Bad cosmetic surgery.... gone good!

by David Andrusia

EDGE Media Network Contributor

Wednesday December 9, 2009

We've all shrieked with horror while standing in line at the market or during an awards show: "What did she DO to her face?" Or breasts. Or butt, for that matter. In fact, it seems that there's as much bad cosmetic work on display as good- which surely makes us all think twice before going under the knife.

The best plan, of course, is to take all precautions in finding an excellent surgeon the first time out. Pay careful attention to his/her approach- is it conservative, over-the-top, or somewhere in between? And while the surgeon will certainly show you his/her very best work, pictures don't lie: skillfully amended noses trump scary scoops every time.

This said, there's more help than ever for cosmetic surgery gone awry. This is our guide to some of the best "make-up artists" in Los Angeles and New York- and how how they turn bad surgery good.

Y Wait for a New Face?

Dr. Yan Trokel, MD, DDS, a New York City based cosmetic surgeon and medical director of The YAN Center for Corrective & Cosmetic Surgery, has invented a revolutionary anti-aging and beautifying procedure he calls the Y Lift.

The Y Lift is is a true three-dimensional lift that pulls up and back, while voluminizing the skin. (For more information, visit ) As we age, we experience a loss of volume, thinning out of muscle, dissipation of fascial fat, and bone loss. Dr. Trokel uses a special proprietary instrument that allows him to instantly lift the muscles and tissue underneath the skin through minuscule holes in the upper and/or lower parts of the face all while the patient is under a local anesthetic- with minimal swelling and bruising.

After the lifting has been performed, he injects a pair of fillers: Juvaderm, which Dr. Trokel advocates because its main component, hyaluronic acid, is a natural substance similar to the one found in our bodies; and Radiesse, a filler made from bone derivative, thus providing a "strong" look to the face.

Amazingly, this minimally invasive procedure requires no incisions or stitches, and only takes 30-45 minutes to perform. Patients can immediately resume most daily activities post-procedure.

According to Dr. Trokel, the Y Lift is an excellent way to improve the results of unsuccessful surgical eyelifts and/or facelifts. "I have a lot of patients who come in post-facelift who are unhappy with the unnatural 'tightened' look," he says. "Since the Y Lift uses injectibles, higher and fuller cheekbones as well as stronger jawlines can be sculpted."

The Y Lift runs between $5500-$8400, depending on how much work is needed.

Similarly, Dr. Trokel also performs minimally invasive butt lifts using the same lifting and filling technique. "In 30 minutes, I can instantly give you a more appealing rear all without surgery, costing approximately $6,200," says Dr. Trokel. "I am so busy with these two procedures, that all I seem to look at are peoples' faces or butts- or both," he jokingly adds.

Best Breasts

On the other coast, Dr. Andre Aboolian, a Beverly Hills-based plastic surgeon who has appeared on Extra Makeovers, is known as "the body doctor" among cognoscenti, especially for his skill in reversing bad plastic surgery procedures. He has earned a reputation as the go-to man for botched breast implants... of which L.A. is clearly the world capital.

"Many breast implants go wrong due to two factors: they are too large, and improperly placed," Dr. Aboolian says.

"When you see that off-to-the-side look, it is usually due to [the surgeon] having placed the implant(s) at an imprecise point in the pocket." As for size, "I myself refuse to do inappropriately large breast implants- not only because they look unnatural and improportionate, but also because they may result in other issues, including sagging and back problems.

"To correct botched breast surgeries, three things have to happen," Dr. Aboolian continues. "First, I must select a more appropriate size that is proportionate to the person's body. Second, I often have to correct the capsular contraction (scar tissue that heals in a way that squeezes the breast, giving it an unnatural look). This is done by taking out the scar tissue and redefining the pocket in which the implant sits."

"Third, I very often need to perform what is in essence a 'breast lift' to undo the sagging effects of too-large implants." The goal, he says, is "to create natural looking breasts."

For the most complicated cases, reconstructive breast surgeries can take up to five hours and cost upwards of $15,000. For less complicated procedures, Dr. Aboolian charges about $8,000.

Next :: noses and lipo and chins. (Oh my!)

Nose News is Good News

Internationally known for his reconstructive nose work, Dr. Jay Calvert (based in Beverly Hills and Newport Beach) devotes about half of his rhinoplasty practice to revising previous rhinoplasty.

"Up until the mid-80s, really, 'old school plastic surgery' was deconstructive in nature," Dr. Calvert says. "A typical nose job consisted of rasping the hump, if there was one, taking out too much cartilage and, usually, breaking the bone.

"This was fine for an exceedingly large nose, but if smaller refinements were required, things often went badly," Dr. Calvert continues. "At the same time, there were several doctors, especially known in New York, who did the exact [same] nose on all patients, regardless of the shape of their face and the nose's relation to other features. This led to comments such as, 'Oh, you've been to see Dr. X.'"

According to Dr. Calvert, "Beginning around the late '80s, we saw a constructive approach to rhinoplasty, and this [was] pioneered in part by Dr. Jack Sheen, a prominent surgeon in Santa Barbara. Here, an analysis of the nose is done pre-operatively. In short, the 'smash [the] nose and make it smaller' philosophy was gone, and most surgeons began taking a much more balanced approach to creating noses that fit an individual's face in the most balanced possible way."

To refashion noses, Dr. Calvert uses diced cartilage in fascia (a supple material that lines every muscle in the human body), usually taking the needed tissue from the patient's right ear. In this way, he is able to re-craft a nose a with natural appearance, avoiding the problems associated with earlier techniques, when too much cartilage was excised.

Taking between 2Ĺ and 3Ĺ hours, this delicate reconstructive surgery typically costs between $10,000 and $35,000, depending upon its complexity.

Too Tight; Not Right

Nobody needs major proof of facelifts gone wrong; any Hollywood awards show provides ample examples. The problem, says Dr. Toby Mayer, a noted Beverly Hills plastic surgeon who authored the classic medical textbook Aesthetic and Reconstructive Surgery of the Scalp, is that "many surgeons make the wrong decision as to what a patient actually needs."

"In many cases, I see patients needing corrective surgeries for brow lifts that were done incorrectly by pulling the brows towards the temples," continues Dr. Mayer. "This results in the dreaded 'surprised' look, with excessively pulled brows." (Jessica Lange and Marie Osmond are prime examples here... assuming they had work done.)

"Worst of all," continues Dr. Mayer, "is when a brow lift results in a hairline raised so high that it replicates the adverse effects of male pattern baldness, which is especially unfortunate in women patients."

To avoid this look, Dr. Mayer and his partner Dr. Richard Fleming invented a procedure 30 years ago that actually lowers the hairline while raising the forehead and eyebrows. The happy outcome here is a fresh, youthful look without displacement of a woman's (or man's) original hairline; a rested, natural appearance.

Indeed, Dr. Mayer is known for his corrective work in this area. Surgically, he creates flaps that replace bald-scarred strategic areas of the forehead and scalp, so that a patient's original hairline is restored with minimal scarring.

Dr. Mayer has also done remarkable work using this technique to provide men with thinning hair or baldness with natural, full hairlines, in the operation known as the Fleming/Mayer flap. This is vastly different than the hair-plug technique used in earlier decades, usually to unfortunate effect.

To ameliorate badly performed facelifts, Dr. Mayer uses a balloon technique. Here, medical balloons are placed at key points in the face or scalp. When deflated, the balloons have significantly stretched the skin, allowing Dr. Mayer to work surgically to create a youthful (but not overly taut) result, while correcting scars and/or loss of hair due to over-pulling of the skin and poorly performance facelifts.

This, of course, is the desired outcome; as Dr. Mayer says, "I have patients whom I've seen on the 'Today' show who say, 'I'd never consider plastic surgery' - when, in fact, I've already operated on them. That they can say this credibly is the best reflection of the subtlety of my work."

Next page :: lipo... and large penises!

Lipo Redux

Harry T. Haramis, M.D, a plastic surgeon in private practice in Manhattan (at the Sleek Surgical and MedSpa), has seen more than his share of botched liposuction work. This most typically manifests as bumps (rather than smooth postsurgical skin) and leftover fat in key areas- in fact, "The worst thing is when people can tell a patient has had lipo, but they look worse after the procedure," says Dr. Haramis.

"In some of my corrective work, I see ridges, bumps, and depressions that are the mark of inadequately trained surgeons." How to avoid this? The doctor advises, "See an experienced, board-certified plastic surgeon first and foremost. Even if you have less than ideal results, an experienced plastic surgeon should have better outcomes now in the days of smart lipo."

To achieve optimal results, either in corrective work or in first-time liposuction patients, Dr. Haramis uses the Vaser, a patented ultrasound machine that has been on the market for about two years. Through high frequency sound waves, it selectively targets fatty tissue without damaging nerves or blood vessels; this is because the sound waves melt and liquefy fat, allowing for more uniform removal and a better result.

The previous liposuction technique was essentially akin to a vacuum cleaner and required general anesthesia; by contrast, the Vaser allows for a gentler procedure, with the patient awake, needing only local anesthetic only. The Vaser technique results in less bruising and swelling.

"What this means for a patient is a much shorter healing time," Dr. Haramas notes. "As before, we advise that he or she wear a surgical compression garment afterward, though typically only for a week or two," as opposed to the longer times previously required. In fact, in most cases, he or she can go back to work in the next day or two- though, of course, you should refrain from heavy lifting.

"For many patients," says Dr. Haramis, "the combination of Vaser technology and power liposuction is a remarkably effective method, especially those for those on whom I'm performing 'redo' work."

"Depending upon the areas involved and the patient's desires, Vaser-based lipo typically starts around $3600 per area."

Roll Reversal

It's no secret to EDGE readers that penile enhancement procedures have become more refined - and thus popular - over the past. But what to do when penile enlargement surgery goes wrong?

According to Gary J. Alter, M.D., Assistant Clinical Professor of Plastic Surgery at UCLA (in private practice with offices in Beverly Hills and New York), "In the original surgical procedure, penile girth is increased with fat injections or with the placement of a graft of the patient's own skin and fat - or, alternately, with cadaver skin. But fat injections can disappear with time, and the injected fat often results in penile shaft asymmetry and/or the formation of firm nodules."


"As well, if the grafts of skin with fat (dermal fat grafts) don't heal well, then penile curvature or shortening can occur- which, clearly, is the obverse of the desired result."

As an acknowledged expert in the field of primary and corrective genital surgery, Dr. Alter advises that correction is intricate but possible. In many cases, "Fat nodules or asymmetry from injections may be removed or tailored to achieve the desired aesthetic result. If dermal fat grafts or cadaver skin become infected or cause deformities, surgical removal may help resolve the problem.

"However, depending upon the severity of the problem, complete correction of the initial surgery may not be possible."

Advice: choose your surgeon wisely to increase the chance that it goes right the first time.

Last page :: chins.

Chin Corrections

According to Michael J. Yaremchuk, M.D, FACS, "Bad mentoplasties can be spotted 20 feet away, for their "stuck-on-look" chin. Conversely, good implants should mimic the natural contours of the chin, and their edges should merge imperceptibly with the native chin; beware those that are designed without appropriate lateral transitions.

"Another cause of unfortunate mentoplasty results occur with capsular contracture. In this case, implants with smooth surfaces (silicone) cause a fibrotic reaction of the surrounding tissues. If the implant is large and the overlying soft tissues are thin, the fibrotic capsule can be seen, making the implant visible through the skin."

Dr. Yaramchuk continues, "The surgery has changed dramatically in the last 20 years. Back then, small pockets were made in the chin area and a limited selection of designs were available for placement. The implant designs and methods of placement did not respect the natural contours of the chin."

Since then, however, "Porous polyethylene is a material which has obtained increased popularity for facial skeletal implants. Its porous nature allows some of the soft tissues to penetrate the implant avoiding the capsule formation inherent in smooth (silicone) implants. It can also be carved and attached to the skeleton with screws."

As for finessing "bad" chin job, "Removing silicon chin implants is easy. However, restructuring the chin can be problematic. The chin implant often causes some depressions in the underlying bone. Most importantly, the soft tissue response often leaves an imprint in the tissue itself.

"Improving the appearance of less than ideal chin implants require removal of the implant, smoothing the surface of the underlying bone, and replacement with the appropriate implant."

For optimal results, "I replace the silicone implant with a porous polyethylene one of appropriate contour that is affixed to the skeleton with titanium screws. Screws are not a problem. The patient is not aware of their presence. They are inert and biocompatible. Costs for redo mentoplasties typically range from $5,000 to $6,500."

The groundbreaking developments in corrective plastic surgery techniques during the past ten years have been profound. While it is always preferable to source a preeminent surgeon the first time you undertake a cosmetic procedure - Board certification and patient recommendations are both key elements - it is now, more than ever, possible to reverse unfortunate results with a competent, aesthetically forward surgeon skilled in these new techniques. To locate a Board-certified physician near you, go to the sanctioned locator of the American Society of Plastic Surgeons.

David Andrusia writes on food, travel, style, and beauty. Author of the bestseller BRAND YOURSELF, he is a career consultant in Los Angeles. Visit him online at