Contoura Facial Plastic Surgery - Episode 11 The Confident Choice Podcast Revision surgery info Dr. Roberto Garcia

Transcript

You’re listening to the Confident Choice Podcast with me, Dr. Roberto Garcia, a double board-certified facial plastic and reconstructive surgeon. Honest conversations and expert advice about the decisions that make you feel your best.

Well, welcome everybody to Episode 11 of The Confident Choice. I’m your host, Dr. Roberto Garcia, and as always, we are broadcasting from beautiful Ponte Vedra Beach, where today is actually kind of overcast. We need the rain. My wife keeps telling me we need rain, and it’s been super dry, as you guys probably know. There have been some fires in the Gainesville area and up in Georgia as well.

Anyway, we’ve had quite a run these last three weeks. I think you guys can all agree that the last three guests we’ve had have been fantastic. I thought Dr. Basil was a great addition and complemented those non-surgical modalities really well. It was great to hear the perspective of somebody with a little bit different training than us, but still a very talented and gifted surgeon. I was really honored to have him on our show.

And then two weeks ago, having my brother on and really bringing the entire specialty of facial plastic surgery into focus—defining it, explaining how it came to be—I thought that was incredibly meaningful. I’m so proud of our academy and proud of what facial plastic surgeons have been able to achieve.

It reminds me of something my dad always talked about, and I won’t get into Dad’s lesson just yet—that’s for later in the show—but the idea was always: keep your head down and keep grinding. You don’t need to scream, you don’t need to be boastful, and you never need to hurt another business or prevent another business from doing work. You just focus on your work and do the best you possibly can.

I think that mentality has been taught not only at the academy level, but also at the fellowship level. You can only really control what’s in front of you—the patient in front of you—instead of worrying about what other surgeons are doing or whether they’re taking food off your plate. You’re not helping the patient when your mindset is there.

I’ve always had the mindset that I don’t care what other practices are doing. I don’t care if other specialties are doing surgeries that maybe aren’t as specialized as we are. If they’re doing good work, they’re doing good work. It’s just a fact.

And then last week with Mrs. Goldman—she’s incredible. Do you guys know what she does? She mentioned she’s a businessperson. You know when you go to places like the Smithsonian, the Met, or these big museums, and you walk through the gift shops where they have puzzles of famous artwork and things like that? That’s what her company does. She makes those. She’s incredibly gifted and has done it exceedingly well.

Actually, speaking of that, we were in Gainesville this past weekend for my oldest daughter Isabella—congratulations, baby—who graduated from the University of Florida with a degree in advertising and marketing. We were staying at my brother-in-law’s house, and they had one of those puzzles we bought them: a Florida Gator-themed puzzle. It was something like twelve dogs sitting on a couch watching a game. The colors were really challenging, but the kids and I built it this weekend. Of course, I left it on the table to show my brother-in-law that we’re not all creatively challenged.

But all joking aside, as we enter the last part of Season One, I’ve got some really interesting ideas for Season Two. We’re going to start bringing in different types of guests who may be outside the realm of plastic surgery. I can’t tell you how many people have come up to me asking, “Hey, can I be a guest on your podcast?” So, we’ll probably start bringing in other voices. Believe it or not, I actually like listening to other people talk. I get tired of hearing myself sometimes.

Today, though, we’re going to close out this season with what I think is a very serious topic: revision surgery. We’re going to talk about what revision surgery is, what constitutes an appropriate revision surgery, when we should do revision surgery, and what you as a patient can expect from any kind of revision procedure.

Let me first define revision surgery, because people have different interpretations of what that means. I consider revision surgery to be any correction of something occurring after the face has healed—generally around one-year post-op.

Now, I used to have this steadfast rule, and you might remember it, Lori, that I wouldn’t touch or correct anything for a full year. But as I got older and gained more experience, I realized that around six months, I can usually tell when something isn’t going to improve further. I’m not going to have a patient sit with something for another six months if I already know it’s not going to get better.

So, the definition is exactly that: anything that needs to be corrected outside of the normal healing parameters.

What is not a revision is when somebody comes back four or five years later wanting additional tweaking of a procedure. That should not fall into the calculation of a surgeon’s revision rate.

When I look at revision rates nationally—and certain surgeries absolutely have higher revision rates—it really comes down to surgeon experience, complexity of surgery, and believe it or not, it’s not always the surgeon’s fault. I think I’ve talked about this before. You can have the same patient, do the same surgery on them today and then again ten years later, and they’ll heal completely differently.

What’s going on inside the patient’s body has a huge impact on healing and whether revision work may eventually be needed.

In my practice, I don’t skirt revision issues. If I see something that’s not right or not what I envisioned for the patient, I’m usually going to recommend fixing it.

I used to be more rigid about charging patients for revisions, and every year at academy meetings there’s discussion about whether surgeons should charge for revision work. Some people say if you don’t charge, you’re accepting culpability. Others argue that charging acknowledges its simply part of natural healing. I don’t really get caught up in all of that.

If I have to tweak something, I don’t necessarily see it as “fault.” The same way I don’t blame a patient if something about their healing contributed to the issue. We’re not keeping score. What matters is whether there’s a problem, whether it should be corrected, and when it should be corrected.

In my hands and in my experience, I fix my own problems, and I don’t charge patients for revision work.

The national revision rate overall is around 15–20%, and rhinoplasty has the highest revision rate by far because of the complexity of the surgery and the forces inside the nose that can alter cartilage, bone, and scar tissue over time.

I see a lot of revision nasal work done elsewhere. I’m not here to comment on who should or shouldn’t be doing these surgeries—that doesn’t matter to me. But I had a patient who had undergone rhinoplasty five times. Sweet girl. She had essentially lost the bridge of her nose because multiple surgeries had compromised blood flow to the nasal skeleton, leaving her with what’s called a saddle-nose deformity.

She had been everywhere and undergone multiple procedures where surgeons kept chipping away at the nasal structure. Ultimately, we performed what I consider a major reconstruction, and thankfully it turned out really well.

The reason I bring her up is because she had this TikTok or Instagram channel where she helped people who loved scary movies but didn’t want to be startled. She’d create spoiler alerts and warning videos so people could prepare for jump scares. I thought it was actually really thoughtful.

This was someone constantly in front of a camera, filming content every week, and the appearance of her nose deeply affected her emotionally.

The emotional side of revision surgery is huge because your best chance at surgery is the first surgery. Once you go into a second surgery, your success rate drops significantly—about 50%. And the more complex the revision, the lower the success rate becomes.

I always tell patients: if you’re revising something, make sure it’s a small tweak—a slight tip adjustment, a small septal deviation, a little residual bump. But when you’re talking about major reconstructive revision surgery, like we did for this young woman, I prep patients honestly. I told her directly: “Your chances of success are less than 50%.”

That’s a scary conversation for patients because they’re thinking, “Wait a second, the other surgeons told me they could fix it no problem.”

And to all the facial plastic surgeons watching this: with revision surgery, underpromise and hopefully overdeliver. Never promise anything. No matter how talented you are, scar tissue and healing are unpredictable.

You can’t always assume previous surgeons “did it wrong.” Sometimes there’s something inherently unique about the patient’s healing that contributes to the problem.

So, I told her, “Listen, there’s a strong likelihood you won’t get the exact result you’re hoping for, but we’re going to strive for it and I’ll do everything in my power to help you achieve it.”

That emotional honesty matters.

I see this same thing with aging face surgery. Just yesterday, two of my facelift patients had undergone previous facelifts—one with me about nine years ago and another elsewhere about fifteen years ago.

You never really know what you’re walking into when someone has had surgery somewhere else. Operative notes only tell part of the story. Healing dictates the rest.

There are even times when I look at a revision case and think the patient simply isn’t emotionally ready to go through that roller coaster again. Sometimes I’ll tell someone, “Let’s sit on this for a little while. It may not be perfect, but it’s not a deformity.”

In fact, I had a patient today who came from Mobile after a FaceTime consultation. She hated a dip in her nose from a prior rhinoplasty and felt she’d been “botched.” She even told me she reached out to the TV show Botched, but they weren’t taking applications.

She came all the way here expecting major revision surgery. During our consultation, though, I told her, “Let’s try something conservative first.”

She had a dip here and a hump here, so I placed a small amount of filler—Restylane—in the area. It’ll last about six months. I wasn’t trying to create permanence; I just wanted to see if we could restore the aesthetics she wanted.

I’m not kidding you—within seconds of injecting and massaging the filler into place, she started crying.

“Oh my God,” she said. “I never thought my nose would look like this again.”

And I’m thinking to myself: she had worked herself up over something that took ten seconds to fix.

She looked at me and said, “This is exactly how I always wanted my nose to look.”

So, I told her, “Great. Save yourself a revision surgery. In six months, we’ll place something more permanent, and you’ll never have to worry about this again.”

That’s where honesty and surgical virtue matter. Telling her she needed a massive revision surgery would not have been the right thing to do.

I think considering a patient’s emotional wellbeing is a huge part of revision surgery.

And because this is a deeper, more serious topic, I’ll say this: if you ever meet a surgeon who claims they’ve never had complications or never needed revision surgery, one of two things is happening—they either don’t have enough experience, or they’re lying to you.

Patients ask me all the time whether I’ve had to revise procedures. Of course I have. I’d actually be concerned if a surgeon told me they’d never done revision work.

What I can’t control is the inner workings of the human body. I don’t know if someone has a collagen issue, nutritional deficiencies, or whether they’re vaping, smoking, or drinking and didn’t disclose it. These things happen, and they impact healing.

So, my take-home point is this: if you’re ever faced with revision surgery, get your mind out of the finger-pointing game. All that does is make you angry and keep you up at night.

Patients will come in and say, “Well this doctor did this…” and I stop them immediately.

We’re not worried about the past. The only thing we can control is what steps are in front of us and whether we should even take those steps.

I’m going to close with something my dad told me that I recently found myself repeating to my daughter after graduation.

Plan your work in detail and then work your plan.

When I was 20 years old, sitting at a bar in Milwaukee, I wrote down on a napkin what I wanted 50-year-old Roberto to look like. I’m serious. I kept that napkin for years until I probably lost it during one of my many moves.

I asked myself: What do I need to accomplish by 40 to get to that 50-year-old version of myself? What do I need by 30 to get to 40? What about 25? What about this semester, this month, this week, tomorrow?

I reverse-engineered my life.

Things change, of course, but I can tell you this: if you carefully plan what you want your future self to become and work backwards, nine times out of ten you’ll hit the mark.

Parents, pass that lesson on to your kids. Have them sit down with a piece of paper and figure out who they want to become.

Amelia, since you’re in the studio today—Alyssa’s beautiful daughter—your homework for next week is to tell us what Amelia at 25 years old is going to be. Not what you’ll look like, but who you’ll become. Then work it backwards.

I’m kidding—we’re not actually going to share it with anybody.

All right, guys. Thank you so much. I love you all. This has been a great episode.

We’ve been working through a few glitches on Instagram with the sound and audio, but we’ve got it all figured out. We’re newbies at this, but I’ve got the best team in the game working with me, and I appreciate all the positive comments and support.

Next week is a really good one. We’re coming full circle. We started the season talking about what brings people into consultation and why they begin seeking information. We’ve discussed so many aspects of that journey throughout the season.

Now we’re going to close out Season One by talking about the questions you need to ask once you’ve decided to move forward. Where does your head need to be? What do you need to start planning?

We may even touch on what Jackie talked about last week regarding nutritional plans and what we can do pre-operatively and post-operatively.

Thank you guys very much. Have a wonderful weekend, and remember good decisions come from good information.

Have a great day!