I didn’t want to like the TV show “Botched” – the title seems to sensationalize sometimes tragic outcomes of plastic surgery gone wrong. But like so many of you, I do like the show. Reality TV shows about plastic surgery have not always gotten things right. Remember “The Swan” in which “ugly ducklings” were made over? Not the most positive message. It all started with “Extreme Makeover” which did show the beneficial transformative effect that plastic surgery can have on people’s lives, but it was a bit extreme (I guess they told us so.) “Botched” takes us back to that concept in a limited way, but there are some lessons to be learned.

 

One reason I relate to the show is that my own practice includes a lot of revision cases. Sometimes the problem was the result of poor judgment or technique by the prior surgeon, but not always. The Botched! doctors, Terry Dubrow and Paul Nassif, are talented surgeons and do a great job of focusing more on the problem at hand rather than indulging in the blame game. Having a complete history of prior surgeries and treatments is important, but finding fault is less productive than working toward a solution.

 

But the word “botched” implies that serious mistakes were made leading to a poor outcome. Very often the patients on the show have had experiences that could accurately be described that way. Sometimes however bad outcomes are the result of events beyond the surgeon’s control. One recent patient for example experienced a reaction to local anesthetic, and was managed appropriately by her doctor. Despite her surgeon having done nothing wrong or substandard, the patient trashed him on social media. Drs. Dubrow and Nassif took the opportunity to point this out and advised the patient not to seek more injections (which she did not appear to need anyway!) A running them of the show is that anything overdone leads to problems.

 

The downside is that people use the term “botched” almost casually now. Patients post questions on RealSelf like “Was my surgery botched?” Or they come into my office for a consultation saying their prior procedure had been botched. It makes me wish they had chosen a less provocative name for the show, but that’s Hollywood.