As a follow up to my previous post on the E! show, Botched, I’m going to provide further insight into each episode that they couldn’t touch on due to time constraints. I’ll point out potential alternative treatments and highlight some of the psychology with these complex patients. So here goes…Botched, season 1, episode 6!
Mike, Scalp Scar
Mike had a receding hairline and had a typical procedure where a 1cm strip of skin was taken from the back of the scalp. The scar is often imperceptible but in Mike’s case, the scar was very wide and noticeable, especially with his short-cropped hair. There are two options to treat this: remove the old scar and bring the skin edges back together versus place a balloon under the scalp, stretch out the normal skin over the course of several weeks to months and then return to the operating room to remove the scar and close the skin edges under no tension and therefore, minimize the chances of the scar widening again.
Based on the description above, the first option is clearly the easiest but there’s the risk that even after undermining the edges of scalp after removing the scar, the tension would be too great and the scar would widen again. So the surgeons chose to go with the second option and stretch out the normal skin so that there’s no tension after removing the scar and closing the skin edges.
They stretched out the skin over the course of a week which is pretty fast. Usually this is a process that takes up to a month or more. They didn’t show an after-photo and the patient discussed his unhappiness with the result in his camera diary. While the patient appeared unhappy, the surgeons seemed to provide appropriate counseling before surgery and let the patient know that there wouldn’t be a 100% improvement. At this point, the patient just needs to let his hair grow a little longer to assist in covering up the scar.
Michelle, Filipino Facelift
This very unfortunate patient had trauma in her 20’s that caused significant disfigurement to the right side of her face resulting in a sunken right eye and the inability to close her right eye due to paralysis. She underwent several facelifts as she aged and even a new chin cleft for $200! She came in to see the doctors because she wanted another facelift.
At first, I felt that she needed to focus on reconstruction of the underlying facial bones to treat her sunken eye. But during her consultation with her doctors, she commented that her last reconstructive procedure was 1 year ago. So apparently, she probably has done all that was possible for that aspect of her face. In my opinion, the doctors decided not to offer her another facelift because, from a cosmetic prospective, she really did look very good for her age.
Cynthia, Breast Cancer Survivor
Cynthia was very unhappy with her left breast after a mastectomy and breast reconstruction. She underwent reconstruction with an implant on the left and a breast implant on the right to improve symmetry between the breasts. During her consultation with the doctors, she talked about how her original plastic surgeon said her breasts would look great and would have no scars.
It’s impossible for me to believe a doctor would tell her she’d have no scars after a mastectomy and breast reconstruction but regardless, that’s what she heard.There’s always potential aesthetic issues with breast reconstruction after cancer but the main issue here is reasonable expectations. The patient must understand that G-d gave her her original breasts. The surgeon can’t always get as close to the original as they (the patient and the surgeon) would want.
With all three patients, the overarching theme of tonight’s show is communication between physician and patient. Whether the previous surgeons did a poor job explaining the risks of surgery or the patients only hearing what they wanted to hear during their preoperative consultations, communication is key and can be the difference between a happy or unhappy patient.