Inside Scoop: BOTCHED Docs Terry Dubrow & Paul Nassif Take On Bad Plastic Surgery

At the NBC press day, Real Housewives alums Drs. Terry Dubrow and Paul Nassif talked about some of the wild things viewers will see this season on their show Botched. It’s equal parts fascinating and sad.

Botched premieres April 14th at 9pm on E!

This season, you have a man who almost looks like a Ken doll. How do you help him?

Terry: Actually, his name is Justin Jedlica, and he was rejected last season for body implants that we thought were a bad idea. But this season we bring him back for a very specific reason, not gratuitous at all, and it actually turns out to be extraordinarily helpful. So you’ve got to stay tuned and see. But he was amazingly advantageous for us this season.

Did he want a body implant?

Terry: No ‑‑ well, he may have helped us with another patient. So, he wanted back implants and abdominal implants. Last season we rejected him.

What’s the purpose of back implants?

Terry: You know, he basically wants to look like Tarzan or something, right? Hercules. I call him the skinny Hercules. But he wanted back implants in his latissimus area to build up his back rather than go to the gym. You know, call me crazy.

Some people clearly have issues if they’re getting dozens and dozens of surgeries. In your practices, do you have a policy where, if somebody has had a certain number and they just want more, not necessarily to get something fixed, that you won’t do it?

Paul: You know, I’ll answer that one to start off with. There’s something called body dysmorphic disorder. And what we’ll do is — we may not pick exactly how many procedures that person or patient had, but we actually listen to them. We talk to them. We hear their story. We have to be ‑‑ become psychologists during or examinations. And so, I mean, for example, is every one of my patients before surgery actually goes to see a psychologist to make sure they’re ready for surgery. So I’m going to say that we probably turn away about 10% of our patients that just are not good candidates, for one of many reasons.

Terry: For me, it’s about ‑‑ it depends why you want to have a surgical procedure. If you’ve had 12 and you’ve been botched and somebody out there can’t fix them, and they come to us as their last‑ditch effort, we will do that. And if you watch Season 2 of “Botched,” it’s like Season 1 on steroids. I never knew the scope of the problem. And we’re their last hope, so we will do those kinds of patients. But if you’re trying to make minor changes to become perfect, that’s not going to work.

What is the one plastic surgery operation that nets the most number of bad results?

Paul: For the face it’s the nose. I mean, the nose, because of something called three‑dimensional healing and shrink‑wrappage of the skin of the nose, you have about a 22% ‑‑ or let’s just say one in five patients needs a revision, a touchup. And the thing with the nose is if you just make a little bit of a cut here that can ruin the nose later on. So it’s something that has the most risks in regards to breathing and cosmesis because it’s right in the middle of your face. So that’s what I’m going to say.

Terry: Yeah, in the body it’s a numbers game. Breast augmentation being among the most common plastic surgery procedures there are, so it will have the most common number of complications. Plus, as opposed to a facelift or a nose or liposuction, when you’re done doing the breast augmentation and they have healed, that isn’t necessarily the end of the story. They can go on to develop capsular contracture or scarring, even many years later when everything has really quieted down. So a lot of complications associated with having a foreign body put in you.

Do people constantly ask you what work they should have done? Do you look at people and imagine what could be changed?

Paul: Oh, boy.

Terry: For me, when I see a person out there who has had a disaster problem from plastic surgery, I want to sort of go up to them and say, “I think we can help you.” If it’s just something, sort of a large nose or big saddlebags, I don’t even really notice that anymore. In social situations, though, the only time I really think about helping my friends is when he’s having, like, dessert and I’m looking at his chest, and I’m thinking, “This guy needs a breast reduction. He’s got these huge boobs.” [Laughter] That’s about it.

Paul: That’s a constant tension I have to deal with all the time. But in social situations though, you know, one thing that happens to us all the time ‑‑ and it’s happened for years ‑‑ because this is something that, if they know you’re a plastic surgeon, that’s routine: “What do I need? Do I need to have my eyes, my face, my breast?” That’s something that we deal with all the time. But what we try to do is always make a joke out of it ‑‑ because we don’t want to do that. We don’t want to talk about what that patient can actually use.

Is there a recurring pattern of certain doctors that you see their work having been done badly and are there any repercussion when you have to deal with those doctors professionally?

Paul: That’s a great question. I mean, first of all, from this show ‑‑ because we had over 6,000 applicants try out for the show this year. And there might even be more than that. And there’s different situations, either, one ‑‑ it’s not one specific area, but it’s patients that have gone to Mexico and that have had cheap plastic surgery and have been in these little “clinicas” that are ‑‑ you wouldn’t even want to have your animal operated on. That’s number one.

Two, there’s a lot of patients that will go to a back of a salon or something and have procedures done by not physicians, let’s say just by ‑‑ somebody who does your hair injects something in your face.

The other aspect of this is when you have sometimes doctors that we’ve seen that have been on drugs, been on heroin, that have been actually crazy or they do weird things. I mean, that happens also. But then at the other point, we have our friends and ‑‑ who maybe are good surgeons, but somehow there just was a bad complication.

But in regards to somebody recurring all the time, I don’t really see that in regards to doctors in the area doing constantly bad work. At least from my area I don’t. What about you?

Terry: I mean, I have seen a couple of what we call frequent flyers who are doing sort of the same mistake over and over again. That’s typically in the cosmetic surgeon, those doctors who aren’t really trained in plastic surgery but decide to take a weekend course, and they’re applying principles that are incorrect to problems that are inappropriate. So we do see that. And I’ve seen a couple doctors recently lose their licenses because they’ve done it so many times.

Paul: And there’s actually dentists out there doing facelifts and nose jobs. And patients will actually go to them. So it’s crazy.

Have you ever had to deal with someone who had work done at one of those illegal injection parties?

Terry: We encountered that on “Botched” this season in a big way. We had a patient who had cement injected into her face. In that setting, the individual who did it is in prison. But I do see that, and I work for the California Medical Board. I’m an expert for them, certified medical expert. So I do report things that I know to be illegal. And it’s actually unethical not to do so as a physician. So we do that.

We’re now in the age of the booty, so are you seeing a lot of enhancement procedures that have gone wrong?

Terry: We see that in a big way on “Botched,” Season 2. And I think the reason that we are seeing a lot of enthusiasm for the age of the booty is ‑‑ in no small part due to that really popular show on our channel with those attractive large breasts and buttocks. [Laughter]

But we do see a lot of patients this season who have gone down to Mexico for some of those enhancement procedures. And as opposed to using butt implants, they use other things, which you can see from that tease there. They use breast implants. They have all sorts of weird substances from Europe injected into their buttocks. We see a ton of disasters right now. So buttock augmentation is still in the learning curve phase for a lot of surgeons. So you’re seeing it’s the wild, wild West of the big butt right now. We’re seeing all of the side effects associated with that.

You guys certainly are familiar with the “Real Housewives” franchises. Among all of the women on those shows, is there someone whose work you would point out to being really stellar? And conversely, are there women who might be candidates for your show, for “Botched”?

Paul: I’m not going to even answer that one. [Laughter] I’m going to say no comment because, you know, especially when I was on “Beverly Hills,” there were some episodes when they were coming into my office for fillers, and I think I did a facelift on one. But it’s interesting. As you watch, you know, what happens with some of these patients, especially ‑‑ there was something that was tweeted to me yesterday regarding one of the women. I’m not going to mention it, but it’s apparently all over Instagram and Twitter right now, about someone on our show, my old show, that has had so much stuff done in the last two months that it looks like a different person. So they said, “We want this patient” ‑‑ they want her on “Botched” to have her fixed. But I got to tell you I saw the photo of this person, and my God, completely different. Cheeks are blown up. The lips are pulled apart like this. And this is someone pretty young. So I was pretty shocked.

Terry: I think on the “Housewives” what a lot of them do is, right before the season starts, they think to themselves, “Ooh, I need to ‘shuzh’ me up”; right? “I need a pickup,” right? So they go and have a surgical procedure, and right in that two‑ or three‑week period where you should not be in the public eye, they’re on national television. And they shoot this stuff, and they look kind of altered and “Where did they park their spaceship?” kind of thing. [Laughter] But, you know, anybody who is giving my wife a hard time needs to be fixed, as far as I’m concerned. [Laughter]

Can you talk a bit about the filler trend?

Paul: Yeah, I mean, well, first of all, as you know, most of the ‑‑ the reversible ones, hyaluronic acids, just even with those fillers, if you have the wrong injector ‑‑ I think that might be the right word to use on this ‑‑ someone who does not know what they’re doing, especially when ‑‑ Terry was talking about non-cosmetic surgeons or somebody who doesn’t have that cosmetic experience. They’re going and learning how to do an injectable quickly. And they inject it in the lower eyes. They inject in the wrong areas. Then you get these deformities. But Sculptra and Radiesse, even they do go away, they usually don’t cause that much scar tissue. Maybe Sculptra does. But it really just depends on not using the permanent, non‑FDA‑approved, illegal fillers, because ‑‑ that’s where your problem is. What’s happening is a lot of these patients will go and they’ll get something injected which is permanent, but ‑‑ it’s not a good filler. It’s something that’s possibly non-medical‑grade silicone, for example. And you inject that in the face, you’ll destroy it. And that’s why watching our show last year, watching it this year, you’re going to see a lot of that.

And these patients, their lives are ruined. Then, plus what it does, too — it can disable you. It can travel throughout your body. It can kill you. It can actually get you paralyzed. All these things could happen.

Terry: In my experience, although we call them non-invasive, which is sort of a euphemism for, “It’s not surgery, so it’s easy and OK,” that’s complete B.S. “Non-invasive” means we inject it with a needle under the skin. And just to your point, when you inject Sculptra, Radiesse, you can get into the infraorbital vessels, which track back to the eye and cause blindness. And we are seeing that now. So the inexperienced, untrained injector of FDA‑approved substances right now is causing a ton of problems that we are seeing in our practices. And I mean, Sculptra, although it goes away, the side effects can be very significant: nodularity, scarring, blindness, all sorts of things. So you’re exactly right. It can be quite grotesque.