Realself.com is a public forum for asking questions about cosmetic procedures which patients have had or are thinking of undergoing to the website’s participating physicians.  The website allows doctors of the following specialties to respond:

  1. Plastic Surgeons
  2. Facial Plastic Surgeons
  3. Dermatologists
  4. Oculoplastic Surgeons

Unfortunately, experience and credentials are not always fully evaluated by the public, and undesired outcomes, often with long term repercussions, can result.  Sometimes with only a few weekend courses under their belt, Internists, Family Practitioners, Dentists, ER Physicians or OBGyns hang up a shingle Aesthetic Procedures.  An article by Tom Seery, CEO of Realself.com, points out that consumer satisfaction rates are about 30-35% higher when a specialist is performing Botox or Dermal Fillers vs. “all providers”.

Now for the most Botched Cosmetic Procedures:

1.  By far, the #1 most botched procedure is tear trough injection with fillers.  Complaints range from lumps, prolonged swelling, worsening of appearance, pain, prolonged bruising, vascular injury, numbness, and firm nodules.  The skin around the eye is very thin, and there is very little room for error in this procedure.  Dr. Weiner is a firm believer that this injection should be performed using blunt cannulas with Restylane.  There is less swelling, bruising, and significantly less vascular risk with cannulas.  Lesson:  Leave this injections to “the pros” for better outcomes and safety.

2.  Botox being botched is a close 2nd.  Common problems are eyebrow or eyelid droop, uneven smile, ineffectiveness, bruising or swelling, or “Dr. Spock” look.  Sometimes a touch up can improve these results, but often one has to wait for the Botox to wear off.  This can be 3-4 months.  So that deal on Botox that is supposed to improve ones looks becomes a nightmare where one looks abnormal and/or worse.  Lesson:  Botox deals aren’t usually worth it.

3.  Laser hair removal resulting in burns is fairly commonly asked about on Realself.  If the laser operator is not using the appropriate laser or settings for one’s skin type, permanent pigmentation problems can result.  Fortunately, most superficial burns will reverse over the course of several months.  In several states, rules for operating a laser are very lax, allowing techs without significant training to use the laser.  Florida is one of the strictest in the country.  The operator can only be a nurse practitioner, physicians assistant, doctor, or specially trained electrologist.  Lesson:  Get the most qualified person to operate the laser, preferably a physician with years of laser experience.  Dr. Weiner has over 25 years of laser experience.

4.  Lip augmentation with dermal fillers is another highly botched procedure.  The most common lip problem is uneveness and lumpiness.  These are a direct result of poor technique by the injector.  Hyaluronidase to dissolve the filler is usually required, and then you are back to where you started (so 2 procedures to get back to square one).  Bruising, swelling, and prolonged downtime is seen when lips are injected using needles in combination with injector inexperience.  Dr. Weiner is a huge fan of using blunt cannulas for the lips to minimize the recovery time and bruising.  Overfilled, and unnatural lips are also a problem, mainly due to lack of knowledge of the natural anatomy of lips by the provider.  Lips should have a ratio of about 40% upper to 60% lower.  When the upper lip is larger, or the natural landmarks (tubercle, cupids bow, shape) are not preserved, the lips become obviously “done” and unattractive.  The sausage lip is when the lips appear tube like (like a sausage link) which is another common error by the inexperienced injector.  Lesson:  Lips are another area with several intricacies  that require an experienced injector.  Cannulas limit bruising, swelling, and downtime so you can enjoy your lips without interrupting your social life.


The take home message is that all providers are not equal.  Please do the homework, look at reviews, ask friends, and ask the facility “Who is actually doing my procedure?”.  In general, specialty trained physicians will give better outcomes with higher satisfaction rates.

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