A Chat with the Botched Doctors On the Alluring Sideshow of Hack Jobs

But there’s also a circusy aspect to it, as far as people being shocked by how the patients look initially. Did you foresee the sideshow aspect of it or was that not until you saw the first patient?

Dubrow: There is a car accident component to it and a sideshow thing where we get the freaks and geeks and weirdos. But part of what gets you botched is that pursuit of weirdness and extreme changes.

Nassif: And that also warns other patients not to do this.

Dubrow: So we like to show that. But I didn’t foresee that at all.

Nassif: I didn’t, either.

In general, what do you consider “bad” plastic surgery?

Nassif: Plastic surgery that you know they had plastic surgery. Good plastic surgery is someone that just looks good and natural.

Dubrow: Right, but botched plastic surgery is both plastic surgery that’s even beyond that to a certain degree. There’s plastic surgery that doesn’t look that great and you can see that they’ve been altered slightly or even significantly. We do have that on the show, but we [also] have stuff that’s gone really, really wrong. And those are the hardest cases for us.

Before you started practicing, did you think about the moral aspect of this work? You’re changing someone’s appearance and playing such a huge role in rebuilding their self-esteem. There’s an element of profiting from people’s insecurities. Did you wrestle with that at all?

Dubrow: Yes. I’ll be honest with you. I went into plastic surgery because I liked the renaissance component. We do head-to-toe surgery and we do a lot of different things both for deformities and cancer and trauma and congenital deformities. Once I got to be a full-fledged popular plastic surgeon who does primarily cosmetic surgery, I started to feel really weird about that. I started to feel like it was a waste of all that amazing training and that here I am, I have the ability to sew a thumb back on. I can make an ear out of no ear. I can make a breast out of no breast. I can do some pretty incredible things and I don’t do any of that. All I do is suck fat, take bumps off noses and make breasts bigger.

And for a few years straight, I would come home and say, “What am I doing with my career?” I felt very weird about it. And then I started justifying it in my own mind by saying I make people happy. Okay, so I make people happy, that’s enough. But I always felt there was something missing. And Botched has been a transformation for me in my career in that I finally feel we get to use all the amazing training we’ve had in our lives, the sum total of our knowledge and our experience to do something really amazing. So it’s gone full circle for me, and I feel really good about that. [He points to Dr. Nassif] He’s a much more superficial guy.

Nassif: So for me—besides his stupid comment—I’m originally a head and neck surgeon and we do facial plastic surgery as part of our training. And what got me into this was a little boy came in and got attacked by three pit bulls, lost most of his scalp and a lot of destroyed facial features. I was able to help, as a head and neck resident, put that little boy back together and that resonated with me, and I ended up liking the reconstruction part. So what’s different about what I do, since I only do facial plastics, about 85 percent of what I do is just noses. Sixty-five percent of that is revisions and reconstruction, so there’s a lot of functional components like breathing and all that. This just kind of parlayed into Botched because it’s something I already did. So I never got into that whole feeling that you mentioned of my playing out people’s insecurities. That never actually played into my practice. Since it’s nasal reconstruction, a lot of them pretty much have had bad plastic surgery. Psychologically, I think it helps them, and functionally it makes their breathing better.

Were you guys always fascinated with transformation? When did you become obsessed with this line of work?

Nassif: I just wanted to be a doctor from the age of about 12 onward. And then from there, the reason I went into head and neck surgery is because anatomy was really interesting, and then facial plastics after that.

Dubrow: I went into medical school thinking I was going to be a heart surgeon. ‘Cause I’m kind of calm under pressure and I’m good with my hands and I’m a pretty quick thinker. I thought that would be perfect for cardiac surgery. It wasn’t until my second year of medical school that a really dynamic plastic surgeon came in to lecture about what plastic reconstructive surgery was and the scope of what it was, and he gave an hour lecture that showed things from reconstructing faces that had blown off and war injuries to cleft pallets and cleft lips to making noses out of foreheads to reconstructing cancer, chest problems and cosmetic surgery. He was very dynamic and he ended the lecture saying, “Plastic surgeons are the last of the true renaissance doctors.” And I’ll never forget that. I thought, Oh my God. This is the field for me. And I walked up to him after class and I said, “I want to do this.” He goes, “Come to my lab.” I went to his lab and was in there for seven years. I published thirty papers in the field of plastic surgery and it was like, this is my calling to be a plastic surgeon.

The culture around plastic surgery has definitely shifted. Do you think celebrities have become more open about getting work done?

Dubrow: I think that—it’s interesting. In the beginning, meaning in the ’80s, a celebrity wouldn’t talk about it at all. Then in the ’90s, it became okay to admit to Botox and fillers. And then in the 2000s, it was okay to start talking a little bit about breast implants. But beyond that, I have two feelings about it. Number one, it’s nobody’s business. These are people’s private medical situations. And I don’t even think it’s okay to ask celebrities if they’ve had anything done.

On Bravo, Andy Cohen will ask the housewives straight up if they’ve had work done.

Dubrow: He will, but you don’t see him asking celebrities when they come on Watch What Happens Live, “Tell me what you’ve had done.” There’s sort of an understanding when you’re a housewife that if you think it you say it and so you’re paid to be totally open. So they know that’s the game, that’s the contract you sign. You’re gonna bring it and talk about it. It’s okay on that playing field. But again, he’s never bringing on Cher and saying, “List the procedures you’ve had done.” So he gets it, too. He’s not pimping out plastic surgery on celebrities. And then the other thing is celebrities have to have plastic surgery because they depend on their looks. It’s a visual medium, so whatever it takes so they can continue to work and show their talent, continue to be employed is fair game. I just think we’ve been a little harsh on celebrities and their plastic surgery. Having said that, I do a show now called Good Work, which is on after Botched, where we do chat about celebrity plastic surgery but we’re very careful, I hope, not to be insensitive and not to be face or body shamers and to do it properly.

It seems like women are more open to embracing our plastic surgery choices and whatever other women want to do with their body. When you have women coming in who aren’t sure that they want to go through with it, how do you deal with that without pushing them?

Nassif: In regards to the face, some patients will come in, especially when it comes to the minimally invasive procedures, like Botox and fillers, which is something that we don’t have a problem with doing because one, it’s not permanent. It’s not surgery, even though there are risks involved with all those types of procedures. And they will ask our opinion. In something like that, I personally don’t have a problem giving my recommendation for gentle rejuvenation items. However, if a patient comes in and you can tell there may be an issue, that there’s a little bit of body dysmorphic disorder or something like that, where they don’t really know what they want with their body but they’re trying to inquire “Well, what should I do?” And they don’t have a real good reason for it. It’s not something specific, like, “I have a huge problem with my nose and I can’t breathe, I want you to fix it,” versus “Take a look at me. What do you think I need?”

Usually, in a situation like that our job is not to sit there and judge these folks and say, “Well, you need a face lift, you need your eyes lifted.” We usually will not do that. Other doctors have no problem doing that. But compared to what we do, we try not to push patients to have plastic surgery out of the blue. They have to have a definitive concern; they have to be realistic. They have to be psychologically stable and healthy. They have to meet numerous criteria before we even operate on them.

Dubrow: I think what’s weird for us is that plastic surgery is the only field in medicine where you’re realistically selling patients the products. They don’t have a disease where they have to have a treatment. They don’t need treatments, so you are selling them. So we, I think, take the attitude where they sell us. You want your upper eyes, lower eyes and facelift done and I look at your upper eyes and go, “First of all, you don’t need your upper eyes. Scratch that off. It won’t help you.” And they go, “Oh great.” I try to down-sell them. We both do that. We try to sell that only procedures—it’s not even selling, because we don’t need to sell because we’re who we are, to be honest with you. We are booked for a year. So we try to make patients happy. We try to give them a great plastic surgeon experience without selling them.

On this new season, there’s a woman who says, “I’m dying for a nose job. Who wants to look natural?” Which is extreme. How do you approach those types of cases differently?

Nassif: We do have to handle those differently. I mean, we’re more intense on the preoperative standards, such as: Psychologically are they intact? Do they have any problems such as body dysmorphic disorder or plastic surgery junkies or OCD, things like that. We really want to make sure why we’re doing it. However, most of these patients that come to us, after the screening, have really been botched. And as Terry will say, when these patients come in that do have body dysmorphic disorder, they’ve been so destroyed that they need to come back to being “normal” again. And we are their last hope, so even though they have a psychological condition, some of these patients we will operate on them. But we have to get the psychologist involved because we have to try to help them. We need to try to get them back to, not beautiful, not taking a little hump and making something perfect but get them back to looking somewhat normal. And every one of these patients, we go through intense conversations because the risks are a lot higher with revision surgery. We tell these patients what could happen to them. The nipple could die, the nose could turn black, these horrible things could happen.

Dubrow: Right, the difference between a regular patient and a revision-slash-botched patient is that although the risk is greater for botched patients, the chance of a huge improvement is less for a botched patient. Sometimes because they come to us and because we’re on television and we’re known for this, they expect the same kind of outcome in a botched result as in a regular result. If a patient comes in with a B breast and you try to make her a full C, they expect it to be a perfect version of their breast that’s full C. With us, they come in with destroyed breasts, they still sometimes expect perfect, full C breasts because we’re the botched doctors.

But I’ve seen you guys telling them, “Hey, realistically, it’s not going to be perfect.”

The problem is, we’re so focused, to be honest with you—this might sound crazy arrogant—we’re so good at this that we are often making them as good as a normal patient. But we can’t have them expect that. So we have to downplay their expectations and hopefully deliver more than we promise.

The whole “looking natural” thing is always interesting because that’s the whole end goal, to look as natural as possible—

Well, that’s what we like. Some patients come and don’t want to look natural and even some of these botched patients.

The Bieber guy from season 1 was very…

Nassif: There’s all kinds of interesting celebrity characters and fantastic surgical candidates [this season].

Dubrow: You know, the interesting thing about Botched, on a side note, is that patients who watch the show, sometimes they are holding us to different standards. They evaluate us only on the After, not the Before.

Nassif: They forget about that.

Dubrow: They forget the Before. And if you look at some of our Afters, you might say, in a vaccum, that’s okay. But if you look at their Before, it’s amazing. So sometimes we do amazing results and they’re still not as amazing as the patient wants, so it’s about setting their expectations.

Do they ever try to come back and get more?

Dubrow: Oh yes.

Nassif: Routinely.

Dubrow: I had a patient who had the worst breasts you’ve ever seen, ever.

Not the uni-boob?

Dubrow: It’s a weird kind of uni-boob, much more complicated than a standard uni-boob, which is like a once in a career thing anyway. This was uni-boob gone mad, gone crazy, and I fixed her. On camera, I say to her, I go, like, bathe me in the how-fabulous-am-I moment. And she goes, “I’m happy…” And I’m like, you’re “happy”? How ’bout you’re ecstatic. “Well, I was hoping I would be a little bigger.” I went ahh. I got her to actually look pretty. I went from horrible to pretty, not just monster to ugly.

[Dr. Nassif grimaces]

Dubrow: Because a lot of what we try to do in revision surgery is monster to ugly. But now on Botched, it has to be monster to pretty. They don’t judge us by the Before. They judge us by the After.

[Here’s where the doctors started breaking down the science of their new skincare lines. If you’re interested, Dr. Nassif’s is $95 here. Dr. Dubrow joked about napping during Nassif’s explanation and then promoted his line, Consult Beauty.]

Part of the reason for these products is that women in particular unfortunately have this fear of aging because of pressures. How do you satisfy older patients without losing their natural appearance of aging?

Nassif: It’s interesting, when you have some of these patients who come into our offices in their early 40s and they’re just starting the aging process, or even late 30s, what we like to do. We’ll start some of the Botox and fillers and skin care in their 30s just to keep them looking good, but then when they get to their 40s, sometimes they need a gentle, subtle natural appearing lift and a tuck, especially like a mini facelift, a little skin on the upper eyes. So when we have these patients come in and they just always want to eternally look fantastic, we have to be gradual, versus someone who comes in at 60 for emergency facelift, where you’re taking somenoe who has a lot of excess skin and all of a sudden changing their face. Still natural, but there’s a drastic change that’s usually not typical anymore.

Dubrow: Yeah, we like the less-is-more viewpoint. We like when people do less things earlier on, hold things back and then as they start to develop, if they know they’re gonna have plastic surgery, do little things earlier so they can avoid the big procedures.

In Beverly Hills, people always say there’s a heightened sense of body image culture. Compared to New York, there is more pressure over there.

Nassif: Being in Beverly Hills, a lot of these folks—self image, body image, looking good and having a great body, whether you’re in Orange County, where he’s at or where I’m at in Beverly Hills, it’s all the same in Southern Cal and there’s a lot more pressure, especially in our area of the industry where everyone’s an actor or actress so they always have to eternally look good so they can play younger parts. So looking good and self-esteem and the constant strive to be youthful is very big in the Beverly Hills area. But at the same point, we have to be careful of that. Because we don’t want to jump in and glorify that. Our goal is, we’re seeing these patients to make sure they’re doing it for the right reasons, to be subtle with what we do and make them feel good about themselves but not add into any addiction or any other problem.

Dubrow: Same answer.

Is that part of why you practice there? There’s obviously money to be made in that area.

I mean, we were both raised in Southern California so it’s just natural for us.

Right now, I guess butt lifts and injections and lifts are en vogue. What are celebrities doing that makes it look so natural? I’ve heard of fat grafting andI’ve seen some Before and After where it’s really subtle.

Dubrow: The greatest increase in terms of percentage gain in plastic surgery procedures in the last twelve months has been in the buttock augmentation. The most common way we do it now is through fat transfer. It used to be implants, which wasn’t very common. A lot of complications associated with that, but it’s very common now to do transfer of fat from the abdomen into the butt. It’s effective, it’s not without it’s risks, but it’s pretty straightforward and it’s very popular. It’s natural and most of it will take and patients like it.

Has Botox popularity gone down or up?

Nassif: Up. It keeps going up every year. The newer toxin is Botox, Dysport, Xeomin. Botox is still probably the most widely used muscle relaxant. And every year I think their sales keep increasing because I think it’s something that’s not invasive. It’s not reversible, but it’s not permanent and the filler is the same thing. The good fillers are all reversible. So we keep seeing an increase annually in non invasive area, which is that, in addition to non surgical skin tightening, like Ulthera and other skin tightening products. If you can get something where you can put some topical on your skin like what we have, the skincare lines, and improve your skin complexion, that’s fantastic.

Botched Season 2 premieres tonight at 9/8c on E!.

Images via screenshot/E!