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Posted on July 17th, 2014 by Dr. Albert Carlotti
Dr. Michelle Carlotti and I often got lots of questions during the “Extreme Makeover” days as we are “in the business.” The tawdry “Dr. 90210,” The Swan” and of course the fictional show on FX, “Nip Tuck,” all generated questions from family, friends and patients about our “opinion” of these shows.
Now comes the show “Botched” on E Entertainment TV.
Previous reality shows often presented patients who were looking for a dream result, they are filmed pre-operatively, in the OR and then of course the infamous unraveling of the gauze to show the “miraculous” result. During the real estate bubble, people in Arizona were inspired by these shows in droves and borrowed against their home equity to undergo all kinds of cosmetic procedures. It would seen that every week an new “reality show” on plastic surgery was on TV and local news media was running a “new technique” in plastic surgery religiously on evening broadcasts.
Then the real estate crash hit along with “The Great Recession.” Boom, the media stopped covering plastic surgery and the reality TV shows all but disappeared on the topic.
Now comes the show “Botched” which is bringing a new angle to the topic of cosmetic plastic surgery by highlighting two California surgeons who are specifically focusing on treating complications caused by other plastic surgeons. This show is entertaining for sure and I believe it is notable to a return in the public’s interest in cosmetic surgery once again as discretionary income seems to be available again.
This all aside, I think the reason why family, friends and patients ask us about a show like “Botched” is because they find both the multiply operated (and often disfigured) patients wanting more surgery shocking as well as the demeanor and comments made by the two surgeons on the show.
Wow, do they say blunt things to their patients! When former supermodel Janice Dickenson takes out her own surgical drain and removed her bandages prematurely, at her first post-op visit Dr. Terry Dubrow is bleeped out saying to her “Are you trying to f**c this up?” “You are you own breast worst enemy!”
Clearly this is meant to entertain, but is the demeanor of this doctor professional behavior? Certainly patients who blatantly disobey their doctors’ orders and recommendations make the doctors upset. The quality of care can be severely damaged by patient non-compliance. We have seen this in our practice countless times. But should a doctor use profanity in such a way to express it to their patient? Perhaps not.
I think the other inherent problem with this show is that it highlights a number of patients who clearly have Body Dysmorphic Disorder which is a real psychiatric diagnosis whereby the patient has a disillusioned sense of self driving them to have countless cosmetic plastic procedures with no chance of themselves being satisfied as a result of their disorder. Personally, I have refused treatment several times to patients with this disorder until such a point that their mental illness is under control. My concern is that it conveys once again that only the extreme personalities want cosmetic surgery and that it instills fear in potential patients that they will end up with some sort of “botched” result.
Millions of cosmetic surgery procedures are performed around the world annually. Only a scant few end up with truly “botched” results. The notion that going to a Board Certified Plastic Surgeon gives a patient “a guarantee of a treatment result” is also dispelled as these multiply operated patients have clearly been in others’ hands and have been “botched.” I am sure that the previous doctors did not intend to cause a bad outcome.
The truth is that not all surgeons are capable of performing procedures to meet patient expectations. When a doctor holds a consultation, it is imperative that they really assess the patients expectations and determine whether they can be met. When a patient, as on Botched, states that he wants to “look just like Justin Bieber” that should be a glaring red flag to deny care. But, sometimes patients won’t tell you their hidden expectations that truly drive their motivation to have surgery.
I had a patient once who really expected that her rhinoplasty was going to help her finally for the first time, at the age of 47, “get a husband.” We have had people really believe that we could make them “look 20 again” which of course is impossible. Red flags are not always apparent and that is the risk the surgeon takes when they decide to operate on someone, especially when treating a previous surgeon’s complication or less than desirable outcome.
Perhaps 40% of my practice in Cosmetic Surgery involves re-treatment of patients who have had less than desirable outcomes in another Plastic Surgeon’s hands. There may be physical scars, but almost certainly there are emotional scars that need to simultaneously be addressed, assessed and managed if the patient is going to be satisfied this time. Frankly, as long as I dealing with an emotionally stable person with a good support system of family and friends, I will tell you that we can often times make major improvements and help heal the patient physically and emotionally. It is a real privilege to do so.
So is Botched all bad? No. Is it sensational for TV? Yes. Are there controversial moments I disagree with? You bet. The silver lining is that it can be an icebreaker for patients to get answers and get proper treatment here at The Carlotti Cosmetic Surgery Center and I am grateful for that!