Botched. It’s a show on E!, a peculiar subreddit, a popular hashtag—and a word you’d never want associated with your face. Plastic surgeons bristle when they hear it.
“We’re not allowed to use the word ‘botched’ in the office,” says a nurse who works for a well-known plastic surgeon in New York City. If a patient mentions a problem with another doctor’s work, she’s trained to respond, “Let’s see what we can do about it.”
And maybe that’s the point. Because while the word “botched” sets off alarms in doctors’ offices, the corrective plastic surgery it requires is on the rise. The American Academy of Facial Plastic and Reconstructive Surgery (A.A.F.P.R.S.) reported a 61.5 percent increase in revision surgeries between 2019 and 2022.
Dr. Theda Kontis, the president of A.A.F.P.R.S., attributes the uptick to social media and its glut of carefully curated “after” images, which encourage patients to believe that flawlessness is a reasonable outcome. With cosmetic procedures, “the expectation used to be: better,” says the board-certified Baltimore facial plastic surgeon. But in recent years, perfection has replaced improvement as the benchmark for success.
Combine unattainable goals with a pervasive sense of iPhone self-scrutiny, and you have a recipe for discontent. As a consequence, patients sometimes use “botched” to “describe things that weren’t really botched,” says Kontis. “They were just not ideal results.”
When I used the word “botched” in my interviews with doctors, one told me it has a “slanderous” tone. “Derogatory,” said another. Several insisted that it’s “overused” and often “a gross exaggeration.” More than one called it a “red flag,” signaling a potentially “hostile” or “litigious” patient.
“If someone comes in using the word ‘botched,’ we immediately are a bit apprehensive,” says Dr. Ben Talei, a board-certified facial plastic surgeon in Beverly Hills. Furthermore, “it’s pretty uncommon that I agree with them, and say, ‘Wow, that surgeon did botch something.’”
“We’re not allowed to use the word ‘botched’ in the office.”
People generally have revisions for one of three reasons: they were underwhelmed by their primary result, they were overdone (and overwhelmed), or they suffered complications during or after surgery.
“Underserved expectations” is how Dr. Elizabeth Chance categorizes the first group. Chance, a board-certified facial plastic surgeon in Charlottesville, Virginia, estimates that about 90 percent of the unhappy patients who seek her help are those whose initial surgery “fell short of what they wanted.” In other words, the surgeon did too little, not too much.
She encounters this frequently with repeat face-lift patients, whose previous physicians sold them a “deep-plane face-lift”—a technique some tout as the gold standard—but instead performed “a baby version of it,” Chance says, or an altogether different type of face-lift.
Proponents of the deep plane believe the technique is superior to others. They contend that this procedure, which lifts up the tissue covering the facial muscles to adjust sagging cheeks and jowls from below, is more comprehensive than the SMAS lift, which manipulates that tissue layer itself, without going underneath it. The recovery from a deep plane is generally longer than that for other kinds of face-lifts, but when the procedure is skillfully executed, the outcomes tend to be durable and undetectable.
According to Chance, as demand for the deep plane rises, more surgeons are adopting the term for face-lifts that don’t technically qualify, leaving patients feeling disappointed, if not deceived.
It’s as if “they were promised a soufflé and walked out with scrambled eggs,” says Dr. L. Mike Nayak, a board-certified facial plastic surgeon in St. Louis. It’s a clever metaphor, but when the mix-up involves your face, the repercussions are more dire.
Most of what we think of as “botched” occurs when doctors do too much—“pushing tissues farther than they can safely be pushed,” says Nayak—causing disfigurement (“a weird surgical look”) and/or complications, such as nerve injuries, skin death, or functional issues (a collapsed airway, for instance).
The face-lift that looks like a face-lift is a classic example of “too much,” notes Dr. Lara Devgan, a board-certified plastic surgeon in New York City. Patients commonly ask her to finesse their stretched Joker smiles or their taut, windswept, or otherwise misshapen faces after doctors pulled their tissues too tightly. Another distortion comes when a doctor pumps an inappropriate amount of fat into the face.
While Devgan can use surgical techniques to relax visible tension or suction away excess fat, she admits that “not every problem can be completely solved.” She tells me about a patient who came to her after having a lip lift elsewhere. The space between the patient’s nose and the top lip was made “super-short, like a bunny rabbit’s,” rendering it all but impossible for the woman to kiss, whistle, or make the “m” sound. Rather than risk exacerbating the problem with more surgery, Devgan used scar-softening massage, steroid injections, and judicious injections of filler to successfully restore the form and function of her patient’s mouth.
“They were promised a soufflé and walked out with scrambled eggs.”
The lip lift is particularly tricky. “A lot of lip lifts don’t look natural in movement,” says Dr. Sarmela Sunder, a board-certified facial plastic surgeon in Beverly Hills. “The mouth doesn’t move as quickly [after surgery], and that draws the eye.” Patients know something’s off but can’t articulate what it is. “They’ll say, ‘Oh, I look plastic now’ or ‘I look like I’ve had something done.’”
While lip lifts can be “really challenging to fix,” Sunder can sometimes normalize the mouth’s movement with Botox.
A bigger predicament, says Sunder, are brow lifts that are too high, creating a startled expression. She employs tissue expanders and skin grafts to lower them, but not all can be fully reversed, especially if a considerable amount of skin was removed. “We may only be able to give them back a couple of millimeters when they really need a centimeter,” she says.
Nose jobs have one of the highest revision rates in cosmetic surgery, with studies citing a range of 5 to 15 percent. “It’s forever been known as the operation that is least forgiving and most finicky,” says Nayak. Michael Jackson reportedly endured multiple surgeries on his nose, making him an extreme example of rhinoplasty gone awry.
Experts can improve minor flaws, like nostril asymmetries and residual bumps on the bridge, fairly easily. A more onerous task, says Dr. Richard Reish, a board-certified plastic surgeon in New York City, is restoring a nose that’s been aggressively whittled to resemble Barbie’s (yes, the doll). The look is scooped, upturned, pinched—and currently trending.
Reish performs hundreds of rhinoplasty revisions each year and once treated a woman who “basically had no nose left,” he says. “Every morning, she would apply clay on her nose [to give it shape] and then apply her makeup on top of the clay,” he says. Reish rebuilt her nose using grafts over three surgeries in three years.
The most devastating result Chance has confronted are eyelids that can’t close following a blepharoplasty. While it’s rare, she says, when a surgeon removes too much skin from the upper eyelid, or alters the lower lid in a way that causes it to pull down, the unprotected eyeball becomes vulnerable to dryness, irritation, and infection. Chance refers these patients to three oculoplastic surgeons who are equipped to repair this unusual degree of damage.
What surgeons see more routinely are complications that crop up during recovery: prolonged swelling, stiffness, numbness, lumps, divots, and unattractive scars. Time resolves some of these, but a good surgeon can minimize them in the interim.
For the record, “not all complications indicate a botched surgery,” notes Dr. Steven Teitelbaum, a board-certified plastic surgeon in Santa Monica. The body can heal unpredictably and imperfectly. “Skin can stretch. Infections can happen. Scars can thicken and widen—and that’s outside of a surgeon’s control,” he says. What’s not, however, is “a scar that is so misplaced it looks terrible,” Kontis adds. “There are normal and expected problems, and then there’s way out of line.”
Patients bear some responsibility for their recovery, too. First, they must disclose exactly what medications they are taking before the procedure and cease anything the doctor prohibits, like blood thinners and unapproved supplements. (One nurse has noticed an increase in patients who lie about taking Ozempic and similar drugs—an omission that can cause patients to aspirate when sedated, because their stomachs aren’t completely empty for surgery.)
To avoid setbacks during recovery, patients have to follow their doctor’s instructions to the letter. Get the hyperbaric oxygen treatments and manual-lymphatic-drainage therapy, if advised. Avoid exercise and household chores for at least two weeks after surgery. Otherwise, one can experience swelling, poor wound healing, and hematomas. Sometimes the incisions widen and the scars need to be surgically revised.
Here’s where I’d normally spell out how to avoid all of the above. Unfortunately, “the only way to guarantee no complications is to forgo surgery,” says Nayak.
Indeed, procedures can go sideways. Recovery can be rocky. But you can protect yourself by picking a reputable plastic surgeon. Start by collecting personal recommendations from friends. Ask about their experiences, from start to finish. While it’s rarely written about, every surgeon I spoke to said that beyond technical excellence, a good surgeon must also be attentive—helping patients through each stage of recovery and addressing any issues as they arise.
The most qualified surgeons are board-certified by the American Board of Medical Specialties in plastic surgery or a related specialty, such as otolaryngology and head-and-neck surgery (for facial plastic surgery). If an oculoplastic surgeon is performing an eye lift, they should be board-certified in ophthalmology.
In vetting doctors, most patients are tempted to look at the photos on their Web site or Instagram. Realize that you’re seeing only their best work—and that social media is rife with deceptive pictures staged to glorify results.
The most reliable “after”s show patients months to years post-surgery, free of makeup and filters. Look carefully at the backgrounds, lighting, angles, and facial expressions to be sure they’re identical to those in the “before”s. From there, seek consistently impressive outcomes—and lots of them. Surgeons who specialize in face-lifts or nose jobs perform these operations almost every day, and their photos should demonstrate a “pattern of results,” says Talei. Audit the surgeon’s video content to get an idea of their personality, aesthetic, and bedside manner.
Even renowned plastic surgeons can have complaints. I discovered this for myself when writing about a facial plastic surgeon whose unprecedented fees attract both fascination and criticism. His reputation always seemed polarized: people on social media occasionally commented about his upsetting outcomes, but many of his peers gushed freely to me about his talent and techniques. Regardless, the intent of my article was to explore his controversial face-lift fees, not corroborate his skills or his shortcomings.
“Skin can stretch. Infections can happen. Scars can thicken and widen—and that’s outside of a surgeon’s control.”
But when the story went live, messages flooded my inbox with furious claims (mostly from private, unidentifiable Instagram profiles) that the surgeon had “botched” them, “butchered” someone they knew, and “ruined” their lives. People were outraged by what they viewed as an endorsement of this doctor.
The backlash served to cement a vital truth: influencer endorsements, scores of followers, exorbitant fees, and even professional accolades can sometimes be unreliable. Alongside proficiency, what plastic surgeons should also be marketing is compassion. “Not to be cheesy,” says Sunder, but the bond between a plastic surgeon and a patient is “a sacred relationship.”
The reality is, “every single one of us has had complications,” Chance tells me. When they occur, the only way to help a patient heal “physically as well as psychologically,” she says, is to take responsibility for the problems and treat them swiftly. When a surgeon disregards patients, they can feel minimized, duped, abandoned, and even—ultimately—botched.
Jolene Edgar is a writer who frequently contributes to Town & Country, Allure, and Harper’s Bazaar
