As the demand for plastic surgery continues to grow, so does the desire for revisions.
Following a pandemic-era boom in plastic surgery (with procedures increasing 19% from 2019 to 2022), about 1.6 million Americans got cosmetic surgery in 2024, according to the American Society of Plastic Surgeons.
When those cosmetic procedures go wrong — or simply could be improved upon — some patients go to Dr. Anthony Berlet, a board-certified plastic surgeon with practices in New York City and Cedar Grove, New Jersey.
“I have sort of a reputation for doing the redo surgeries,” Berlet told Business Insider. “I fix people up from botch-jobs, so I see a lot of it.”
Of the 176 surgeries he’s performed in the last six months, nearly half, 43%, were patients seeking revisions after getting prior work done.
Patients expected that some procedures, like breast implants, would need to be redone because they have “expiration dates” and need to be updated in 15 to 20 years. Others, like getting too much filler or a poorly done facelift, require touch-ups from Berlet.
It can be costly. In addition to the original procedure (the average facelift costs around $18,000 but can go up to $50,000 to $100,000), a facelift revision starts at about $25,000 for Berlet.
Still, it’s not slowing down business for Berlet, who said social media and heightened awareness of high-quality plastic surgery can make people seek out the best possible results — even if it takes a few tries to do so.
“Every day is a little bit of an adventure,” he said. “You see patients coming in and they’ve been living with crazy things, like awful nose jobs for years, and they just thought that was the natural course.”
Berlet shared his most commonly requested revision surgeries — and why seemingly simple procedures like filler injections can be costly to clean up.
Eye lifts are all the rage — including revisions
Eye lifts have become one of the most popular plastic surgeries in the US. Berlet said they’re his most commonly requested procedure in general. That included eye lift revisions, which made up 30% of his redo surgeries in the last six months.
“I do eyelid surgery literally every day,” he said. Even if his patients, who mostly range between 40 and 70, had quality surgery in the past, it may not age very well because “everyone ages a little bit differently.” In general, he said they “last” 10 to 15 years before he recommends a touch-up.
“I see a lot of sags — the lower lids have too much bow to them, so you want to clean that up,” he said. He said the eyes can have residual bags left over or hooding over the upper lids. “There’s a lot that goes on with eyes.”
Older nose jobs can benefit from an update
About 20% of Berlet’s revision requests were rhinoplasties, or nose jobs.
He said people who got nose jobs decades ago might have disliked the look for years or even struggled to breathe properly.
“The older rhinoplasty didn’t rebuild the middle vault of the nose, which was really affected in breathing and gave it a pinched-in look in the middle,” he said. Now, plastic surgeons like Berlet use spreader grafts — thin pieces of cartilage — to open the septum more, providing a stronger nasal structure.
He said improperly done nose jobs run the gamut, though. The tip of the nose can experience “all kinds of warping” if not reinforced properly. At Berlet’s office, a revision usually starts at around $15,000.
Breast implants can come with baggage
Breast implants, which made up around 15% of Berlet’s revision surgeries, are often necessary updates on implants from decades ago.
“The older implants, they could get firm, they could malposition, they could create asymmetries,” he said. Other people come in after having breast lifts and fills at the same time, “so there’s a multitude of things that can go wrong there,” he said. According to the American Society of Plastic Surgeons, getting both procedures at once has a 23% complication rate, including hardening around the implant, scarring, and drooping.
At this point, Berlet usually just removes the implants without replacing them, returning their patients to their original breast sizes. He said he’s considering using newer versions of implants in the future because they “reduce the redo rate significantly.” But for now, implants can be more trouble than they’re worth.
“That was a big decision a couple of years ago,” he said. “I just stopped putting them in.”
Swapping filler for fat
Berlet said that close to 10% of his revisions are related to fat-grafting to tweak facelifts or, most commonly, overdone filler injections.
“It can look very unnatural once you overfill — you see that all the time,” he said. Under-eye filler is one of the more common ones he tweaks. “They’re swollen because there’s chronic inflammation.”
He usually dissolves the filler and replaces it with the patient’s own fat cells, taken from parts of the body like the abdomen or thighs. ” Fat-grafting provides a softer, more natural result,” he said, because it integrates with the surrounding tissue in a way that synthetic filler cannot.
While fat-grafting is more expensive and invasive than getting filler, patients also won’t experience the same inflammation and side effects they do from filler migration. “It also has stem cells that improve the quality of the skin,” he said.
Facelifts often look better the second time
Berlet said he performs 2 to 3 facelifts a week. At least half are redos, some of which involve removing excess filler.
“When you elevate the flaps for the facelift, some of it just literally oozes out,” he said. Some of it is too embedded to be fully removed. “You may leave some of it, but you’re reshaping the face and getting everything back where it should be.”
When it comes to facelifts, he said the best results — like Kris Jenner’s viral surgery — come from having work done in the past. “I prefer to do a revision facelift,” he said. “You can modify the incisions — it’s just hidden better. You can do all these things that make their first facelift look like a nightmare.”
Sometimes, what drives people to get redos isn’t necessarily bad work in the first place. It’s knowing that subtler results are available.
“They come back and they’re like, ‘Oh my God, this is the greatest thing ever happened,'” Berlet said. “I get a little happiness out of that.”
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