When Is It Too Much?
A personal perspective

When you look around in a restaurant and can tell at a glance from across the room which women are no strangers to cosmetic surgery...it is probably 'too much'. 'Too much' for me is when basic anatomy has been distorted out of proportion, and it often can be that last little 'tweak' that pushes a patient over that line, when cosmetic surgery does more harm than good.

You can spot them a mile away. .

The most obvious culprits commonly associated with 'too much' surgery:

1. OVERDONE NOSES - scooped dorsums, pinched tips, too small for your face, too short, you can see inside the nostrils
   
2. OVERSIZED OR MALPOSITIONED FACIAL IMPLANTS - cheeks, chins and lips
   
3. EYES WHICH DON'T CLOSE - scleral show, lid lags, upper lids so tight they squeak, Almond-shaped or cat eyes (too much lateral pull or too many mini or upper facelifts)
   
4. WIND TUNNELS - too tight facelifts which erase the natural lines of expression
   
5. OVER PEELED - shiny, white, de-textured skin which doesn't match the neck, hands, chest
   
6. DUCK LIPS - overplumped, overfilled, overimplanted lips with palpable ridges which interfere with the natural ability to smile and pucker
   
7. HIGH BROWS - the 'what are you staring at' look of an overlifted brow
   

Cosmetic surgery 'victims' (OR ADDICTS, if you will) often fall into these categories:

1. Those who love 'bad' or obvious plastic surgery and wear it like a badge of honor or status
   
2. Those who don't know the work is bad
   
3. Those who aren't happy with their cosmetic surgery, but don't know that it can be improved
   

Many procedures are reversible, or can be improved or made to look better if the patient (and/or the surgeon) is not happy with the result. For example, overdone noses may be altered with autologous and alloplastic implant materials often used to build up depressions and scooped out profiles and add projection to over-shortened tips. Facial implants can be taken out, and either left out permanently or exchanged for a smaller implant or repositioned where the implant should have been placed originally. Some surgeries are more difficult to repair; i.e. Eyelids. The delicate eyelid skin is the thinnest skin on the body and tends to be very unforgiving. Facelifts which result in asymmetries, or the direction of the pull is in the wrong vector, or too tight, etc. can leave patients with the option of waiting until the facial skin loosens up on its own, or consult the surgeon about re-opening the incisions and redraping the skin for a smoother, more natural result. The downside is that you have to start the healing process all over again.

If You're Unhappy,...

• FIRST - Return to the surgeon who performed the original surgery and ask for his advice before you do anything else. Tell him what you are unhappy about and ask him if anything can be done to improve what you don't like.
  
  
• NEXT - If you have lost some confidence in your original surgeon, OR if you prefer to consult with another plastic surgeon about your options, seek the advice and counsel of a plastic surgeon who is skilled at doing secondary procedures and has a reputation for doing this type of work. Not all plastic surgeons are good at secondary rhinoplasty or eyelid revisions. It takes a greater degree of training, expertise and operating experience at these delicate and fine surgeries to master the art of secondary surgery. AND it is important to remember that secondary surgery is more difficult for the surgeon to perform, and more difficult to predict the outcome with any degree of certainty. Another key point to consider is that secondary surgery is usually not recommended for the first six to twelve months after your original surgery. The final result at that point is often very different from what you see at two or three months postoperatively, and many minor imperfections will resolve on their own with no additional surgical intervention necessary.