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My thoughts and commentary on the E! reality show “Botched”


Tonight, the reality show “Botched” aired on E! entertainment television.  While I regularly perform breast revision surgery for both cosmetic and reconstructive purposes, my first impression when seeing the intro and some of the patients snippets was “Wait, WHAT?”!

“Revision Plastic Surgery” describes surgical procedures designed to redo and correct problems resulting from cosmetic procedures performed by non-surgeons, doctors who are NOT Board Certified by the American Board of Plastic Surgery, or occasionally by properly trained Plastic Surgeons who unfortunately sometimes have less-than-great results.

"Uni-boob", or symmastia - implants are migrating toward each other to meet in the midline.  Correction involves removal of the implants and reconstruction of the chest wall muscles, with later re-augmentation at a later date.

“Uni-boob”, or symmastia – implants are migrating toward each other to meet in the midline. Correction involves removal of the implants and reconstruction of the chest wall muscles, with later re-augmentation at a later date.

The first patient presented was a woman with symmastia, or a “uni-boob”.   This is actually a condition I see often and while it is challenging to correct, it can be done!  She also had a “double bubble” deformity related to breast implants being under the muscle with “bottoming-out” of heavy, oversized implants that also migrated across the midline to meet over the sternum.

The team of two Plastic Surgeons’ approach was to first REMOVE the implants altogether, which I completely agree with.  It is important to reconstruct the anatomy which has been distorted and to allow the tissue to settle before reinserting new implants.

I would have made a different incision in order to avoid dividing nerves and ducts to the nipple and areola and further decrease sensation and/or the ability to breast feed, but reconstructing the chest wall anatomy and musculature is the right first step in reconstructing her breasts.  They performed intraoperative breast implant sizing, which is also something I do for EVERY breast augmentation and reconstruction procedure.  It is important to determine which implant volume, size, shape and projection best fits the space of the breast.  The temporary sizer was removed, and they came back another day to perform a breast augmentation in a situation that is as much “from scratch” as possible.  Hooray to my colleagues on the show!

The patient expressed disappointment with having to wait for her re-augmentation and did have some features of body dysmorphic disorder, as did each patient presented.  Fortunately, this woman had a supportive husband and friends and hopefully will come to appreciate the conservative, safe and reasonable approach taken by her surgeons.


Drs. Terry Dubrow and Paul Nassif, Plastic Surgeons performing revision surgery in “Botched”

The second patient was seeking her SEVENTH revision rhinoplasty.  She required bone grafting, cartilage grafting and soft tissue coverage – essentially a near-total nasal framework reconstruction.  The surgeons’ approach was reasonable.  While I rarely perform cosmetic rhinoplasty, I am trained in this procedure and in complex nasal reconstruction.  Noses are hard to do well, and they did a great job!

The third patient was a case of a young man with OBVIOUS body dysmorphic disorder (BDD).  Promoting himself on this show and the internet as “the human Ken doll”, his appearance is totally abnormal and shocking.   This patient boasted having over 100 previous cosmetic procedures including implants in the chest, deltoid region, triceps, buttocks, face, lip injections and was seeking abdominal implants.  He had been previously turned down by Plastic Surgeons, which gave me hope.

The human Ken doll - with obvious body dysmorphic disorder! (BDD)

The human Ken doll – with body dysmorphic disorder!

Luckily, this team of surgeons recognized his BDD and made appropriate decisions.  They did a “house call” at his mansion filled with young men strutting around in underwear.  They exclaimed “is this guy real?” – my thoughts exactly!  “He looked like a cartoon character”, the other doctor stated.  I rarely post images of patients’ faces, but his patient is all over the internet – just do a “human ken doll” image search, so I felt it reasonable to show his picture so you can understand the situation better.

This young man had actually designed his own silicone body implants and was seeking a surgeon who would agree to implant them in his quadriceps and abdomen – areas that are fraught with an extremely high complication rate.  Given this patient’s psyche and his surgical history, he is certainly someone I would never operate on.

Thank goodness the message they delivered to him was a definitive NO.  This patient will certainly go elsewhere, and seek out some other practitioner who will gladly perform the desired procedures, for the right price…  Unfortunately, some people will do anything for a buck and the fame of operating on such a spectacle of a patient.

Congrats to the show, the Plastic Surgeons who seem like decent guys and good surgeons with reasonable approaches to complex revision problems.  Apparently, they were also featured on the Real Housewives of Orange County.  I rarely watch reality TV, but I will continue to watch “Botched”!

To learn more about Dr. Karen Horton, Plastic Surgery in the San Francisco Bay Area or revision breast surgery, visit our website and complete our online consultation request form today!  

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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA