Why revision happens
Revision is not synonymous with negligence, and treating it as such prevents useful conversation. The reasons fall into several categories.
An unavoidable feature of the biology. Grafted fat is reabsorbed unpredictably, so a second fat grafting session is frequently anticipated from the outset rather than being a correction. This is discussed at fat transfer.
A technical outcome within the range of normal. Mild asymmetry, a small contour irregularity or a dog-ear at the end of a scar can occur even when everything was done carefully. Bodies are asymmetric to begin with, and healing is not uniform.
A mismatch between operation and anatomy. A liposuction performed on skin that would not retract, or a mini-abdominoplasty performed on laxity that extended above the navel. These are avoidable through better assessment, and they are the most common source of disappointment.
A technical error. Over-resection, working too superficially, uneven removal, a poorly positioned scar.
A change in the patient. Weight gain, weight loss, pregnancy or the passage of time altering a result that was originally satisfactory.
An expectation that could not have been met. Where the outcome sought was never achievable by the operation performed.
Only two of those categories represent something going wrong in theatre, which is worth remembering both when considering revision and when interpreting a surgeon's revision rate.
Why the second operation is harder
Revision surgery is technically more difficult than primary surgery for reasons that are structural rather than a matter of effort.
Scar tissue. The operative field contains fibrous scar rather than the uniform tissue planes of a first operation. It cuts differently, it does not separate cleanly and it is harder to work in evenly.
Altered blood supply. Previous surgery has divided vessels and changed how the remaining tissue is perfused. That raises the risk of healing problems, particularly where skin has been lifted before.
Less to work with. Where the first operation removed too much, the material needed to correct it is gone. Fat grafting into a scarred bed is the usual approach, and grafts survive less predictably in scarred tissue than in healthy tissue.
Distorted landmarks. The anatomy a surgeon uses to orientate has been altered.
The consequence is that a revision result is less predictable than a primary result, and that partial improvement is a more realistic goal than restoration.
What revision can realistically achieve
Often correctable, at least partly: residual volume that was left behind, dog-ears at the ends of a scar, a scar that has widened where tension can be reduced, asymmetry where one side has more to remove, and mild contour irregularity where surrounding areas can be blended.
Difficult and partially correctable: moderate contour irregularity, depressions from over-resection, and asymmetry where the deficient side is the problem.
Very difficult: skin adherence where the skin has healed down onto deeper tissue, severe over-resection, and results where the underlying issue was skin quality rather than volume.
The general principle worth carrying is that removing more is usually easier than putting back. That is also why under-correction at the first operation is a more recoverable error than over-correction, and why a surgeon who deliberately stops short is usually protecting you.
Timing
Revision should not be considered until the primary result has settled. That means many months, and in most cases the far end of the first year.
The reason is that swelling resolves unevenly, firmness softens over months and scars remodel for a year or more. A great many problems that look permanent at three months have resolved by twelve. Operating on an unsettled result means operating on something that was going to change anyway.
There is one exception: a complication needing treatment, such as a collection requiring drainage or a wound needing attention, is dealt with when it arises rather than deferred. That is treatment rather than revision.
Who pays
This is the question people most regret not asking before their first operation.
Practice varies. Some surgeons include a revision within a defined period at no charge or at facility cost only. Some charge in full. Some distinguish between outcomes attributable to the surgery and those attributable to patient factors or to the passage of time.
What matters is that the policy is known, in writing, before the first operation. The questions to ask are: what is included, for how long, who decides whether a revision is warranted, and what costs remain payable if it is agreed.
A provider whose revision policy is clear and written is easier to trust than one who says the question will not arise. It arises.
The same surgeon, or a different one
There is no universal answer. The original surgeon knows what was done, has the operative record and may have a policy that covers the revision. A new surgeon brings a fresh assessment and no investment in defending the first result.
What is not reasonable is being unable to obtain your operative record. You are entitled to your medical records, and any second surgeon will want them. If a provider is obstructive about that, it is a matter for the facility and potentially for the regulator.
Where the original operation happened abroad, obtaining records can be difficult or impossible, which is one of several practical points made at cosmetic surgery abroad.
Deciding whether to have one
Revision is another operation, with the same risk register as the first plus the added difficulty of operating in scarred tissue. It is not a correction in the sense of an undo.
Questions worth asking yourself: what specifically am I hoping to change, is that on the list of things revision can achieve, what does the surgeon say the realistic improvement is, and what happens if it does not work.
Accepting a result you did not want is a legitimate option and sometimes the wiser one, particularly where the achievable improvement is small and the risk is not. Our page on deciding not to proceed applies to second operations as much as to first ones.