There is little that is as emotionally distressing in the cosmetic and aesthetic world than an elective procedure that goes wrong. If it happens to your client it raises a set of issues that involve liability and insurance – and the person may or may not trust you to be the one to fix it. It is less complicated when you were not the original service provider and the person is coming to you for help. Either way, however, it is important to take the time to provide the person with the comfort they need, the facts about the future, and the truth about whether you are the best resource for them.

The Fixing Doctors

These are the cases that most of us hope to not have walk through our doors, but they happen. Some doctors have made careers out of them. These specialists have gained some attention over the years with the media. Many of them cater to people who had procedures done in the past and the results in the long-term are dangerous or disruptive. Others deal in the immediate aftermath of something gone wrong.

Some of the work these fixers do was written about in W Magazine:

Robert M. Schwarcz is a New York–based cosmetic surgeon who trained under Los Angeles lid-lift king Norman Shorr. A specialist in salvaging bungled facelifts and eye jobs, Schwarcz treats many patients who have been taken in by the false promise of fast and painless surgery. “Cheap lifts like the Quicklift, the Lifestyle Lift, thread lifts—these well-marketed little fixes do a big disservice,” he says. “The doctors don’t do complete dissections, they ignore the neck, and they leave scars.” Among the range of complications he sees: wind-tunnel faces that result from pulling deep muscle and skin too hard in one direction; so-called pixie ears, plastered to jawlines because of overaggressive skin removal; hollowed-out eyes from exercising too much fat; lids that won’t close due to muscle damage; and salivary gland dysfunction. Occasionally patients even arrive with subcutaneous hemorrhages that have turned toxic. “Often there’s an immense sense of guilt, like, Why did I do this to myself?” says Schwarcz. “You need to walk patients through that part of the process.”

David Sarwer, an associate professor of psychology at the University of Pennsylvania’s Center for Human Appearance, investigates the prevalence of Body Dysmorphic Disorder among cosmetic surgery patients. He also consults with revisionist surgeons when they fear that an additional procedure, however good the outcome, may fan rather than quell the flames. “The surgeon may not realize that a patient’s distress far outweighs whatever gains can be made through surgery,” says Sarwer. “And that’s when surgery can be a mistake. A good revisionist recognizes when it’s time to call in the services of a different kind of doctor.”

But for patients whose reasonable expectations aren’t met, corrective surgery can be therapy enough. Maxwell, the breast surgeon, has operated on women who have had up to 12 breast augmentations before coming to him…he employ[s] a sophisticated computer with 4-D imaging capability to show her a near-perfect simulation of her future contours. The technology is particularly helpful when patients come in with misguided hopes about cup size. “I always say that you don’t buy a size-16 shoe when you have a size-8 foot,” says Maxwell. “You have to find the implant that fits the patient.”

If you are interested in specializing in being a fixing doctor there will be opportunities at our annual meeting, SCALE 2019 Music City, to learn more from those who are in the field.

Beyond Bad Surgery and Changed Minds: Why Procedures Go Wrong

There are two different types of issues that commonly arise with procedures. The first is allergies. This can happen with any type of cosmetic or aesthetic treatment. Some people will inevitably have an allergic reaction to the types of things that most other people tolerate fine. This includes lasers.

It is well documented that laser hair removal can cause hives due to hypersensitivity, which is why we test a patch prior to doing a full treatment. (Source). However, any type of laser or other energy treatment can also trigger an allergy. Sometimes there will be no way to know that this is going to happen, but it is important that you have your patient give a full disclosure of their allergy and medical history. This can protect you and them in the event of an unexpected reaction. Also if you have any concerns about that history or performing a non-invasive procedure that you think may cause a reaction, it is best to not move forward.

Injectables like botulism toxin and fillers can also cause allergic reactions that can become medical emergencies. You should always make sure that any patient or client you are providing these services to understands what the signs of a reaction are so that they can seek help if they occur. Full disclosure of the risks and complications that may occur, be they common or rare, will help to prepare them and you in the event that something goes wrong.

The second are surgical complications.

Making It Right Again

When something goes wrong one of the first things you should do is notify your insurance company. Follow their lead on what actions to take. Listen to the client or patient without response, but with empathy. And remember that if you have done a procedure correctly, you have disclosed the risks and the patient or client acknowledged those risks, then one bad experience should not damage your practice or reputation. You can help the person on the other side and leave them feeling good about you.