Botched (2014–…): Season 7, Episode 12 - Oops, I Need Surgery Again - full transcript

A woman's nose is Jamaican her crazy, and she hopes Dr. Nassif can give her the Tiffany Pollard profile she's always wanted. Meanwhile, a singer obsessed with the 2000s and Brittany Spears seeks bigger boobs, and Dr. Dubrow helps a young mom fix her knee after nearly losing her entire leg in a rope swing accident.

Tonight, 2 patients
desperate to look like

their celebrity idols.

I wanna look like
Tiffany Pollard.

I love her nose.

I have no clue
what the doctor did here.

I just think my nose look
like a chicken butt.

I don't know what
a chicken butt looks like.

I know what a chicken butt
looks like.

Britney Spears is one
of my biggest inspirations.

She has very significant
animation deformity

that could occur
when you're undergoing

the male to female transition.

♪ I'm a pricy bitch ♪

♪ And I don't care
if you don't like me, bitch ♪

I think I'm kind of
a cheap bitch.

Then a woman who
almost lost her entire leg

from a freak accident.

I hit my left knee
on a rock ledge.

My knee looks very disfigured.

This is absolute
medical negligence.

This is not something
that I wanna deal with

for the rest of my life.

We're racing against the clock.

- We only have about 2 hours...
- 10-minute warning.

Or you can actually
kill the leg.

That sucker is encased in bone.

♪ I wanna be sexy ♪

♪ Sexy, sexy ♪

♪ I wanna be hot ♪

♪ Fix me, make me beautiful ♪

♪ I wanna be perfect ♪

♪ You gotta get on it ♪

♪ On it ♪

♪ You got to get on it ♪

It's Serena, bitch,

and I'm 22 years old,

and oh, baby,
my breasts are toxic.

♪ You wanna get in my door,
well, you can't be scared ♪

♪ You wanna be on,
well, I'm over here ♪

When I was growing up
in the early 2000s,

Britney Spears, Paris Hilton,
Lindsay Lohan

were the Hollywood "it" girls,
and I wanted to be

my very own "it" girl.

I'm obsessed
with the early 2000s.

Crop top, short skirts,

and my all-time favorite...
Velour tracksuit.

♪ I woke up on the right side
of the bed ♪

♪ 'Cause you weren't there ♪

Listening to Britney Spears
as a little child

before I became
my authentic self,

Britney was one
of my biggest inspirations

to be a singer.

Now I'm on fire.

Then at 16 years old,
I decided to transition

to a woman by taking
Hormone Replacement Therapy.

Hormones can make you
look more feminine,

but they can't do everything
that plastic surgery

can do for you.

I've had one
breast augmentation,

a rhinoplasty,
fillers in my cheeks,

fillers in my chin,
fillers in my... lips.

It's hard to keep track.

I've poked a needle just
about anywhere you can.

But right now my breasts look
too natural,

and my breast tissue
separates from my implant.

When I flex my muscle,
you see here's the implant,

and here's the breast.

And I want them bigger.
I want everybody to see them.

My personality is exaggerated.

I just need the body
to match it.

I'm Cadine. I'm 38 years old.

This great, mon. Hey!

I'm from Jamaica,
and my whole nose...

This Jamaican me crazy. Look.
It's terrible.

After having three surgeries,
I have a scar on my nose,

and it has this "V" shape,
this ugly thing just hanging.

People that say,
"What wrong with you?"

"Don't worry about it.
Me got it."

Oh, my goodness, Ma. It's such
a beautiful day, isn't it?

I always hated my nose
growing up.

It was so big.

Growing up in Jamaica, we do not
talk about plastic surgery ever.

But watching TV, I was like,
oh, my God. I want that.

You know I didn't want you to go
through all of that trauma.

In Jamaica, we believe it is
natural to be how God made it.

I know that, Ma, but sometimes
in life, you know,

we think that we're not

or we want something
to tweak about us.

Why not try?

Having three surgeries
on my nose

impact me and my mom's

It really has, you know,
broken us a little bit.

You know, she told me so,
she told me so

not to touch myself,
and I didn't listen,

and I went back,
and it got worse,

and then going back
the third time,

she was so mad and devastated
because I didn't listen to her.

I'm gonna fix this, you know,

so I can have this smile
once again

and feel confident, you know?

My nose is a hot mess.

Like, I have to put extra makeup
to hide my scar,

and I just kind of use my hair
to cover my face

every day, all day.

So I call my hair Lucy
because, you know,

it's so loose and flowy,
and I just, like,

always play with her.

She's always the one helping me
to hide this.

Lucy and I, we're friends.
I love her.

I know in my heart that,
you know,

I made the wrong decision.

I feel unhappy.

I don't wanna cry. I'm sorry.

Because you have done
three surgery on your body,

as a mother, I'm very scared,
and I am concerned

about what will happen
for this journey.

I just started again,
since you're the one

who taught me about this...
- Fasting?

I just started fasting again,
and I've already lost

in one day, 3 pounds.

But you're gonna drink like a...

I'm a little concerned
about this giant water bottle.

Every 10 minutes,
I'll be peeing.

- Is that a gallon?
- I don't know.

Giant water bottle means
giant bladder

having to pass through
that not-so-giant penis.

- What do you got?
- This is Cadine.

Oh! I have no clue
what the doctor did here.

If I try to fix that scar,
I'm gonna destroy her nose.

Forget the scar. How you gonna
give this nose any shape?

Can you please send in Cadine?

- There she is.
- Wow, look at that hair.

- Cadine.
- Good morning, Dr. Nassif.

- Nice to meet you.
- It's really nice to meet you.

- How are you?
- Hi, Cadine. Nice to meet you.

- Is this your mom?
- Yes. Nice to meet you.

- How are you?
- Sonia.

- Sonia.
- Sonia, nice to meet you.

- Dr. Dubrow.
- Same here.

Dr. Dubrow.
Pleasure to meet you.

- Same here.
- Welcome.

- Have a seat.
- Thank you.

Look at that hair. Wow!

- I love it.
- Thank you.

Well, I can only see
half of your face, though.

Because of my nose,
I hide it all the time.


- There you go.
- Sorry.

So... Jamaican?

- Yes.
- Yes, sir.

So let me ask you a question.

Are there plastic surgeons
in Jamaica?

- No.
- Do a lot of Jamaican women

have plastic surgery
at some point?


So that really makes
the story interesting.

So tell us about your nose.

So 2018, April, my friend told
me about this doctor in Florida.

Was it a Board-certified
plastic surgeon?

- Not certified.
- Not Board-certified.

- So it was a cosmetic surgeon.
- Yes.

To call yourself
a cosmetic surgeon,

obviously, you should have
a medical license,

I would assume,
but nowadays,

you never know
what you're gonna find.

I told him that I wanted to have
this part to be more narrow

and my nostril to be smaller.

So basically, what he was
gonna do is to lift it

and then do the nostrils.

So I had my first surgery
with my nose,

and couple days later, I said,

let me just take off
the plastic tape.

Plastic tape?

You mean like when you put on
an IV, that kind of tape?

- Yes. I took...
- That's not the typical tape

we use on the nose.
- I took it off,

and the nostril is so uneven,
so wide,

and all my skin was gone.

Oh, Jesus.

That's why you have the scar.

He says, "Okay, when it's
healed completely,

I'll cut it out... the scar."

So second surgery, 2019,
he cuts this.

The doctor just kinda, like,
cuts skin and...

Yes, and suture it together.

And then that's why I have
this long cut on my face.

That was on me,
like an idiot thinking

that I can trust him enough
to fix this completely.

But it wasn't on you.

I know you're blaming yourself
for that a little bit.

- All the time.
- Yeah, don't.

My third surgery,
he decided to go

and take the cartilage
behind my ears and put in,

and that's how I have
this ugly drop.

What was the goal of putting
ear cartilage in the nose?

- To make it more projecting?
- Yes.

- When was that surgery?
- That was last year.

It wasn't a plastic surgeon.
Who would attempt ear cartilage?

I mean, it'd be interesting
to find out...

- This guy has got...
- ...what type of doctor

this guy really was.

This guy is Jamaican me crazy.

Well, yes.
Really crazy.

Was that a nice joke
he just said?

- Yeah, mon. Yeah, mon.
- Yeah, mon, Yeah, mon.

How many times have you heard
that joke in your life?

- All the time.
- All the time.

Dr. Nassif and Dr. Dubrow,
I say...

Me say I...

So, Mom, would you agree

with her having plastic surgery
right now?

- Or you would leave it alone?
- I would leave it alone.

- You would?
- Yeah.

What do you think about that?

I think my mom need glasses.

Mom, you're Jamaican her crazy.

I just think my nose
look like a chicken butt.

I don't know what a chicken butt
looks like.

I know what a chicken butt
looks like.

I remember when I was a kid.

And I'm eating this chicken,
really getting into it,

and my older brother
says to me,

"You know that's the butt
of the chicken."

Right? And ever since then,
I've been acutely aware

of chicken butts.

Is there a celebrity who you
think has a nice nose

that you'd like to have?

Tiffany Pollard.

- Mm.
- He did her nose.

- I know.
- Ohh.

She had her nostrils
made smaller,

and the tip pushed down.
- I love her nose.

That was perfect.
I wanna look like her.

Cadine, you have a lot of issues
going on,

and until I get
inside the nose,

it's a little bit worrisome.

Feels like there's no support
at all.

What percentage
is gonna make you happy

of fixing your nose?
- 80 or 90%.

That's kind of a high number.

I am tired of people looking
at my knee.

It's just disfigured.

♪ I wanna be perfect ♪

All right, let's take a peek
at your nose.

When you say chicken butt,
what... show us.

What are you talking about?

So when I hold my face down,

this piece is hanging.

That's how the chicken butt

That's right. That is...
I see it.

So the chicken butt's

that little round thing
at the end of the chicken.

- Yes.
- Now I get it.

The only thing you can say
about that, really, is...

- It feels like there's...
- No support. support at all. That skin
is atrophic. It's very thin.

And the nostrils are asymmetric.

So with the combination of
elevating the tip of your nose,

bringing the bones in,

bringing both nostrils in

by cutting on the sides
and inside,

building out this possibly here
to give you more projection,

I'm gonna need to use
some of your rib cartilage.

But I'm not gonna be able
to remove the scar,

because your skin's been
destroyed in the past.


The problem with operating on
scar tissue

is that when you actually put
a knife through it with scalpel,

the scar tissue can grow back.

You can't control scar tissue.

What percentage is gonna
make you happy

of fixing your nose?

I know you like
Tiffany Pollard's nose,

and that was a virgin nose
that we operated on,

but we'll see what we can do.

80 to 90%.

That's kind of a high number.

That's a scary number.

Your expectations
have to come down

because I am operating
on damaged tissue.

I'm okay with 50%.

All right, well, that's...
That's fine.

- I'm okay with that.
- 40.

40? Oh, it's even dropped
to 40. That's fine.

We don't need to go
lower than that right now.

- Right.
- Unless you have

some major catastrophe which
we wanna make sure you don't.


If it were up to you,
would you have her do...

Let's say she were 17.
Would you sign the consent form?


You want her to stay
the way she is?


I work in the medical field
for 17 years,

and I am very anxious about it
just thinking about

what her body have been through
and doing it again.

Oh, my God. That's too much
trauma on one patient body.

I think she's more nervous,
this whole process, that's why.

- You want to do it?
- Yes.

- Ready to go?
- Let's go. No doubts.

All right, well, let's do this.
I'm up for it.

- Yeah, mon, me, too.
- Let's go for it. Yeah, mon.

- Yeah, mon.
- Yeah, mon, let's do it.

Yeah, mon.

I can't believe she's already 3.

I know.

Thank you for coming
to help set up.

Is it hurting your leg at all
being up there?

It's just not steady.

- Be careful.
- My name's Kaitlyn,

and my knee does not match
my body.

My left knee looks
very disfigured, discolored.

The texture is very odd,
and it has a lot of loose skin.


My knee kind of crackle
whenever I extend it.

My son... he always makes fun
of the way that I run

and says I look like
an injured deer.

I can't sit on my knees.

Like, bending down
to put the kids in the bath...

I just don't have the
coordination in that knee.

It is upsetting
that you're not able to do

the things that you wanna do.

I am tired of people
looking at my knee,

people just very rudely
stare at you,

tell you
that it looks disgusting

or "What happened to your knee?
That does not match your face."

Sometimes it makes me sad.
Sometimes it pisses me off.

I just can't believe
that where we're at today.

What are the chances
of being able to come

to such awesome surgeons?

I'm hoping that Dr. Nassif
and Dr. Dubrow

can make my knee look better.

This is not something that
I wanna deal with

for the rest of my life.

Nice to meet you.
Dr. Nassif. How are you?

- Hi, Kaitlyn. Terry Dubrow.
- Hi.

Please have a seat.
So I'd like to get right to it

because this is kind of
a complicated problem.

How did this happen?

All right, well, it's been
two years since the accident.

- I was on a float trip.
- A what trip?

- A float trip.
- Like a lazy river...

- Yeah.
- ...kind of a thing.

- Yeah.
- Yeah.

So it sounds like a float trip
is partying on a float boat.

Yeah. There's a bunch
of rope swings,

and I fell off. It was about
10 to 15 feet that I fell,

and I hit my left knee
on a rock ledge.

- Ahh.
- Ugh.

It obviously
burst open your skin.

- Mm-hmm.
- Right?

- And broke your knee bone.
- Yeah.

- Open fracture.
- Yep.

And that's something, especially
with all that beautiful water.

With all those organisms
in there, okay, so...

- Yeah.
- There's your infection.

So an open fracture is called
a type III injury,

meaning it's the most severe

because not only
is the bone broken,

but the skin's open, so you have
immediate contamination.

More than a third of people

who suffer contaminated
open fractures

of their extremities
will lose that extremity.

- Where was this?
- They were in...

- This was in Noel, Missouri.
- Yeah, Noel, Missouri.

- Noem?
- It's the middle of nowhere.

- Noel.
- And how far away were you

from a medical center?
- It was an hour from there

to their trauma center
in Kansas.

Mm. Okay, so what happened
at the trauma center?

They had started me
on IV antibiotics at that point.

Of course.

I was running a temp in pre-op.

- You were in the pre-op area.
- Mm-hmm.

About to go to surgery
and have hardware put in.

- Mm-hmm.
- Right?

- And you had a fever.
- Mm-hmm.

To fix an open fracture
like Kaitlyn had,

you put internal hardware
to allow the bone

to be stabilized
and allow it to heal.

Generally, you can leave it
in there permanently

unless it starts to cause
a problem like pain,

and then in the future,
it sometimes has to be removed.

So then what happened?
Went to the operating room

- and they just...
- threw it in?

They put it in, yup,
and then...

- And they closed the wound.
- Closed it up, yep.

And then I told them

that I could smell
my infection in my knee.

How many days are we post
the procedure?

Like two.

I've seen this exact situation
where it starts to smell.

They open up the dressing,

and there are maggots
in the wound. I kid you not.

And so then I had surgery.

Opened it up,
left the hardware in,

and then a wound VAC on.

So when they opened the wound
to put a wound VAC in...

And this is a key question...
Was the hardware exposed?

- Yes.
- Was it in the wound?

So they had exposed hardware
that they're treating

with a wound VAC.
- Yeah.

That is an absolute setup
for infection

that will seed itself
into the bone,

cause osteomyelitis
and put you at great risk

for losing your leg.

Never, ever do that.

I've been an expert
for the California Medical Board

for over 21 years,

and this is
absolute medical negligence.


I went to a different doctor
to get my second opinion.

He said, "If you would've

left that there,
you would've lost your leg."

He... They took the hardware out
the next day.


That point, you know, they said,
"We can do this flap."

So the ortho guy did that flap.

Did they put hardware
at the same time?

Mm-hmm, yep. I still had
a knee fracture at that point.

- So did it heal at that point?
- Yeah.

- How long ago was this?
- In 2017.

And here you are with this,

for lack of a better word,

How does it bother you?

I do have pain
right in the front.

I can't put a lot of weight.

Like, I can't get down my knees,
and, like, play with the kids.

As a mother, I don't want her
to have to feel that way

for... the majority of her life.

- So it bothers you a lot.
- Yeah.

We asked for your complete
medical records,

and as it turns out,
on your X-ray,

you actually have
broken hardware.

You have checked every disaster
you can possibly check.

- How much of it can we remove?
- And bend the knee.

And still be able to bend
your knee? Not much.

It's actually really tricky.
If I don't take enough,

she won't be cosmetically happy,
and if I take too much,

she won't be able
to flex properly.

It's emotional.

I'm sorry. I'll be right back.

♪ I wanna be perfect ♪

Kaitlyn, first thing I wanna do
is show you

this broken hardware.
Look at this.

That shouldn't be discontinuous.

If you have knee pain,
it needs to come out.

What I'd like to do is have
my buddy, Dr. Scott For man,

who's the most outstanding
orthopedic surgeon,

figure out what to do
about that.

- Right.
- Okay.

What to do about this

We can tattoo the skin graft
to match the surrounding skin,

but you've got these bunched up
contour irregularities.

The question is, how much of it
can we remove?

And bend the knee.

And still be able to bend
your knee? Not much.

Removing the proper amount of
skin is actually really tricky.

If I don't take enough,

I'm not gonna fix
her contour irregularities,

and she won't be
cosmetically happy.

And if I take too much,

she won't be able to flex
and extend properly,

so this is form versus function
in many ways.

What do you think about this?

If we're doing the hardware,
and that helps with the pain,

- You're in.

Yeah, I'm in.

I have absolutely zero fear
in this.

We were brought here
for a reason.

It's funny, because a lot of
people would be skeptical.

I mean, you had
a really bad experience

with the medical system
in Kansas.

But forgive me.
You're not in Kansas anymore.

That's real funny.

Oh, my God, Mom, I'm so scared.

Don't be scared.
It'll be okay.

Oh, Jesus.

Oh, I'm so nervous. I'm, like,
having anxiety, emotion.

I'm excited, though.

I appreciate you're there
for me.

Your emotion will come,
and it's gonna be okay.

Even though my mom is not a fan
of plastic surgery at all,

but just to be here
to support me with all this...

That shows how much love
she has for me.

I'm ready for you.

Ooh. Bye, Ma.

Today for Cadine's surgery,

I'll begin by opening up
the nose

while Dr. Peng harvests rib.

Next, I will fracture
the bones to narrow the nose

before adding diced cartilage
glue grafts

to build up her dorsum
and give her tip rejection.

Finally, I will come on the
outside and inside of her nose,

called alar base reduction,
and use articulating rim grafts

to give her narrower,
symmetric nostrils.

Gonna start now cutting...
Scrape through scar tissue.

It's a bloody mess in here.

You know, it's almost like

a small bomb went off
inside the nose.

This looks like sh...

Jesus, look at that.

This is just like meat,
ground beef.

I don't know what it looks like.
Ground pork.

Going through Cadine's nose,
it's like a war zone.

I can't see normal anatomy.

I'm not seeing anything

This easily is
in the top 10 worst nasal

anatomic disfigurements
that I've ever seen.

The rib is coming out.

So this is the reconstruction.

This is
the diced cartilage glue graft

going in a different pipe
through the nose

to augment the dorsum,
to make the tip look better,

to make the profile look better.

And yet these
articulated rim grafts

can help make the nostrils
more even.

Cadine's nose use all of her rib
on her reconstruction.

Usually, there's always a piece
of rib left over.

But with Cadine,
there was nothing left

because her nose was so mangled
from her previous surgeries.

This is
a massive reconstruction.

Okay, so we're starting
the incisions

for the alar base reduction.

This is to narrow the nostrils
and the flare of the nostrils.

We're performing
a base reduction.

We take out a little
diamond shape of tissue,

basically cut on the inside.

That would decrease the width
inside the nose

called the nasal sill.

this will make her nose

look like Tiffany Pollard's.

Right now I just don't know if
she's gonna get what she wants.

Well, hopefully,
didn't make this too small.

- Thank you all.
- Thank you.

So what do we have?

We have
a very interesting patient

named Serena.

She has a lot of the things
that could occur

when you're undergoing
the male to female transition.

So you can see a very
significant animation deformity.

Let's bring in Serena and see
what's going on with her.

Sure, let's do it.
Can you please send in Serena?

- Serena.
- Hello!

- Hi.
- Hi. Nice to meet you.

- Hi. I'm Dr. Nassif.
- Hi, Serena. Terry Dubrow.

- Hello.
- Nice to meet you.

I'm very excited
to see the doctors.

Even though I love
my boyfriend,

I have a little crush
on Dr. Nassif.

I love a hairy man.

I can't contain my freakiness.

And how did you guys meet?

Through the internet
'cause nobody goes out anymore.

Wait. When you say you met
on the internet,

how did that happen?
- Instagram. It's like,

you know, Direct Message.
- Instagram.

So are you guys kind of
influencers on Instagram?

Yeah, I like to promote
what I'm doing... my music.

- So you're a musician.
- Yes.

So would you say
your musical tastes

are of this era or another era?

I mean, I was raised
on Britney Spears.

Early 2000s... definitely
an influence, an inspiration.

- All right.
- I know. Uh, are we gonna

be able to get
a little taste of that?

You can get a taste
of whatever you want.


♪ I'm a pricy bitch ♪

♪ And I don't care
if you don't like me, bitch ♪

♪ So what, dress fly as ,
hot pink tracksuit ♪

♪ Juicy up on my butt,
you slut ♪

♪ No, my time ain't free,
, you better pay up ♪


Uh-huh, it's an anthem.

Now you do it.

I can't even...

Give me a little thing.
♪ Pay up, pay up ♪

♪ Pay up, you pricy bitch ♪

♪ Pay up, pay up,
you pricy bitch ♪

- ♪ You pricy bitch ♪
- There we go.

♪ You know my time ain't free,
, you better... ♪

- I can't do that one.
- You better pay up.

You better pay up.

I'll give you
a little somethin', somethin'.


It looks like Dr. Dubrow
is actually right for once.

I think I'm kind of
a cheap bitch.

What's your story?

- Influencer, too.
- Yeah?

Transitioned really young,
like at 13.

- At 13?
- Yeah.

- What about you, Serena?
- Um, I was about 18.


Mentally, I was always
kinda there.

- Always.
- Yeah.

I remember one time I came home
from a friend's house.

I had her little Halloween wig.
I opened the door.

I remember my dad answered,
and he said, "Who's that?"

- Mm.
- I always... I love my parents.

I always had a really great
relationship with them.

Your parents were
completely cool with it.

- Always.
- Really?

Ever since I was young,
like anything I wanted to do,

very accepting. I'm so thankful
I had that.

'Cause I have friends
who have different situations,

like, being kicked out or told
not to do what they're doing.

And it sucks.
I was always supported.

Just positive encouragement.

Sometimes that's all
somebody needs.

It's emotional.

♪ I know what struggle is ♪

♪ You know that I've seen
darker days ♪

♪ Mmm, mmm, mmm ♪

I'm sorry.

I'll be right back.

♪ Oh, oh, oh ♪

I haven't seen that before,

I've never seen him
fall apart like that.

That sucker is encased
in bone.

It's like an archaeological find
where you have to chip away

without inducing
a patellar fracture again.

♪ I wanna be perfect ♪

I haven't seen that before,

I've never seen him get up
and walk out of a room

and fall apart like that.


I'm the father of three girls
and a boy,

and this story
just really got to me

because I'm so concerned about
every little thing with my kids,

and it just reminds me
how important it is

to be a supportive parent,
and when you're not,

how devastating it can be
on your children.

Okay, I feel better.

I just had a moment,
an emotional moment.

- Welcome back.
- Sorry about that.

- No, you're fine.
- I guess I was just tapping

into what it would be like
to not be happy

with the way you were born,
you know what I mean?

- Mm-hmm.
- Yeah.

A lot of what we do
as plastic surgeons

is people aren't happy
with the way they're born,

or the way they've become
as they get older.

By the way, I'm so happy
for you guys because...

- Thank you.
- You both look beautiful.

- Thank you.
- And you both look happy.

And I'm so glad your parents
are so accepting.

Thank you.

What was the first thing
you did?

My breasts. 450 cc's.

Under the muscle.

Yes, which I think I might
be regretting.

My problem is if I lift
my arm or flex...

- Mm.
- ...I get a separation.

Did your doctor tell you
you might get that animation?

- No.
- See, that is the challenge...

- Mm-hmm.
- ...with someone who has

very little breast tissue
to start with.

Yeah. And that's not
what I want.

- And I want them bigger.
- Like how much bigger?

- 1,200, 1,000.
- Oh.

- I like to grab attention.
- Yeah, we can see that.

So let's go in the exam room,
have a look,

and see how we can advise you,

My feeling is that Serena's not
gonna listen to any advice.

If she wants to go
to the extreme,

she's gonna do it.


- Look at those shoes. Wow.
- Wow!

- Do you love?
- Look at 'em.

- Nice.
- You love?

- I do.
- I love.

How can you say this foot
is not gorgeous?

They're Loubou...

- Christian Louboutin.
- Christian Louboutin.

- Is that what they are?
- He knows.

- Exactly.
- Serena, let me give you

a piece of advice, if you're
looking for somebody

who's gonna support
your "Pricy Bitch" thing,

he's not it, okay?
This guy is cheap.

- I'm frugal is the right...
- Oh, frugal.

Oh, very benign way
of saying "cheap bitch."

She's a pricy bitch.

♪ She's a cheap bitch,
not a dollar in her pocket ♪

♪ If you wanna go somewhere,
you better bring your wallet ♪

- I can have you on the album.
- Mm-hmm.

The doctors are loving
my song.

Obviously, I think they could
pass as pricy bitches for sure.

On a more serious note,
the breast situation.

- Mm-hmm.
- So do me favor.

Put your hands on your hips
and push. That's...

This is where I get the problem.

Yeah, your old crease
was probably right there.

- Mm-hmm.
- Yeah. So that shows

where your muscle used to be
down here and down here.

So the question is how much
bigger can you go

and get minimal worsening
of the animation?

I think you could do 600.

What say you?

That's small.

- Bigger?
- No. I think you...

You think I could go 1,000?

- I don't think... No. No.
- Bigger.

That's more than twice
your size.

I'd be willing to increase
Serena's implants

by about 200 cc's and fix
her animation deformity

by releasing the muscle
from the underlying tissue.

If I go any larger,
all that's going to do

is create a bigger problem to
fix than she had originally.

And at the end of the day,
Paul and I fix deformities.

We try not to create them.

If you go big, big,
it's gonna make new problems.

Your surgeon, to put
a bigger implant in there,

would have to lower
the crease more,

just to make space,
and if they did that,

you'd get that blub bubble
of implant mound below it.

- Yeah.
- The double bubble.

So is that something that's
common with trans patients?

It's common with anyone
who has a short distance

from their
natural inframammary crease

to the bottom of their areola.

What if I did over the muscle?

The over the muscle would fix
the animation problem,

the flexion problem.
- Okay.

But it wouldn't fix
the double bubble problem.

The bigger you go,
the bigger the double bubble.

I don't know. I think the risk
might be worth it.

It's not a risk.
It will happen for sure,

no question about it, mm-hmm.

- You play a hard game.
- I'm telling you the truth.

Dr. Dubrow,
I hear what you're saying,

but I really want 1,000 cc.

I think I'll take my chance
with this one.

Pleasure meeting you. Thank you.

- Nice meeting you.
- Thank you, my darling.

- Love you.
- I caught it.

No boobs for you.

What are you gonna do,
handcuff me

and keep me away
from the surgeon?


I might like that, girl.

Kaitlyn. How are you?

- Dr. For man.
- There you go.

You get the both of us.

Hoping things will change
after surgery.

Obviously, I wanna get
all the hardware out.

Getting it out of there
is gonna get rid of that pain.

It's cosmetic, but it's also,
I think, functional.

See, here's the thing.
I'm kinda racking my brain

to make sure I can give you

something that's substantially
better cosmetically.

Right. Yeah.

Taking the hardware out,
anybody can do that.


with 30 years' experience.

For Kaitlyn's surgery today,

we'll start by using
a surgical tourniquet

to stop the blood flow
to the leg.

I will then make an incision
through her previous scar

so Dr. For man can assess
and extract the broken hardware.

Next, we'll deflate
the tourniquet,

and I will debulk the skin graft

and remove
any excess soft tissue,

hoping to give her a better
overall cosmetic result.

So how long can you have
the tourniquet on for?

Two hours before you gotta
let it back down.

That's it. If not,
you would start to get

muscle thrombosis and things,

Uh, you worry about... the nerve
is the first thing to go.

Although the tourniquet
is very useful

for keeping the blood
out of the surgical area

so you can see
what you're doing,

if you don't deflate that
tourniquet in that two hours,

you may get the hardware out,

but you can actually kill
the leg.

Okay, let me take
some scissors.

So that's the wire?

That's the wire,
and I have to clip it out

so we can cut it off.

Boy, it's really incorporated
in the bone.

So I'm gonna try and unbury this

and then follow it down
to the pin.


I love that she made bone
to heal her fracture,

and then she made too much bone.
- Yeah.

Because of Kaitlyn's pain,
her hardware has to come out.

But fortunately,
her bone is healed,

so she no longer needs it.

The problem is, she's developed
so much bony overgrowth,

it's really difficult
to remove it,

and let's face it.
The clock is ticking.

One hour on the tourniquet.

Tick, tick, tick, tick.


That sucker is encased
in bone.


Oh, you can tell she's in pain.

Let me just kind of

take a quick peek here.

Let's see what it looks like.

It's critical that the flap
be alive.

♪ I wanna be perfect ♪

Ah. That sucker is encased
in bone.


We only have 30 minutes
to get this hardware out,

but it's completely encased
in overgrown bone.

So it's like
an archaeological find

where you have to chip away
directly over the hardware

and the wire
to get at the hardware itself

without inducing
a patellar fracture again.

Yeah! No pressure at all.

Oh. So close.



That was one
of the broken wires?

Yes. There you go.

- Oh, my God. All of this...
- That's one.

- get this done.
- Wow.

- That's one?
- There's another one.

How many more minutes
do we have left?

24 minutes.

The first half of the hardware

took us 90 minutes
to get it out.

Now we only have 20 minutes
to get the rest of it,

or we have to deflate
the tourniquet,

and it'll be filled with blood,

and we won't be able to see
at all what we need to see.

Ugh, it's really tough.

That's your 10-minute warning.

We're racing against the clock.

- Oh, you're getting it.
- Yeah.

- Yeah!
- Oh!


- Nice.
- Damn.

That's two hours.



Now that the hardware's out,

we're gonna deflate
the tourniquet,

get control of the bleeding,

and start working
on the overlying soft tissue

and the skin graft itself.

Soft tissue time.

I have to be very careful
not to remove too much skin

from Kaitlyn's knee,
because if I do,

when she flexes and extends,
it may rip the whole thing open,

and we'll be back
to square one.

- This looks pretty good.
- Yes.

We removed
the main contour regularities.

We left enough skin so that she
could flex and extend safely.

- Exactly.
- So now it has to heal.

The best way to describe
this case...

Huge pain in the ass.


- Wow!
- I love the outfit.

Uh-oh. You can tell
she's in pain.


- You okay? Ribby?
- Yeah.

You can hold a pillow
when you wanna cough.


Make sure you do deep breathing.

You know, and if you need
to take a little Xanax

to relax you, that might get you
to breathe a little bit deeper.

- Half of a pill.
- Okay.

Like, every four or five hours
for maybe two days.


So let me just kind of
bring that up.

I just wanna take
a quick peek here.

Sorry. Put your head back
for us.

Yeah. You look beautiful.

- Here you go.
- Look how small that is.

That is so perfect.

Oh, yeah.

Paul has really outdone himself.

I don't know that it looks

exactly like Tiffany's nose
did post-operatively,

but it's pretty close,
and in this situation,

pretty close
is an absolute home run.

I feel good.
I like how it looks,

and I'm extremely happy.
- Did you look at it?

- Yes, I did.
- Looks great.

- Thank you.
- I'm glad you like it.

Mom, what do you think?

I just wanted to see her
look like Cadine again.

I look like Cadine now, Ma.

A little.

I'm more open
to plastic surgery now,

especially being
with the greatest surgeon,

and now seeing that her nose,
it looks good,

and that make me happy.

...and that she gonna be
more herself.

To be honest with you,

this is the coolest thing
I've ever seen.

I might wanna go running
in that outfit.

I'm getting one for my wife.

Am I making you laugh? Sorry.

- Congratulations.
- Thank you.

- Thank you, Doctor.
- Oh, Ma, I'm excited.

This journey... I couldn't
do it without you,

so I wanna say thank you
so much, Ma.

You are so welcome.

I just want to see you
out of the pain.

I will be. I will be.

By this weekend,
we'll be dancin'.


Well, I'm excited to see
what it looks like.

It's been seven days of...

- Of suspense?
- ...kind of wondering, yes.

- Yeah.
- And waiting.

This is the only surgery
that's gone this smoothly,

so I'm happy for that.

- Hello.
- Hi.

- Wow, what an apparatus.
- That's right.

- So how do you feel?
- I feel really good.

Let's see what it looks like.

It's critical that the flap
be alive,

because if it's not alive,

she'll have a worse problem

than she had pre-operatively.

- Wow.
- Thousand times better, right?

- Yeah.
- For sure.


Oh, my goodness. Not even
the same leg or knee.

- Yeah.
- It's an incredible difference.

- It's alive.
- It is alive.

Skin graft looks great.

He was able to get
all of these excess skin.

I'm excited to see, you know,
what it looks like in a week,

two weeks, a month,
you know, out from here.

You're golfing.

- So look who I have here.
- Hi!

I've already experienced
not having

the same day-to-day pains
that I would normally have,

so that's amazing.

You know, it was
a very positive experience,

and I'm so thankful for it.

You're gonna have to probably
wear that brace for six weeks

just to protect it.

If you have a mishap, it could
tear. That would be bad.

- Definitely wear the brace.
- Okay.

Lots of pain, or not too bad?

No, after about two days,
it wasn't bad at all.

Man, you guys are way tougher

than California patients,
I'll say.

Yeah, we'll go back to work,
all right, while you're golfing.

Enjoy. Look at his cigar.

- Okay, bye.
- Talk to you later.

Ah, see? Ah.

It actually feels amazing
to finally have a surgery

that ended positively.

Now thanks to Dr. Dubrow,
my knee... it's amazing.

Before my surgery,
I honestly thought

my nose looked like
a chicken butt.

Thanks to Dr. Nassif,

this Jamaican is no longer
going crazy.

- Let me see the side.
- Uh, ooh.

♪ I wanna be perfect ♪

- Hello there.
- Kaitlyn, how are you?

- How's the knee going?
- It's doing really good.

All my range of motion's back,

- Yeah.
- Pain's a lot better

up top from where
that hardware was.

Wow. Digging out that hardware
was not easy.

I'm so happy Kaitlyn's
knee function has improved.

Her pain is completely gone.

The only thing left
is the cosmetic.

So we're gonna do
some cosmetic tattooing

to try to get the knee skin
to look like

the surrounding peripheral skin.

- Bring it.
- Okay.

- Yeah. Yeah.
- Yeah, let's do it.

It actually feels amazing
to finally have a surgery

that ended positively.

It catches me off guard
whenever I see it in the mirror.

- All right.
- Congratulations.

It feels really good
to have matching knees.


- So happy. Thank you so much.
- Thank you.

- Yeah, it's beautiful.
- It's amazing.

It'll be beautiful.
It's gonna be beautiful.

You know, I'm not gonna let
the past hinder

the things
that I wanna do today.

I'm still young,
and it feels great to be back

to my fun, adventurous self.

You're leaving me.

Come on, slowpoke.

Before my surgery, my knee
was disfigured, discolored,

and had lots
of loose, saggy skin.

The nonstop stares and comments
made me feel so insecure.

I was in constant pain,
and I just wasn't able

to be as active
as I wanted to be.

But now thanks to Dr. Dubrow,

my knee actually looks
pretty normal.

The saggy skin is gone.

The skin tone actually matches
my other knee,

and I'm pain-free.

No more rope swings
for this girl.

I am staying in the kayak
this time.

You know, Dr. Dubrow,
Dr. Nassif, Dr. For man...

They were able to fix it,
make it look, you know,

a hundred times better,
I feel like.

I mean, I never expected that
four years ago.

I would like to tell Dr. Dubrow
thank you,

just being able to do
day-to-day things with my kids.

You not only
changed my life physically,

but you have just, like,
my well-being

and everything as well.

I'm glad you weren't afraid
to get back out there.

I know. It does feel nice.

Before my surgery,
I did not go a day

without my hair, Lucy,
to hide my nose.

Lucy was a shield for me.

- Hey, girls.
- Hey.


But now I decided
to cut Lucy loose

because I can be comfortable
with myself

and show this beautiful look
of mine that I call Sasha.

♪ Got to turn it up,
yeah, we're gonna celebrate ♪

- Girl, I feel good.
- You got a glow about you.

Sasha bring out this light
in me.

I knew that Dr. Nassif would
work his magic on my nose,

but let's just say

Tiffany Pollard might just be
jealous of my nose.

- Let me see the side.
- Oh, okay.

Oh, girl, let me see
the other side.

Girl, look at that.
Look at that.

You look so good.

- Thank you, sis.
- Her confidence

is through the roof.
- Through the roof.

She's done a 180.

I'm so glad I have
my friend back.

Before my surgery,
my nose was Jamaican me crazy.

It had a weird "V" shape
hanging down.

I honestly thought my nose
looked like a chicken butt,

but now thanks to Dr. Nassif,
the chicken butt is gone.

The shape is beautiful,
and I absolutely love it.

I feel amazing,

and this Jamaican
is no longer going crazy.

- Say hi to everyone, Ma.
- Hey, Mommy!

What did you think about
her nose before versus now?

She looks much, much better now.

My family's against surgery.

She's totally not against it

because she see
that it helps me.

I can't thank her enough
for her support and her love.

- It means a lot to me.
- The doctors...

They really were able
to bring the light back to her.

Yes, I'm happy because
she's happy. "A" -plus.

- Ooh, "A"-plus.
- "A"-plus.

You got an "A" -plus from Mommy.

I can't thank Dr. Nassif
and Dr. Dubrow enough.

I can't. Words cannot explain
how I feel inside

just to give me this, you know,
confidence back,

this smile.
This happiness.

This is a blessing.
You guys know my pain.

You guys know what
I went through.

Now I can shine.
World, are you ready for me?

Here I come.

- To me and my new look, Boo.
- Yes.

- We're going to the club now!
- Yes!


There's nothing stopping you
from achieving a lot more

when you're literally there

After our consultation,

I could teach you how to swing
on or off.

Ooh, baby, ooh, baby.

I've always called 'em
the janky boobs.

That's her double bubble.

How many times
have you seen this?


When I was 1 years old,

a flesh-eating bacteria
destroyed my nose.

Take a look at her cannula.
It looks a little bit grayish.

Oh, sh..., this is exactly what
I was worried about.