‘Botched’ doctor on the ethics of extreme plastic surgery

When done for the right reasons and with realistic expectations, plastic surgery can have a positive impact on a patient’s life. Yet unfortunately, there are some extreme cases that go wrong, as Dr. Paul Nassif of E! Entertainment Network’s “Botched” knows all too well. Extreme plastic surgery often tests the bounds of medicine and ethics and can end with unnatural results and even medical malpractice lawsuits.

Dr. Nassif spoke with Real Self and Avvo to answer our top six questions about extreme plastic surgery.

Q: How do doctors decide when a patient’s request is too much?

Dr. Nassif: One of the key characteristics of a patient who is a good candidate for surgery is realistic expectations. Patients with unrealistic expectations often desire surgical modifications that can appear unnatural and will not complement their natural facial features. Unsurprisingly, these patients are more likely to be unhappy with the end result.

Q: Why is there always a doctor who says yes to extreme plastic surgery?

Dr. Nassif: Surgeons have their own comfort level that dictates what they will or will not do in the operating room. Surgeons also have aesthetic visions specific to their background and training; these visions may influence their decision to say yes or no.

RELATED: Extreme plastic surgery: Who decides what’s ethical?

This is why it is so important for patients to do their homework, read reviews and choose a skilled and experienced surgeon they feel comfortable with.

Q: What are some warning signs of extreme plastic surgery?

Dr. Nassif: Extreme plastic surgery is often characterized by an unnatural result, where the patient has clear aesthetic or even functional issues with the end result. For example, with an overdone rhinoplasty, a patient may have a nose that is too small, pinched or over-rotated. And a pinched appearance can mean the nose has collapsed, which usually leads to trouble breathing.

With plastic surgery, less is often more. A conservative approach is generally best for a great outcome.

Q: What are common results of unclear or unrealistic expectations? 

Dr. Nassif: Good communication between doctor and patient prior to surgery is essential. This is very important to ensure that the patient is happy with the end result. If that connection is not present and expectations are unrealistic, the patient may not be a good candidate for surgery.

Aside from the skill and expertise of the surgeon, communicating needs effectively and ensuring that patient and surgeon are on the same page prior to the procedure are the best bets for a fantastic outcome.

Q: Is there a psychological test patients must complete before undergoing an elective treatment or surgery?

Dr. Nassif: It’s important for all plastic surgery patients to undergo psychological clearance prior to having surgery. This can help determine whether the patient is having surgery performed for the right reasons. The clearance also lets the surgeon know that the patient is psychologically stable and can handle all necessary steps, both pre- and post-op, to promote the best possible recovery.  

Q: If a procedure doesn’t go quite right, what’s important when considering a plastic surgery revision following a surgery that didn’t go quite as expected?

Dr. Nassif: One of the most important things to consider when having a revision surgery is the surgeon’s experience with correcting work performed by other doctors. Revision surgeries are much more complex than primary procedures, and they often include factors such as scar tissue, three-dimensional healing and shrink-wrapping of the skin.

It is also important to consider credentials, board certification and the before-and-after photos that showcase the surgeon’s previous work with revision surgeries. This helps ensure that the surgeon can deliver results and also gives the patient a general idea of what to expect following surgery.