Post-cosmetic Surgery Problems: Causes, Prevention, and corrective techniques

• Corrective surgery can address common post-cosmetic surgery problems and complications. Explore causes, prevention, and effective techniques for correcting unsatisfactory results.
• Facelift surgery has many limitations, and results may not be as expected because facial structures vary from person to person. Each method can only address certain layers of facial structure.
• Breast augmentation with muscle splitting – without cutting the muscle from its attachment point – can prevent the silicone implant from shifting and reduce the risk of pulling or tension on the breast tissue when the muscle contracts. This technique provides long-term benefits and a more natural look.

1. Upper and lower blepharoplasty
2. Augmentation rhinoplasty
3. Rhytidectomy (facelift surgery)
4. Breast augmentation

Cosmetic surgery is highly accessible and safe, which has made it widely popular.  It is an option for achieving one's own version of attractiveness and to boost confidence. In addition to individual structural problems, there are also age-related sagging issues that require surgery to correct and improve areas such as the eyes, nose, breasts and face. However, undergoing surgery does not guarantee the same beauty for everyone. Some people are satisfied and want to have additional surgery to look even better, while others may be disappointed or even face issues that require correction.  

Upper and lower blepharoplasty, also called double eyelid surgery, involves the correction of droopy eyelids. Although it is considered minor surgery that does not take much time to complete or require fasting beforehand, it requires a highly skilled and experienced surgeon to achieve esthetically pleasing results.  

Common problems after eye surgery that may not meet expectations include eyelid creases being too small or too large, uneven creases or deformity, as well as post-operative issues such as crease detachment, inflammation or infection.

Causes of issues with upper and lower blepharoplasty

Unsatisfactory results from double eyelid surgery or the correction of droopy eyelids is a common problem. Many people undergo eye surgery and feel dissatisfied with the eyelid crease, thinking it does not suit their face, or that after correcting the eyelids, their eyes appear uneven. The causes include:

• Lack of thorough consultation with the surgeon, leading to misunderstandings  
• The wound being not fully healed while the patient is eager to see immediate results
• A surgical method unsuited to the problem, such as stitching the double eyelid crease without removing excess eyelid skin, or not removing enough excess skin, which over time can cause the eyelid to sag and push against the crease, leading to crease detachment
• Failure to remove excess fat or removing too little or too much 
• Eyelid muscle weakness
• Structural limitations of the patient's orbital bones

Methods to address problems after eye surgery
In addition to having a clear understanding of the patient’s needs and limitations, and importantly the doctor’s recommendations, the following methods can also be used to address problems:

• Patients should strictly follow the doctor's advice and attend follow-up appointments  
• Wait for true results within the specified time frame, which may take about 2-4 months after the surgical wound has fully healed, as the eyelids will become less swollen and look more natural  
• Choose an experienced surgeon for your eyelid revision surgery 
• For those with eyelid muscle weakness, the doctor may address the issue by tightening the eyelid muscles to enhance their strength, alongside other surgeries  
• Assess the overall facial structure before making corrections to understand the original condition and predict the possible outcomes, allowing for a joint decision-making process​​​​​​​

Rhinoplasty is a popular type of surgery, especially for those who want a prominent, attractive nose. However, it is also a procedure that frequently encounters problems, such as crooked or slanted noses, inflammation, or even nose tip perforation due to overly thin or tight skin or inflammation, and the nose shape not matching the desired outcome.

Causes of issues with augmentation rhinoplasty

• The original nasal base is crooked
• Inappropriate selection or shaping of the silicone implant
• Use of an unsuitable surgical technique 
• Trauma after surgery
• Previous injection of non-degradable filler in the nose, which may spread to surrounding areas, leading to nose deformity, chronic inflammation or fibrosis 
• Previous thread lifting to raise the nose, which caused fibrosis. If the threads cannot be completely removed before rhinoplasty, it may result in nose deformity.

Methods to correct problems caused by rhinoplasty
Common problems from rhinoplasty often arise from the patient's expectations, as well as issues with facial asymmetry. Patients undergoing revision surgery need to understand their original nasal structure and predict possible outcomes so that they can make a joint decision with the surgeon.

• In cases where thread lifting or non-degradable filler was previously used, correction must be done by surgically removing all remaining threads and filler before performing repeated rhinoplasty  
• In cases of crooked silicone or thin skin due to inappropriate silicone for the patient, correction can be made using either closed or open rhinoplasty to remove the old silicone and scar tissue, followed by inserting a new silicone implant more suited to the patient. Additional strengthening of the nose tip may be required using cartilage or artificial dermis.  
• In cases of crooked silicone or nose tip perforation caused by the original nasal structure, correction can be made using open rhinoplasty to remove the old silicone and scar tissue before reconstructing the entire bone and cartilage structure. Special techniques must be used, including the use of ear cartilage or rib cartilage to help reshape the entire structure.  

Precautions following rhinoplasty

• Rest for the period specified by the doctor, take medications, and follow the doctor's advice
• Avoid activities or sports that may cause impact for about 3 months, as the nose will settle into its final shape within 1-6 months after surgery 
• Infection and inflammation can occur with any surgery, but the chance of infection for rhinoplasty is generally less than 0.5%. However, doctors provide antibiotics medication before and after surgery to all patients.

In addition to having clear and beautiful skin, many people also desire a firm and youthful face despite the passage of time. There are now various face-lifting methods to choose from, tailored to address sagging according to individual needs:

• Filler: Besides filling in nasolabial folds, filler can also help naturally lift the face. It works by filling in the underlying structure to make the skin appear lifted. Filler injections can be applied in a series of sessions for specific areas of the face or completed in one session.   
• Botulinum toxin: This treatment reduces wrinkles and can realign the facial muscles, giving a firmer appearance and a more defined jawline. There are two techniques, as follows:  
  • Dermolift: Botulinum toxin is injected into small points along the skin of the face, particularly around the jawline.
  • Nefertiti lift: Botulinum toxin is injected into the lower facial muscles and neck, helping to define the jawline.  
• Thread lifting: Suitable for individuals with sagging at the cheeks and corners of the mouth, or those with undefined jawlines. It can also lift the eyebrows and eyelids. Currently, barbed threads are more popular than smooth threads, as the barbs grip the sagging tissue and reposition it, providing an immediate lifting effect. This procedure also stimulates collagen production around the threads. Common issues with thread lifting include bruising, swelling, and visible thread lines after surgery, although the face typically looks more natural after 2-4 weeks.  

However, these methods have several limitations and results may not always meet expectations, as facial structures vary among individuals. Additionally, each method can only address certain layers of the facial structure, and the effects are temporary, meaning frequent repeat procedures are required.

Facelift surgery
This is a procedure that adjusts the structure of muscles, the muscle membrane layer (SMAS), and sagging fat layers to return them to their proper position. Importantly, it allows for the removal of excess skin to make the skin tighter, reduce wrinkles, and provide a smoother and more natural appearance. Facelift surgery is suitable for those with wrinkles or sagging skin, or those who want to adjust their facial structure for a more youthful look. 

The advantage of facelift surgery is that it provides clear, predictable and long-lasting results, effectively addressing all layers of the facial structure at once. 

However, various face-lifting methods may lead to undesirable outcomes. The main cause of such issues is selecting a treatment method that does not match the patient’s condition. Other causes include:  

• Lack of thorough consultation with the surgeon, leading to misunderstandings  
• The wound not being fully healed, but the patient being eager to see immediate results 
• Structural limitations of the patient's facial bones

Methods to address problems caused by facelift surgery
In addition to ensuring a clear understanding of the patient’s needs and limitations, as well as the doctor’s recommendations, which is very important, the following methods can also be used to prevent problems:

• Strictly follow the doctor's advice and attend follow-up appointments  
• Wait for true results within the specified time frame, which may take about 2-4 months 
• Choose a surgeon experienced in this type of surgery  
• Assess the overall facial structure before making corrections to understand the original condition and predict possible outcomes, and then make a joint treatment decision

Precautions for facelift surgery are as follows:

• Patients who are overweight should lose weight before surgery for best results 
• Underlying health conditions can contraindicate surgery, such as hemophilia or Ehlers-Danlos syndrome  
• Patients with diabetes, high blood pressure or high cholesterol must have their conditions well controlled before surgery can take place  
• Those with a history of keloid scars should not undergo surgery
• Pregnant or breastfeeding women should not undergo surgery 
• Patients who have had Botox, fillers or thread lifting on the face should wait 3-6 months before surgery
• Patients who have undergone laser treatments should wait 4 weeks before a facelift 
• Smokers should stop smoking at least 4 weeks before and after surgery 

Breast augmentation surgery helps address the concerns of individuals who have small breasts and want to increase their size, as well as those with overly large breasts who wish to reduce them to a more proportionate size. It also helps lift, firm and adjust sagging breasts or those that are spaced too far apart or too narrowly, in order to make them appear more natural.  

Breast augmentation can be performed using implants or by injecting the patient’s own fat into the breasts. The current standard is the use of silicone implants, which may be combined with fat injections to enhance the natural appearance of the breasts, particularly in slimmer patients, who should first undergo a thorough consultation process in order to understand the possible outcomes of fat injections.

Breast augmentation techniques
There are two main types of silicone placement in breast augmentation: over the muscle and under the muscle, each with its own advantages and disadvantages. However, modern surgical advancements have led to improved techniques, including:

• Dual plane silicone placement combines the benefits of both over the muscle and under the muscle techniques. In this method, the silicone is placed partially under the muscle, with the upper part of the implant under the muscle and the lower part over the muscle. This technique helps to conceal the edges of the implant, providing a more natural look and reducing the risk of capsular contracture. However, the dual plane technique involves cutting the muscle from its attachment point, which can reduce muscle strength and cause issues with the reattachment of the muscle in a new position. This may lead to the shifting of the implant and visible pulling of the breast tissue when the muscle is flexed or during exercise (Also called Breast Animation). A more recent development in breast augmentation is the muscle splitting technique, where the upper portion of the muscle is separated along the line of muscle fibers to create a pocket under the muscle to hide the silicone edges without cutting the muscle from its attachment point. This helps prevent implant movement and visible tissue pulling when the muscle is flexed, providing long-term benefits and a more natural appearance.

Breast lift surgery techniques

• Donut technique: Suitable for moderate sagging, where the nipple is 1-3 cm below the standard level. The skin around the areola is cut in a donut shape, then sutured inward to tighten the area. This technique can also reduce the size of the areola, with the scar around the areola barely noticeable.  
• Lollipop or vertical technique: Suitable for severe sagging, where the nipple is 2-3 cm below the breast fold. Excess skin is removed, and the nipple is repositioned higher up the breast. The skin from the outer and inner parts of the breast is moved toward the center, causing the breast to lift, with the upper breast and nipple maintaining a rounded, aesthetically pleasing appearance.  
• Wise pattern technique: Suitable for individuals with large or significantly sagging breasts, where the nipple is more than 3 cm below the breast fold. This involves a vertical incision from the nipple down to the breast fold, along with an incision under the breast to remove excess tissue. The breast tissue is then tightened under the breast fold, and the nipple is repositioned appropriately.  

All breast lift procedures can be combined with breast augmentation to achieve fuller, more esthetically pleasing breasts.

Breast surgery requires careful consideration of the patient’s original chest structure, a suitable surgical plan, and careful selection of the surgical technique and type of breast implant to prevent complications. 

However, with the growing number of providers offering this surgery, there is a greater chance for problems to arise, such as uneven breasts, breasts that are too far apart or too close together, silicone shifting from its proper position, rapid sagging after surgery, unattractive scarring, and many other issues.

The best advice is to choose a surgeon who specializes in this field. Making an appointment for a consultation with a specialist allows for all questions to be answered and various correction methods to be considered. Once confident, a decision can be made to proceed with treatment.

Cosmetic surgery is performed to enhance one's vision of their own beauty in the most natural way possible, improving appearance and self-confidence. The key lies in individual satisfaction and necessity. Therefore, it is essential to choose a reputable medical facility and experienced surgeon. You must also be sure that you understand your own limitations, expectations and results, and then follow pre- and post-operative care instructions.