Botched (2014–…): Season 7, Episode 16 - The Comeback Patients - full transcript

DR. DUBROW: Tonight a woman
almost lost her life

from a routine tummy tuck.

I have a scar on my stomach
that I can fit my whole hand in.

I touched her.
She was ice cold.

I told her, "I'm gonna take you
to the hospital."

[crying] If it wasn't for him,
I wouldn't be here. [Sniffles]

DR. NASSIF: And a fellow doctor
was duped by a colleague

and lost everything.

I thought I was getting
Restylane or Juvederm.

- What was it?
- It was silicone.

- Ooh.
- All of sudden,



it just went boom, and there was
this huge granulomas.

Yeah.

What happened to your practice?

I had to close it.

Oh, my God.

So this is where I can cut
in the nerves.

She can wake up paralyzed in
different parts of her face.

This is going straight
down the bone. [Sighs]

DR. DUBROW:
And a former patient

has made quite a transformation.

I had everything done. Look.

From head to toe.

- Like, everything.
- Everything.

Wow.



I would like my breasts
to look bigger

than what they look right now.

♪ I wanna be sexy ♪

[♪♪♪]

♪ I wanna be hot, hot ♪

♪ Fix me, make me beautiful ♪

[♪♪♪]

♪ I wanna be perfect ♪

♪ Waking up in the sun ♪

♪ By this paradise ♪

♪ And it can't get better ♪

♪ Oh, it can't get better ♪

♪ I love the way,
love the way you ♪

♪ Love me like
you've never come my way ♪

I'm Jessica.

I've met the doctors
few times in the past,

but back then, I looked...
a little bit different.

My name is Rodrigo. I'm 31.

I'm from Brazil,
but I live in London.

I had my entire jawline
reconstructed.

Three nose jobs.
Silicone implants in my chest.

I had
the most perfect six-pack.

I was Rodrigo Alves,
but now I'm Jessica Alves.

I'm the woman that I was meant
to be at birth.

Jessica, I wanna see.

- ♪ Ta-da ♪
- There you go!

It fits you perfectly.

I was living a double life.

At daytime, I was Rodrigo Alves.

I had beautiful jackets
and shoes

and I would attend
amazing events across the world.

At night, I was Jessica Alves.

I would go back to home
or my hotel,

take everything off
and put my wig on,

put red lipstick, lingerie,
sit in front of television,

and have a pizza.

I was afraid to come out
as a transgender woman.

So I tried my best to be a man
with plastic surgeries

to make me look more masculine,

but I felt like I was lying
to myself,

lying to my friends,
to my family.

To a point,
that life became unbearable.

So I started my transition.

Throughout the years,
I have had 76 plastic surgeries.

I have spent
about a million dollars.

In one year and a half,

I have had
my face feminization surgeries,

my butt feminization,

breast implants, and my
gender reassignment surgery.

And it's just
a wonderful feeling.

Everything makes sense
to me now being female.

♪ I'm ready for you,
mmm-mmm, baby, mmm-mmm ♪

♪ Can I get some
of your buttercup? ♪

[whispers] Yes.

Life is a catwalk now.

Everywhere I go,
I get attention. I turn heads.

Cars stop. Cars crash.

I love my body now,
but without a bra,

my breasts are far too low,
far too apart.

I really hope that
Dr. Nassif and Dubrow

will be able to help me.

I wonder what
they're gonna think of me

when they see me now.

Will they actually recognize me?

♪♪♪

I wouldn't wish this on anybody.

Maybe Hitler,
but that's about it.

My name is Gina, and I lost half
my cheek and my lower eyelid

from what I thought
was a simple injection.

Instead I got injected
with silicone.

Some nasty [bleep] was
put in my face,

and I was devastated.
Silicone is just...

It wreaks havoc on your body.

Looked like I had this huge
alien popping out of my face.

As a female, like,
your identity is your face.

My sense of self-worth
was just... just demolished.

You just feel like... like kinda
like your world has ended,

like why did this happen to me?

Like you wish you could get
a, you know, time machine

and go back and you know,
wish you could change

just the... just those minutes
or just one little procedure

just totally derailed
my entire future.

♪♪♪

Ah.

What are you doing?

Is that an otoscope thing?

It's for ear wax.
It has a camera.

It's like a freaking forest
in here.

Ew. Disgusting.

Trust me,
do not show Brittany that.

You will never have sex again,
I promise you.

By the way, you wanna hear
something crazy

that I just developed?

- What'd you develop?
- A hemorrhoid.

Terry, I know we're close,
brother,

but I don't wanna hear
about your friggin' hemorrhoids.

My ears are clean.
Let's check out my hemorrhoid.

- Wait.
- [groans]

- Check it out.
- Oh, my God. Look at that!

That... is the hemorrhoid.
Look at that thing.

Look at that.

As a Board-certified physician,

I wanna tell you very clearly,

never stick anything
inside your ear canal.

It may do serious damage.

- I just got lightheaded.
- Smell it.

- No, get away from me.
- Smell it, smell it.

However, if you wanna stick it
up your ass, go ahead.

You know when you've
actually told me

that a picture
really says it all?

A picture is worth
a thousand words.

Oh, my gosh.

She got injected, and this is
what happened to her.

- This is her today.
- Whoa.

She's got a major, major,
major problem.

Wow.

Can you please send in
Dr. Anderson?

This is a doctor? Holy [bleep].

- Hello.
- Dr. Anderson.

How are you?
What do you want us to call you?

- Gina.
- Gina.

- Gina.
- And I'm Dave.

My brother.

In Oregon, I've seen
all the specialists,

and they can't help me.

So I need to go to the best
to get help,

and Dr. Nassif and Dr. Dubrow...
They are some of the best

and most knowledgeable people
when it comes

to silicone complications.

- What kind of doctor are you?
- Neurology.

Those were the smart ones
in med school.

You know what they say
about surgeons.

They know nothing
and do everything,

and neurologists know everything
and do nothing.

[laughter]

So, Gina,
looking at these photos,

please take us back because,
you know, you're a doctor.

We're kind of a little lost
how this happened to you.

- Yeah.
- Mm-hmm.

Well, actually, a colleague
offered to do filler for me.

I was like, you know,
I'm in my 40s.

I'm gonna look
a little bit better,

and I thought I was getting
Restylane or Juvederm.

- What was it?
- It was silicone.

Ooh.

And obviously, it's something
that's not FDA-approved

and illegal to inject.

Both cheeks?
Anywhere else on the face?

It was actually both cheek
I was injected,

but it turns out there's no
silicone in my left.

What? But...

So we think it was
two different injections.

Yeah, or two different products.
We're not really sure.

Isn't there a notation
exactly what was injected?

- Mine was lost. Yeah.
- The whole chart?

Yes.

Wow.

So when did you
exhibit symptoms?

- Like around year four.
- Year...

Year four, boom.

All of a sudden,
it just went boom,

and there's just
huge granulomas.

Yeah, in a day or a week
or what...

In almost, like,
in just a couple days.

When you get a granuloma,

which is a foreign body
inflammatory reaction,

that typically happens
within six months to a year.

The fact that Gina didn't start
developing those granulomas

till way later indicates

it's a very slow, smoldering
inflammatory chronic response

that potentially could be
very, very difficult,

but not impossible to treat.

How many separate operations
have you had on this area?

I had five.
The first one wasn't bad,

and just removed the granuloma,
but then it came back.

So four months later, they tried
to get the silicone out,

and that didn't work because,
like, the granulomas came back.

So it just kept coming back
and forth.

And then a month later,
just got so much worse.

The granulomas actually made
a hole in my cheek,

a big hole.
- Yeah.

They actually did a flap
to the lower eyelid area

to reattach the skin

Then a year later,
it was the same procedure...

A local skin flap, and then
less than a month later,

to clean it out again because
my... the granulomas came back.

When was your last surgery?
It was June of last year.

I think there might be
some silicone,

but the granulomas have
really decreased a lot.

In the process of all this,
what happened to your practice?

- I had to close it.
- Oh, my God.

When you can't sleep
and you're in constant pain,

it's hard to, you know,
think on your feet all the time.

- And the eye...
- So you have

chronic facial pains.
- Yes.

Now this isn't, like, just me
looking like slightly pretty.

I mean, this is like
I'm in agony.

I don't sleep.
My hair started thinning,

kind of like a hair loss,
and I just started feeling

kind of, like,
weak and fatigued.

It's been a nightmare.

How many years did you
actually stop the practice?

- Um, two years ago.
- Two years ago.

Just seeing her, all the things
that this has cost her

has been very devastating.

Gina's afraid to even hope
because it's just been

such a long slog through
sort of the valley of despair.

What are your goals now?

What would you really like
to have happen?

To restore my appearance
would be great

and also decrease my pain.

And who would've thought
a simple injection

would lead to years of this?

I know.

Let's say somehow we were able
to do something for you.

Can you think about getting
back into medicine

if we made you better?
- Heck, yeah.

- That would be wonderful.
- That would be so incredible

that if we could do something

to actually get you
practicing again.

Yeah, we gotta figure this out.

- Yeah, definitely.
- You know, so that we can

actually get your life back.
- That would be great.

- Thank you.
- Let's go do it.

♪♪♪

This is extremely complicated.

Who knows what can happen,
playing with silicone?

Because
it's like playing with fire.

The surgeon was going like this
to my stomach,

and there was water.
- So she has a seroma, too, now.

He told me that he would take
a syringe, take out the fluid,

♪ I wanna be perfect ♪

♪♪♪

Here's the main focus
right here, right?

This tissue right here
and that scar right here,

we're looking at the bad tissue,

tissue that needs to be removed
and thrown away.

Mm-hmm.

You have a complex puzzle.

So thinking about this,
starting with the eye,

we have to add some volume
to that lower eyelid, okay?

I have a buddy I've known
from college.

His name is Dr. Guy Massry.
He's an oculoplastic surgeon.

So I need that specialist
to help me do that.

That area
of that triangle there,

you're having
chronic pain there,

we need to somehow free up
that nerve.

- You have a little belly fat.
- Yep.

So maybe we take a little bit
of that belly fat

and we have to add some volume
underneath here.

Now I can tell you now
this is not gonna be easy.

This is extremely complicated.

Who knows what can happen,
playing with silicone?

Because it's like playing
with fire.

There's a lot
of high stakes here

because I'm not gonna know
if all the silicone

is gone... possibly in surgery,
but most likely after surgery,

because we have
to see how her face reacts.

She can get granulomas.

She can get collections of fluid
called seromas.

Any of these things can happen
after surgery,

so it's a big mystery.

Would you be happy with
a 30, 40, 50% improvement?

Yes. I'd just like
anything to get better.

As a doctor,
I'm actually pretty nervous.

My case would be considered
a zebra,

which means that it's something
very exotic,

a case that you pretty much
never see.

But I feel like
I'm in good hands.

[sighs]

- So...
- Yes.

We need to put our heads
together,

knowing that it's gonna be
an extremely difficult surgery.

You need extraordinary measures

for an extraordinarily
complex problem.

♪♪♪

- Did you work out today?
- I did.

You know, I tried to jog
for a little while.

I started feeling pain,
so I stopped.

My name is Bianca,
and I have a scar on my stomach

that I can fit my whole hand in.

Every day, I have to put
some kind of lotion.

It itches a lot.
It feels like it's ripping.

It is very, very painful.

After I gave birth
to my daughter,

I felt horrible about my body.

I wasn't confident
with myself anymore.

Jose started taking me
to the gym,

and I started losing weight.

But that wasn't enough, because
the skin was still hanging

off my jeans.

I felt like I had to do
something about it.

So I'm thinking I need
a tummy tuck to feel sexy,

and now my stomach is deformed.

I miss a lot of things
we used to do.

You're not the happy Bianca
I know.

You don't look at yourself
in the mirror

like you usually do.

You don't model for me
like you always do.

[laughs] I can't.

I don't even like touching it,
honestly.

Since it's a thin layer of skin,
I feel the inside of my stomach.

I don't know if that's normal,
but when I eat too much,

I feel like I have to throw up
because it's so tight.

This time,
it's gonna be perfect.

[voice breaking]
Thank you, honey. Thank you.

- Okay?
- Just yes.

♪♪♪

Bianca, please have a seat.

Okay. We have a lot
to talk about.

- Yes, we do.
- So let's go back.

- Why did you need a tummy tuck?
- What was going on with you?

Um, after you get pregnant
and have a baby,

you do have that extra skin,
so I had my surgery,

but they didn't tell me I wasn't
gonna come out with my grenades.

- [laughter]
- Grenades. Yes.

- The drains.
- We call 'em grenades 'cause

that's what they look like.
- They look like, no.

But why did you expect them?

Because all the surgeries
I-I seen comes out with drains.

By the way, there is something
called a drain less tummy tuck.

- Okay.
- Where you pull it down,

and you stitch it up.
It's a thing.

- Oh, it's possible.
- It's possible.

Okay, so did you go in
the next day for post-op check?

The next... Yes, I did.
My, uh, tummy,

it was already, like,
black and blue.

This is one of those
tick-tock, tick-tock moments.

I'll tell you why.
You have a problem.

It's a reduction
of blood supply.

The surgeon was going
like this to my stomach,

and it was water.

There's fluid
underneath the skin.

So she has a seroma, too, now.

He told me that he would take
a syringe,

take out the fluid,
and he took almost a gallon.

A seroma is clear yellow fluid
that occurs post-operatively

underneath the skin
of a tummy tuck

that could potentially impair
wound healing.

In Bianca's case, most likely
had she had drains placed,

it would have helped
to prevent the seroma,

and the complication that she
ultimately developed.

Sometimes, you've gotta dive
on a grenade to save the day.

- ...back to New York.
- Did he address the black skin?

- No.
- [scoffs]

By the way,
the fluid's not the problem now.

- No, it's the tissue.
- I mean, it's a small problem.

The tissue, yeah.
A week later, I'm sleeping,

'cause that's all I did
was sleep.

I was in so much pain.

Was the skin getting darker
during this time?

It was... It was dark. Yes.

It's dying.

He comes, and all I feel is him,
"Bianca, get up."

And as I touched her,
she was ice-cold.

- Mm.
- And pale.

She went to get up,
and she couldn't hold herself,

and she dropped back down.

I come home, and I told her,

"I'm gonna take you
to the hospital."

You were close.
You were close.

Thank God Jose came home early.

[voice breaking] If it wasn't
for him, I wouldn't be here.

[sniffles]

The surgeon promptly takes you
down to the O.R.

and does what?

They said, "We have to do
surgery on her right now."

They told me I had
skin necrosis,

and it was poisoning my blood.

So they removed the dead tissue
and left me with an open wound,

a big hole.

And then I had to a skin graft.

- Where'd they get it from?
- My left thigh.

- Big skin graft.
- Yes.

So this is affecting
your daily activity,

exercise, health, uh...

I can't work out the way
I used to work out with him.

I can't lift my arms up because
it feels like it's ripping.

Okay. There's cosmetic and
functional issues, obviously.

What would you like to see here?

I would like
to feel normal again.

My daughter used to tickle me
with my husband in bed.

You know,
do things like that again,

be able to hug my daughter.
Pick her up.

♪♪♪

To be able to wear
a bathing suit

without people looking at me
or judging me.

[sniffles]

Needless to say,

you have a heck of a problem.

The question is,
can we fix it?

Now I have the most beautiful,
perfect-looking vagina.

I have to be very careful
how I sit,

how I walk, how I shower because

I just get turned on
very easily.

- Wow.
- [laughs]

is that fungus?
What happened?

Actually, it looks like cotton.

I found gauze
from the previous surgery.

That can cause
a chronic infection,

♪ I wanna be perfect ♪

Stand up for a sec.
Can we take this off?

- Do you mind?
- Sure.

All right. So in order
to reconstruct this area,

and to make it hopefully
less tender and look better,

we have to take
the skin graft off.

But now what?
We have a big hole.

For Bianca's surgery,
we need to do what we call

a plastic surgery
to recreate the defect.

If you're going to remove
the skin graft,

you actually have
a larger reconstructed defect.

That's why once we remove
the skin graft,

we'll really know
the actual size of the opening

that we have to close.

I need as much loose tissue
as I can possibly get.

I can lift this up
and pull it down.

I can lift this up
and pull it up

and meet somewhere
in the middle, right?

The question is, can I do that?

Don't be surprised if we end up
with an open area

that we need dressing changes
and a wound VAC.

I'll take a detour.

No problem. That happens
all the time with these cases.

So this is a true high-risk
abdominal wall reconstruction.

I'm willing to take
those risks on.

Do you think she should do this

based on what
we're talking about?

I do. I feel confident knowing
that she's in your hands.

But the real answer comes
how she feels, of course.

- How do you feel?
- [sighs] Um...

I scared you, right?

- Yes, you did.
- I was traumatized.

Yeah, big-time.

I'm scared for my life
all over again,

and I'm scared I can catch
skin necrosis.

I'm scared I can die.

I'm scared that this procedure
can go wrong.

You know, it's the tough choice.

I mean, you wanna take
this journey with me

and go down this road and try
and make it look better?

I would love for it
to look better.

I know.

I would love for you
to help me.

All right. Let's do this thing.

- Let's do it.
- I'm up for it.

- Thank you.
- Thank you so much.

♪♪♪

- Doctor.
- Doctor.

- Doctor, Doctor.
- Hi.

- How are you?
- Hi. How you doing?

- How you feeling?
- All right.

All right, so you know Peng.

Then this is Dr. Massry.
We have done

a lot of these complex cases
together,

and this is one of his fortes.

Again, this is very complex,
risky surgery.

♪♪♪

DR. NASSIF:
For Gina's surgery today,

my team and I will begin by
removing the scarred down skin

under her right eye
to free up the nerve

and hopefully stop her pain.

Then we are gonna harvest tissue
from her stomach

to create a dermal fat graft
and rotate the malar fat pad

from her lower cheek
to fill in the defect

and give her volume.

Finally, Dr. Massry will perform
a closed canthoplasty

so that the corner of her eye
is symmetric to the left side.

All right, here we go.

We're making our incision now.

So here's the tissue coming out.

So here's bone right here.

That means that this infection
and granulomatous tissue

eroded into the bone.

In addition, there's a lot
of pus and debris and junk.

What is this right here?
Look. Look at that.

Ohh.

It's like a big fungal ball.
Go ahead and pull it out.

Is that fungus,
or what is that?

Actually, it looks like cotton.

We're gonna have to make sure
we irrigate that well.

Thank God I found that gauze
from the previous surgery.

That can cause a chronic
indolent, horrible infection

that could eat away
her whole maxillary sinus.

The eye then can get infected,
and you can lose vision.

All right, Dr. Massry,
take that belly fat.

So I'm going to put fat down
for volume and coverage.

So I'm now cutting the graft.

All right,
this is gonna be great.

Our next step is
the mid face-lift.

So in essence we're bringing
all this tissue deep below,

lifting it up.

This is the final step.

Dr. Massry will do
a canthoplasty

where he uses a stitch to lift
up the corner of the eye

on the right so that it matches

the corner of the eye
on the left.

I gotta tell you,
that looks pretty good.

- It does.
- We didn't see any silicone,

which hopefully means
no more granulomas.

Yeah, take a look
at that projection.

It's pretty impressive.
This whole case is a home run.

- I think it's a grand slam.
- Yeah.

♪♪♪

- All right.
- What do you have for me today?

So... very interesting patient

who has been
on an interesting journey.

Her name is Jessica.
We know this patient.

Jessica has had many, many
surgical procedures

which she'll tell us about.

- Jessica.
- Yeah.

- Jessica has abs.
- Yeah.

But they sort of look like
surgical abs, don't they?

Yeah.

And she has issues regarding
her breasts.

Can you please send in Jessica?

- Jessica.
- Hello. Good morning.

- How are you?
- I'm very well. Thanks.

How are you, Jessica?
Dr. Nassif.

- I am delighted.
- Nice to meet you.

Wonderful to see you again.

Actually, you have already
met me before.

- Yes, I remember.
- Hello. How are you?

How are you? So nice...
You look wonderful, by the way.

I'm very well.
Well, I'm better than ever.

- I can see that.
- Don't you really recall?

Jessica's transformation
is either so dramatic

and so effective that Paul
doesn't recognize her,

or he's just incredibly stupid.

Or both may be true.

I was a man before,
and my name was Rodrigo Alves.

♪♪♪

- Rodrigo!
- It was Rodrigo.

I warned you not to touch
your nose anymore.

- Yes.
- If you let one of these doctors

touch your nose now, this...
will turn black

and then die and fall off.
- [gasps]

I had everything done. Look.

- From head to toe.
- Like, like everything.

- Everything.
- Wow.

It is pretty surprising, right?

- This is very surprising.
- It is a surprise to everyone.

Yes.

This is
an incredible transformation.

Jessica does not
look like Rodrigo.

Throughout the years, I've had
a lot of plastic surgery...

- Yes.
- Oh, yes.

- ...including rib removal.
- Yeah.

So many rhinoplasty
to fix my breathing.

- Yeah.
- But I've kind of given up

on my nose, so now I have just
been concentrating,

focusing on my transition.
- Right.

So nine weeks ago, I had
my gender reassignment surgery.

- Whoa.
- And now I have the most

beautiful,
perfect-looking vagina.

[chuckles] Aw.

- Where did you have that done?
- In Thailand.

- Tell us, what do they do?
- It's unbelievable.

- After the penile inversion...
- Mm-hmm.

...the doctors,
they use a layer of the abs

called the peritoneum.

So they use that to create
the line of my vagina.

So my vagina...
It is self-lubricate,

which is wonderful.
- Really? Yes.

And the doctor... he kept
all the sensorial nerves...

- You're kidding.
- ...from my previous genital.

- So I have sensation effect.
- You're kidding me.

I have to be very careful
how I sit, how I walk,

how I shower because I just get
turned on very easily.

- Wow!
- [laughs]

it is the best surgery
that I have had in my life.

End of the day, no matter how
you feel about transgenderism,

it takes a lot of bravery,
there's a lot of risks,

and you have to feel really good
for Jessica's courage

and overall state of mind,
so I'm really happy for her.

So what are your goals
with your breasts, then,

that you're seeing him for?
- Right.

They look good now because
I have a push-up bra.

But if I take this bra off,

the breasts... they are low
and they're spread apart.

I would like my breasts
to look bigger

than what they look right now,
higher, and close together.

And I would like to go up
to 1,250.

I believe if I go bigger,
you're gonna be able

to fill in this space
that I have here,

which is quite big.

Remember, the more and more
work you do on your breasts,

especially the larger you go,

the more complications again.
It's gonna start all over again.

I just wanted to perfect
the female that I became.

- Mm-hmm. Totally.
- Makes sense.

- There you go.
- [laughter]

I started finding
some unusual things.

- Really?
- I found a foreign body,

like a piece of gauze...
- What?

- ...in your sinus.
- Oh, my God.

Jeez, the defect just keeps
getting bigger.

How are we gonna get
this down to there?

♪ I wanna be perfect ♪

- Hello.
- Hello again.

Let's see what's going on.

Let's take a look at your mounds

relative to your arm positions,
okay?

So stand up for a second.
Okay, hair back.

Paul, look at her breast mounds.

Are they at the elbow,
or are they somewhere

in the mid arm point?
- Mid arm point.

Okay, have a seat.
Let me tell you what I think.

The truth is,
your breast mounds

are positioned where
they're supposed to be,

relative to the rest
of your body.

Now, if you, for example, close
off the bottom of the pockets...

- Mm-hmm.
- ...to put 'em up higher.

- Mm-hmm.
- What would that do

to the distance between
the nipple and the crease?

Where would the nipples be
relative to the mound?

Oh, the nipple would go down.

Yes.

It's an abnormal look.
It's a weird look.

- Yeah.
- Now what if I pulled

your mounds closer
by closing off the sides?

Mm-hmm.

What would it do
to the nipples?

They would be
even more far apart.

Exactly.

Nipples and breast mounds
are kind of like

Paul and dinner.

When you move the mound over,

the nipple goes
in the opposite direction.

When you're at dinner with Paul
and the check comes,

Paul also goes
in the opposite direction.

So no matter what
breast surgery I do,

the nipples will still be
too far apart

or too low, would not be
positioned correctly.

Correct. Now if you go bigger,
if you were to go very big,

you would get
more upper fullness.

They would be closer
just because they're bigger.

- They're bigger.
- Yeah.

But do you really wanna go
to that level of caricature?

I don't want to be seen as that.

I'm much more than the visuals
that you see.

I'm interested in being
a beautiful woman

and live a happy life.

So in other words,
I should just continue using

the push-up bras?

That's gonna be the best...
Best idea for you.

Even when I go to the beach,
wear bikinis with push-up bra?

They make bikinis that have
built-in push-up bras in them.

I haven't seen it.

Girl, you gotta go shopping.

Girl.

[laughter]

♪♪♪

How are you?

Uh, actually pretty good.

Do you mind if I touch
your upper eyelid?

- I just wanna feel that.
- Yeah, it's fine.

It's soft, and the lymphatic's
not draining right now.

All right, remember you had
an area of necrotic skin,

and that was really bad.

Once I cut out that tissue,

that's when I started finding
some unusual things.

Really?

I found a foreign body
like a piece of gauze...

- What?
- ...in your sinus.

- Oh, my gosh.
- So we took that out.

How in the heck did I get gauze
in there?

Probably from one
of the other procedures.

How is the pain you had?

- Yeah, it's a lot better.
- Really?

Yes, I'm actually able
to sleep now.

We're not out of the woods yet,
because one,

I don't want that wound
right here pulling apart.

Mnh-mnh.

I don't want you
getting an infection.

Did you see any silicone
at all or no?

No, I didn't see that.

I'm just really grateful
that I have a chance now

to reclaim my life because, um,
things are starting

to look dismal.

This is the best I've felt
in a long time,

so I'm just really crossing
my fingers

that this is finally the end
of my personal hell.

I've been in this game
a long time.

- Yeah.
- This is really...

- It's amazing.
- I'm really impressed.

I mean, this is, like,
super sophisticated.

This is a giant step
in the right direction.

I know. Yeah, thank you
so much. Thank you, thank you.

♪♪♪

- Bianca, how are you?
- Good. How are you?

- Good. You know Heidi.
- Yeah.

I know what to do.
I have a great plan.

I just have no idea
if the plan's gonna work,

because it's all fun and games
until you try

to close the wound,
and you can't get it closed.

So that's why this case is
so difficult and so high risk.

- You ready to do this?
- Yes, I'm ready.

- Hey, let's do this.
- I'm ready.

Let's make it good, okay?

I've done this kind
of problem before,

never to this great a degree.
I mean, truth be told, we are

pushing the envelope today,
but there's no other choice.

♪♪♪

DR. DUBROW:
For Bianca's surgery,

I'm going to start
by making an incision

around the belly button to
release it from the scar tissue

and reduce it
down to a smaller size.

Next, I will remove
the skin graft,

recreating the defect.

Then I'm going to elevate
her skin

and tighten
the abdominal wall muscles

to try to create as much
skin laxity as possible.

Finally, I'll close her up,

hopefully leaving Bianca
with a scar-free stomach.

Big question mark is how big
is this defect going to be

once I've removed
that actual skin graft?

So the defect... it's 15 by 6 1/2.

All right, so we're releasing
the belly button

and shrinking it down to size.
Okay.

So this is the skin graft,
removed.

Now look at the size
of the defect that we have now.

- Yeah.
- Yeah.

So it was this.

And now it's... 27...

by 12.

So it's almost double.
Damn it.

There are two opposing issues
going on.

On the one hand,
I need enough loose skin

to close the defect.

On the other hand, I need to
leave enough blood supply

so that the wound heals.

Jeez, the defect just
keeps getting bigger.

But each artery that I sacrifice
in lifting up more tissue

to get more elasticity

sacrifices
potential blood supply

that will allow
this wound to heal.

This is a push-pull situation.
It's very dangerous,

and it's very risky.

How are we gonna get this
down to there?

This is never gonna happen.

Seeing your face look great

and then slowly do worse
every single month

has been really hard.

That kind of really erodes
your spirit.

All right, so let's look at it.

I actually really don't wanna
look at it because

I'm just afraid of seeing
that scar again.

♪ I wanna be perfect ♪

You normally don't see
this much scarring up here

on a redo, but this is
a very thin abdominal wall.

So it's very heavily
liposuctioned.

That's clearly why
that all this skin died.

When you do a tummy tuck,
you do some liposuction,

but you're never supposed to do
liposuction

in the primary area
that supplies the blood supply

to the healing tummy tuck wound.

If you do, you can reduce
the blood supply substantially,

and the tissue will just die.

She thought that the skin died
because the surgeon

didn't put drains in,
but in reality,

the flap was just
overly liposuctioned.

Now that we've elevated
the flap,

the best way to get more laxity

is to flatten
the abdominal wall.

Whenever you do a tummy tuck,
you tighten the muscle.

I can see evidence that
the surgeon previously

tightened the lower portion
of the muscle,

and the very top

but missed mostly two-thirds
of the central area.

Now the more I tighten it,
the flatter it can become,

the more loose skin I get,

and the easier I can close
the abdominal wall defect.

So his incompetence
is my good fortune in this case.

All right, put the drains in.

Big question is, will this
come down to here? Here we go.

♪♪♪

- [laughs]
- Nice.

- [click]
- Can we do it?

[click]

- Scar's low.
- Sweet.

Excess tissue's removed.

The skin graft
is completely gone.

- The abdomen's flat.
- It's beautiful.

And it's got good blood supply.
This should heal.

- It's really good.
- [imitates explosion]

Let's close it up, okay?

♪♪♪

- Hello, you two.
- Hello.

- Good to see you.
- Likewise.

- How are you feeling?
- Good.

Let's talk.

The goal, obviously,
was to remove the skin graft.

I went in there
and elevated everything up,

and as I kept going higher and
higher and higher and higher,

I could see it was very
diffusely scarred everywhere.

So he way over-liposuctioned,
and that's why you lost

all the blood supply down here,
and that's why it all died.

All right, so let's look at it.

I actually really don't wanna
look at it

because I'm just afraid
of seeing that scar again.

- Oh, my God.
- Yeah, you do wanna look.

- Oh, my God.
- And so I was able

to remove the whole thing.
- It looks amazing.

♪♪♪

How much tension is on that?

Because it looks like
it's, like, closed easy.

Once I tightened the muscle,
got it flat,

it gave me a lot of excess skin,

and it's gonna be
under the bikini line,

and it's gonna be awesome.

[crying]
I'm just lost for words.

Thank you.

You're welcome.

This is why Paul and I
do this surgery.

It's to take people who are
in hopeless situations,

who have nearly
unfixable problems,

and attempt to fix them.

Booyakasha!

You definitely have
magic hands.

- You did nail it.
- That was a good one, huh?

Oh, yeah, beautiful.

♪♪♪

Unfortunately, I'm heading back

into surgery today.

The last few months
have been difficult.

The surgery looked great
in the beginning,

and then I started to have
a recurrent swelling,

which is a seroma in my cheek
that was minimal at first,

and then it just got worse.

And it's actually
pretty painful.

And I've been having trouble

with driving, reading,
and sleeping.

That kind of really erodes
your spirit,

and I'm nervous about it,
and, you know,

anything's possible what could
be causing the swelling,

so we'll see what
Dr. Nassif finds.

♪♪♪

Okay, so let's talk
about this for a minute.

As you know,
she was doing great.

Yep.

And then she's had
recurrent problems.

She's been out here
for the last month.

- You two have drained her...
- Many, many times.

Many, many times, so we thought

that would help her
from crashing.

Conservative treatment...
That's the way to go first.

- Absolutely.
- It hasn't worked.

Following Gina's surgery,

she has had
multiple problems

with what
we call recurrent seromas.

For the last month, every week,

we've been draining off
a seroma,

which is so unusual, so my only
alternative at this point

is to open her up again,
look for the caps of the seroma

and remove it completely,
and hopefully,

this will be it.

- This junk is deep.
- Yeah.

So this is where I can cut
in the nerves.

I mean, you know,
she can wake up

with her nerve paralyzed
in different parts of her face,

and that's what scares me.

- So you're in.
- Okay. So there's your cap.

This capsule is huge.

It's probably about the size
of my hand,

and it looks like
a little monster.

For some reason, Gina's body
is constantly making fluid

in her cheek
following her first surgery.

Once you keep
reaccumulating fluid,

then what happens sometimes is
you make a capsule around it.

Once you make the capsule,
the seroma keeps coming back.

It becomes a vicious cycle.
Why is this happening?

I don't know.

This just goes to show you that
you can never predict

what's gonna happen
in regards to healing

after you operate on a face

that has had silicone
injected in it.

This is going straight down
the bone.

[sighs]

♪♪♪

The specimen will be called
right cheek mass.

♪♪♪

Whew! Son of a beeyotch.

All right.
I need a 2-second break.

So since we have a hole,
our next goal is to plug it.

How much of that tissue moves?

- This?
- All of it.

Is there anything above
that we can stitch it to?

Yeah.

Now my next step
in the process

is I need to restore some volume
back in Gina's face.

So we're gonna have to do
another mid face-lift

like I did in the first surgery.

Once we do that,
we need to do a canthopexy

on her right eye,
which is gonna hopefully

lift up the corner to match
the good side... the left side.

I really hope this works
for Gina.

She's been through so much.

I mean, listen,
if we can keep the eyelid

from something like this,
I mean, it's just a win.

It looks fantastic right now.

- Okay. Great job.
- Thank you, Dr. Nassif.

Thank you very much, everybody.

In my career, I've never seen
anything like this.

Very intense, a lot bigger
than the first surgery.

I'm gonna send out the tissue
to pathology

to see what's causing this.

Is it gonna just be capsule or
old silicone still left in here?

I still don't know.

That tummy tuck surgery
had me left on death's door,

but now a new body, a new me.
It's like, wow.

[kisses]

Young lady, how are you?

Well,
thanks for calling me young.

♪ I wanna be perfect ♪

♪♪♪

- Hello.
- Young lady, how are you?

Well, thanks for
calling me young.

Now especially young,
'cause you look fantastic.

How's your eye pain?

My pain has gone down
significantly.

It's almost gone, and so I don't
have that horrible, just agony.

- [whistles]
- Mm-hmm.

Good.

So just got the pathology back.
It just was foreign body.

So that must mean that a little
bit of that old silicone

you had injected caused
this massive weird reaction.

- Wow.
- Wait until you see it.

So the tissue
looks pretty healthy.

Wow, it looks
totally unbelievable.

And it's looking better.
Like, even morning to night,

there's just, like, improvements
like within eight hours,

and it's just... I'm just...
unbelievably happy.

Silicone can be impossible
to remove,

but thanks to Dr. Nassif,

we have it removed
in the cheek area.

My energy level is increasing,

and actually my mood
has gotten better.

My hair loss has stopped,

and actually, my hair is
starting to grow back.

My thought process is, um,
actually getting faster.

I mean, it's just a miracle.

I was having all this
really bad joint swelling,

and it's gone.

I was having, like,
daily nausea, and it's gone.

It's just life-changing.

I think that this is
the highlight

of just such a, you know,
rough part of my life.

And this is why we warn patients
all the time.

Don't have anything illegal
injected in your face

or your body...
- Mm-hmm.

...because we don't know
the long-term effects,

and it really ruined you.
It destroyed your life.

- Yeah.
- But here's the horrible thing.

We still see in our practice
all the time,

patients that still do it
day in and day out.

Oh, all the time.

You would think
after all these years

of us warning people not to
inject foreign substances

from hardware stores
or plumbing supply stores

that we'd see less.
We see more.

But see, I didn't know this was
happening to me,

and that's the thing.

- And hopefully, it's over.
- I hope so.

Let's hope.

I'm just so grateful.
Thank you so much.

I hope to God,
because I want you to start

seeing patients again.
- Mm-hmm.

Congratulations. It's good.
You're in a good place.

So happy for you.

I would like
to practice medicine again

in the near future.

I'm just so grateful that
they chose me to help.

I mean, this will give hope
to so many people,

'cause when you have, like,
hardly any hope,

it's so hard,
and you have to look for, like,

beauty every day, and now
when people see it,

they'll actually have hope,

and that's what we all need,
so thank you.

Yeah, you look good.

The only thing that
would make this better

is if I had done this.
- Exactly.

- [laughs]
- Don't inflate his ego.

♪♪♪

In the last three years,

I felt like
I was living in a disaster.

That tummy tuck surgery
had me left on death's door.

I would've never thought I would
be in this position right now...

A new body, a new me.

It's like wow.
My scar's completely gone.

There's nothing there.
I'm in disbelief.

♪ I never felt ♪

♪ Never felt this way ♪

- Oh, my God.
- [laughs]

The last time I saw you...
[kisses]

...in a 2-piece was years ago.

You look amazing, baby.

Since the surgery
with Dr. Dubrow,

she just smiles every minute.

She has a walking glow.

It's a complete
free, new Bianca.

I'm speechless still
to this day.

I feel like a hot mama.

- You are a hot mama.
- [laughs]

Before my surgery,
I had a scar on my stomach

that I could fit
my whole hand in.

The scar was so painful,

it kept me from working out
with my husband.

And I wasn't able to eat
big portions,

but now thanks to Dr. Dubrow,
the scar's gone.

I can work out,

and I haven't had any pains
in my stomach at all.

And now I love showing off
my tummy.

To be myself is... I can't ask
for anything better.

I cried so much,
and it is tears of joy now.

Dr. Dubrow was able
to remove that scar.

It was just removing
those three years

and not letting me look back.

He gave me a future,
being able to show myself off

and be beautiful again.

I'm so happy.

Can't wait to see
that full tan.

[laughter]