So it's a very common procedure that I do.
• 27:07
  SPEAKER_01: And again, breast aesthetics change in regards to kind of what a patient's and a woman's desires really are.
• 27:13
  SPEAKER_01: And so sometimes they want to be bigger, sometimes they want to be smaller, sometimes they don't want to have the implant anymore, and they want to get rid of that.
• 27:20
  SPEAKER_01: So there are so many different things we can do to kind of help them.
• 27:23
  SPEAKER_01: So that th those are the kind of the most common that I I ultimately do.
• 27:28
  SPEAKER_01: Now, sometimes you know, patients that have implants and they have complications from their implants that they're they're not sitting in the right spot, or they they have hardening of that implant.
• 27:38
  SPEAKER_01: Those are very common secondary and tertiary procedures that I do associate with implants.
• 27:43
  SPEAKER_00: How about you?
• 27:44
  SPEAKER_00: I would say the most common would be I'm I'm right there with you from a standpoint of breast interventions, you know, because kind of keeping the breasts looking the best that they can.
• 27:52
  SPEAKER_00: The other would be um facial procedures, you know, secondary, tertiary facelifts, not for problem, just to kind of keep things looking great.
• 28:00
  SPEAKER_00: Um other then would be probably these uh body contour procedures, like revisionary, um secondary abdominal plasty, um revisionary lipo, and then there are other ones like you know, rhinal plastic.
• 28:11
  SPEAKER_00: I I used to do a bunch, now uh Rich Cow does a lot, most of them does an amazing job, where you're tweaking and improving things or potentially there's some unsatisfactory things.
• 28:20
  SPEAKER_00: A lot of people have results that they're kind of like, meh, that they wish was eh, you know?
• 28:27
  SPEAKER_00: And so like I think that they're we are trying to get better at messaging that.
• 28:32
  SPEAKER_00: Like, and that's one of the reasons why, you know, you and I always talk about like breast interventions, that like when people have a breast surgery or breast enhancement, like that breast enhancement isn't forever because, like, number one, they may have issues, they may not want implants, they may get saggy breasts, they may, you know, whatever, but they deserve to have an amazing result regardless.
• 28:49
  SPEAKER_00: And so sometimes when people have like a rhinoplasty, for example, and there's some notching or there's a little bump or there's a hump or there's a deviation, like that can be fixed and made to look more harmonious and natural, even though it's a secondary or tertiary, they can have an elegant, beautiful result, and then like a face.
• 29:05
  SPEAKER_00: You know, if they had a facelift and they just wanted to look get back to where it was, you can obviously do a secondary face.
• 29:10
  SPEAKER_00: But if they had like pixie ear deformity and they have, you know, you know, weird asymmetry, that absolutely can fix, and then this the secondary work will look better than the primary work.
• 29:20
  SPEAKER_00: So at times a lot of patients may have now realized that like they may have a result that's just not exactly what they want, and they can make it what they want.
• 29:29
  SPEAKER_00: So I think that's the beauty of our space, and the secondary, tertiary stuff can be really fun, really challenging, um, and really valuable, even though at times it could be potentially stressful for patients, other times it can be actually really super rewarding.
• 29:43
  SPEAKER_01: How do you deal with the patient who is aiming for perfection?
• 29:49
  SPEAKER_01: And knowing that in our field that we can never obtain it.
• 29:53
  SPEAKER_01: Yeah.
• 29:54
  SPEAKER_00: This is this is a that's a great comment, and I think that you know, I I always I think I've read somewhere from this concept of approaching perfection.
• 30:03
  SPEAKER_00: You can approach it, you can never actually get it, and especially with what we do.
• 30:08
  SPEAKER_00: I mean, what we do is such an artistic, you know, there's so many variables at play all the time from a standpoint of just anatomy and things that could actually happen from a you know standpoint of just generalized life, and then there's also wound healing.
• 30:24
  SPEAKER_00: So I think anytime we get a patient who like wants that, I want this perfect result, it's immediate like that word, let's talk about that word, because unfortunately that's not achievable.
• 30:34
  SPEAKER_00: Even when you like, you know, when we always uh our whole staff is trained about this when we're talking about breasts, for example, like you know, sisters that are you know, they're fraternal, not identical.
• 30:44
  SPEAKER_00: So they're they're they're they're even with breasts, it's almost impossible to get them exactly the same.
• 30:50
  SPEAKER_00: When you do like an odoplasty, even it's like there's subtle differences in facial surgery.
• 30:54
  SPEAKER_00: So I think that this idea of getting a perfect result it's it's very difficult.
• 30:59
  SPEAKER_00: It's almost impossible.
• 31:01
  SPEAKER_00: But my question to you is that does that patient the patient could potentially view it as a perfect result, but when you look at it, what would you see?
• 31:11
  SPEAKER_01: I never see anything perfect.
• 31:12
  SPEAKER_01: Right.
• 31:13
  SPEAKER_01: Which I I know you don't either.
• 31:16
  SPEAKER_01: Right, and that's that but that's the beauty in individuals and themselves, because I think there's beauty in imperfection.
• 31:22
  SPEAKER_01: That's why I find everybody that we see beautiful in their own right.
• 31:26
  SPEAKER_01: Right.
• 31:26
  SPEAKER_01: And it's like it's uh our obligation to help them achieve whatever they're looking for, to tweak whatever they want that's gonna make them feel better about themselves.
• 31:35
  SPEAKER_00: It's so true.
• 31:36
  SPEAKER_00: And this is the thing about this kind of um our a brave new world future that we're embarking into that we don't know exactly how it's gonna come to fruition, what's gonna happen with AI and filters and you know, augmented reality and the ability to potentially at some point automate everything.
• 31:54
  SPEAKER_00: You know, are we gonna be replaced?
• 31:56
  SPEAKER_00: Is are we gonna be one of Elon's robots to where you can get perfection outcome?
• 32:00
  SPEAKER_00: And are we gonna then lose the uniqueness?
• 32:04
  SPEAKER_00: The thing that actually, like you said, actually probably does actually make us beautiful, makes people beautiful.
• 32:09
  SPEAKER_00: You know, when they do studies about people with perfect symmetry versus the asymmetry, usually you actually, I think, indirectly are drawn to the asymmetric beauty um, you know, uh forms, and it's it's a very interesting phenomenon, I think, that we all need to kind of keep in the back of our heads.
• 32:26
  SPEAKER_00: We really enjoyed this episode.
• 32:27
  SPEAKER_00: Any comments or questions, please leave um in the comment section of our uh YouTube channel or send us questions or comments to our social media platforms.
• 32:37
  SPEAKER_00: Tune in again next time.
• 32:38
  SPEAKER_01: Thanks for listening.
• 32:42
  SPEAKER_01: Thank you for listening to HKB Uncut.
• 32:44
  SPEAKER_01: If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
• 32:48
  SPEAKER_00: To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.