Botox's ephemeral nature can be either its best or worst quality. We all want it to last longer — until we don't. Until our lip flip prevents us from swishing our morning Listerine or sipping our spritz through a straw. Until an errant needle stick upsets our smile or Spocks our brow. In those moments, we're relieved (deeply) when the freeze inevitably thaws.
Reversibility is also a boon on the hyaluronic-acid (HA) filler front, where a round or two of hyaluronidase can typically melt away most misbehaving gels and errors in judgment.
However, plastic surgery, unlike injectables, is revered for its relative permanence. For nearly every cosmetic procedure, How long does it last? is a top Google search (rivaled only by How much does it cost?). With enhanced durability, however, comes a higher price and greater stakes. While we generally enter into surgery in good faith, believing that the outcome, barring any hiccups, will be one we'll appreciate for decades, it's not uncommon for folks to regret going under the knife, even when the procedure is technically a success.
This is precisely how plastic surgeons distinguish a "reversal" from a traditional "revision," which is performed to address a complication or miscommunication. With a reversal, "the desired result was achieved, but the patient no longer wants that result," explains Dr. Umbareen Mahmood, a board-certified plastic surgeon in New York City. It's an extreme form of buyers' remorse that is reportedly on the rise, with more patients wishing to nullify former tweaks as cultural trends change and personal tastes evolve.
"In most cases, a reversal is sought because the area previously treated is now too large," says Dr. Ashley Gordon, a board-certified plastic surgeon in Austin, Texas. "The implants are too big, the butt is oversized, the lips and cheeks are out of proportion with the rest of the face."
Perhaps what seemed sexy at 27 feels unsophisticated at 42. Or that buzzy celebrity-inspired surgery just doesn't land in real life. Or maybe, one's personal aesthetic preferences have simply changed along with what is deemed "desirable" by society at large. Regardless, mistakes are made — and, yes, most can be reversed, at least to some extent, by various means. To that end, "it's all about making you look natural and matching where you are at your current stage of life," says Dr. Rod J. Rohrich, a board-certified plastic surgeon in Dallas, Texas. It's important to recognize, however, that backtracking is rarely simple or seamless. Cosmetic interventions — surgical and noninvasive alike — almost always leave a trace, rendering your anatomy forever changed.
Ahead, plastic surgeons reveal the most in-demand reversals and how they reflect society's ever-shifting beauty ideals and misguided pursuit of fad procedures.
Brazilian butt lift (BBL)
As certain famous backsides have seemingly gotten smaller of late, plastic surgeons are noting an uptick in BBL reversals. "People do look to celebrities and influencers for aesthetic inspiration, so if their favorite celeb is downsizing this or that, patients will usually follow suit," says Dr. Gary Motykie, a board-certified plastic surgeon in Beverly Hills, California.
Others argue that the trend — and what's driving it — is more complex. "There has been an increasing demand for buttock reductions, which includes people who've had a BBL [as well as those who] have a naturally full backside without previous surgery," says Dr. Matthew Schulman, a board-certified plastic surgeon in New York City. While he admits that "we are likely moving towards a more athletic appearance," this doesn't mean that the BBL is falling from favor, he insists. Rather, "it shows that people are paying more attention to their butts and pursuing surgeries to change their shape and size, whether by making them bigger or smaller."
We also can't discount the maturing tastes of those who were early adopters of the BBL. "We're now about 15 years into the BBL movement," Dr. Schulman explains. "The young woman who wanted a full, round butt, and had a BBL in her twenties — she may be in a different place in her life now," he says, describing a scenario he commonly sees in practice. "She's in her late thirties or early forties and she no longer wants the attention that her buttock has brought her."
What's more, with age, pregnancies and weight fluctuations, the butt can naturally get bigger. And this, too, motivates some folks to seek BBL reversals.
Whatever the reason for the desired reduction, the trick is to shrink the butt without sacrificing its shape or causing skin laxity or sagging. "Nobody just says, 'Make it smaller,'" Dr. Schulman notes. "They all say, 'Make it smaller — but keep the round shape.' This is what makes a BBL reduction difficult — we need to remove fat in very specific locations to provide a smaller shape that is still attractive."
Plastic surgeons have different ideas about the best way to meet this challenge. Some prefer a staged approach. "If the patient is open to it, I recommend serial liposuction of the excess fat, as taking modest amounts, over three to five sessions, will give the skin the opportunity to contract," Dr. Gordon says. When lipo leaves behind loose skin, it often needs to be excised, or cut away, and such operations can leave significant scars.
While some surgeons pair lipo with skin-tightening treatments, like Morpheus8 or BodyTite, others don't find them to be very effective. "I have seen many situations where surgeons rely too heavily on energy devices," says Dr. Schulman. "They remove large amounts of fat, believing that the device will tighten the skin, only to find out afterwards that the skin retraction was not as much as they thought it would be." In lieu of tightening tools, he combines judicious liposuction with strategic fat injections to adjust the shape of the behind after reducing its volume. While it may seem counterintuitive to add during a subtractive surgery, he explains that "sometimes when a person considers their butt to be 'too big,' it's more about shape than size."
A couple of caveats: If during a BBL, fat is injected into the gluteal muscle — a practice that’s been condemned in recent years due to the associated risk of fatal fat embolism — it cannot be safely extracted via lipo or other methods. Further, if there are implants in play, they can be removed, but some amount of fat replacement may also be needed to resculpt the butt.
In such cases, Dr. Schulman first takes out the implants and allows the pockets (which hold the implants within the muscle) to close down over time. About nine months later, he'll do a conservative BBL (provided the person has enough donor fat) to enhance the curves of the butt. "If you try to close the pocket with sutures and do this all in a single stage, the fat will always find its way into the pocket," he adds. "This will result in poor fat survival and likely hard fat necrosis, while also putting the patient at risk for fat embolism, since the fat is being placed within the muscle."
As with the BBL, a hike in breast implant removals doesn't necessarily signal that boob jobs are on the decline. There's a similar yin-yang dynamic occurring in this realm. To wit, there were 364,753 breast augmentations performed in 2021, according to The Aesthetic Society. During that same period, 147,684 women had their implants removed and replaced (up 32% from 2020) and 71,284 had their implants removed but not replaced (a 47% jump).
While women swap out their implants for myriad reasons, our experts say the lion's share are leaning more conservative. "Patients are opting for a natural, feminine appearance — they want to look the way they do in a padded push-up bra," says Dr. Mahmood. While she acknowledges that there are cultural and regional variations to this particular beauty standard, surgeons elsewhere in the country report seeing the same. "Outside of Vegas and Miami, things are not quite as big as they used to be," says Dr. Rohrich. "Even here in Dallas, the look is a little smaller — which is a good thing, because bigger implants mean bigger problems in the long run."
Backpedaling on a breast augmentation by removing or exchanging implants is a fairly straightforward endeavor. "If the original surgery was performed appropriately and there have been no issues throughout the years, replacing a larger implant with a smaller one will usually result in the pocket naturally retracting [or tightening up to accommodate the new implant]," Dr. Mahmood notes. "If the existing pocket is too large and the new implant is migrating when the patient lays down, then we’ll tailor the pocket during the implant exchange."
For those choosing to go au naturale post-explant, the surgery can be even more streamlined. "I like to remove the implants under local [anesthesia], if possible, and this is easy to do if the implant shell is smooth," says Dr. Gordon. Taking out textured implants is a bit more involved. Because this style of implant is associated with the rare risk of BIA-ALCL (a type of lymphoma), surgeons customarily remove the scar-tissue capsule that surrounds the implant along with the device itself, to avoid leaving behind any potentially cancerous cells.
Once the implants are out, Dr. Gordon likes to give the tissues a few months to recover before considering further enhancements, like breast lifts and fat grafting. "Many patients are happy after explant and don't pursue additional surgeries," she says. "If the tissues don't retract significantly after explantation, a lift can be done to remove the excess skin and reposition the breasts on the chest wall."
In a somewhat recent development, doctors are spending an alarming amount of time dissolving HA fillers — from the lips, tear troughs, temples, cheeks, jawline…everywhere, really. Stats from The Aesthetic Society confirm their claims: Dermal filler reversals were up 57% last year alone. This, too, may be at least partially spurred by celebrities, notes Dr. Jason Bloom, a facial plastic surgeon in Bryn Mawr, Pennsylvania, as quite a few stars (Courteney Cox, Amy Schumer) have spoken publicly about having their fillers dissolved over the past few years.
Patients' reasons for wanting to melt or minimize their filler run the gamut, but our sources say most are simply over the cartoonish vibe that has long dominated our feeds. "I've had many people tell me, 'I'm just not into the Instagram lips anymore," says board-certified Beverly Hills facial plastic surgeon Dr. Sarmela Sunder. "They're looking for a more natural aesthetic."
Dr. Mahmood is also undoing filler for overstuffed patients who "originally sought to look like Instagram filters or strangers on social media," but now feel distorted and want to start fresh with a less-is-more mindset. Likewise, Dr. Sunder often has people come in lamenting that they look odd or unlike themselves, but they can't figure out what, exactly, is off about their appearance.
Interestingly, she says, overinflated temples are frequently to blame. "They're missing a little bit of a dip there and they no longer have the cheekbone contours they once did," she says. "This can make someone look unusual and sort of plastic."
Dr. Sunder theorizes that shifts in social media usage may be fueling filler reversals. As videos are largely supplanting static images across platforms, patients are beginning to notice that the features that used to pop in a still image don't always look beautiful in motion. "The big lips that served well as a foundation for makeup in a two-dimensional IG photo, for instance, can look very odd and sausage-like in a three-dimensional video," she explains.
She points to this viral TikTok from makeup artist Sean Anthony to further illustrate her point: "His jawline filler looked great in a static photo, but when he moved, it looked ridiculous," she says. A lot of folks are reversing their own fillers for this very reason.
On a related note, some surgeons are also being asked to remove outsize facial implants (from lips and chins) and melt obvious fat grafts to bring people back to baseline. Mercifully, "the extreme look seems to be going out of vogue," says Dr. Motykie.
Most HA gels can be dissolved with hyaluronidase. (The injectable enzyme does not work on Sculptra or Radiesse, which are made with poly-L-lactic acid and calcium hydroxylapatite, respectively; these products are considered irreversible.) "We can use ultrasound guidance to place the enzyme exactly where we want," notes Dr. Gordon. Some HAs are more resistant to hyaluronidase than others, however. "It may take three, four, even five sessions, depending on the volume and type of filler they have," Dr. Sunder says.
In Dr. Rohrich's experience, when someone is grossly overfilled and has been for years, "it can be impossible to get it all out," he says. "Temporary fillers are not always totally reversible, especially when overdone." HA gels can cause long-term changes in the skin, like scar tissue and other irregularities that cannot be resolved with hyaluronidase. "The overdone face is a disaster for us," says Dr. Rohrich. "Sometimes, there's no good solution."
Facial implants can normally be slipped out or downsized without too much trouble. "The lip tissues, especially, rebound nicely, so patients aren't left with permanent alterations in lip shape or size," Dr. Gordon tells Fashionista. When tackling unwanted fat in the lips or face, surgeons aim to gradually melt it with a series of radiofrequency treatments.
Given rhinoplasty's ubiquity among teens, it is perhaps no surprise that nose jobs rank high on the list of regretted procedures. Hindsight being what it is, many eventually discover that "the little pixie nose that looked cute at 19 doesn't suit them at 40," says Dr. Bloom.
It transcends generations, this notion of "patients wishing to have a rhino reversal due to initially choosing a 'trendy' nose," adds Dr. Melissa Doft, a board-certified plastic surgeon in New York City. Take the pert ski-slope noses of the '80s and '90s: This shape has since become passé, but it's also technically unsound — it becomes pinched and angular over time, says Dr. Doft, and this can dramatically age the face.
But it's not only throwback noses that people are wanting redone. "More recently, there's been a social-media trend of a very upturned nose," says Dr. Doft, which can be created surgically or, in some cases, with filler. "Many patients realize too late that they don't like it on their face and wish to have it reversed."
In Dallas, Dr. Rohrich is fielding similar reversal requests from folks who had rhinoplasties done abroad. Turkey, in particular, "is wild for overdone noses," he says. "A lot of patients tell me that's what they wanted when they saw it on Instagram, but after six-to-12 months, they don't like it, because it looks so fake."
Most rhinoplasty-reversal patients are seeking "classic nose proportions that have been tested over time," Dr. Doft tells us. "A straight bridge, a slight supratip break [delineating the bridge from the tip] but not an upturned nose, and a defined tip." In Dr. Sunder's office, the majority want to refine their natural nose rather than adopting somebody else's.
Since overdone noses have had their cartilages imprudently whittled away, surgeons aim to reconstruct them by using various types of grafts. When the bony bridge of the nose has been aggressively shaved down or the cartilage septum (that divides the nose) has been decimated, they rebuild these areas with rib cartilage, which has a similarly sturdy composition, says Dr. Bloom. To reshape the tip, they'll use soft, flexible ear cartilage, because it closely resembles the cartilage that exists naturally in the tip of the nose.
Buccal fat reduction
The popularity of removing buccal fat — which spans from the lower cheek, back to the jaw, and up into the temples — has soared over the past few years, thanks to the "face-slimming" hype surrounding the fix and the explosion of buccal content on social. But the procedure has come under fire lately for skeletonizing patients who shouldn't have had it done in the first place. Dr. Rohrich is currently treating an actor who had the operation performed by another surgeon only a short time ago and was left prematurely gaunt. "He looks a good ten years older than he actually is," Dr. Rohrich says. This isn't a complication of the procedure so much as a mistake in patient selection, as taking fat from the wrong face — an already-lean face, in particular — can quickly lead to an emaciated look.
Fat grafting is generally the solution, but restoring youthful fullness to the buccal hollow can be exceptionally tricky due to the unique characteristics of this fat pad, with some segments situated deeper than others. Buccal fat's mobile nature also makes it "very hard to replace," says Dr. Rohrich.
Other types of facial fat are fixed, but buccal fat moves when we animate, talk and chew. While surgeons can inject fat into sunken areas, they can rarely give back the cheeks' virgin plumpness and born-this-way curves. Even a modest improvement may require multiple rounds of fat grafting, spaced six months apart, Dr. Rohrich notes.
Exemplified by supermodels Kendall Jenner and Bella Hadid, the so-called 'fox' eye tilts upward at the outer corners, giving the eyes an almond shape (that smacks of cultural appropriation). Beyond the temporary trappings of tape and makeup, the look can be achieved with either a surgical brow lift or a nonsurgical thread lift — but it's the latter that doctors have been reversing of late. "In most cases, these patients didn't get the result they were after and they have adverse side effects, like visible scar tissue and irregularities," Dr. Sunder says. Also, we'll say it again for those in the back: Cultural. Appropriation.
Since thick, barbed threads are used to lift the tails of the brow, they don't slide out very easily. Once the patient is numb, "I'll make a small stab incision underneath the eyebrow, in a spot hidden by brow hairs, and go in and dissect around until I feel the thread," Dr. Bloom explains. Because of the way the barbs engage with the tissue, he has to guide the thread out in a downward direction rather than pulling it up and out near the temple.
After, the brow tends to settle pretty well, he says, but scar tissue can be an issue. "Over time, people can develop depressions in areas of scar tissue, where the skin is tethered down, and we'll have to chase it with nanofat or filler to smooth things out," adds Dr. Sunder.
The bottom line on cosmetic surgery reversals
Plastic surgeons hope this recent wave of reversals serves as a cautionary tale for future generations. Nonsurgical treatments, like injectables and threads, may be easier to undo than scalpel-based surgery, but every cosmetic procedure comes with risks and consequences.
When choosing to medically modify your appearance, avoid "falling into the trap of Instagram and TikTok beauty trends," says Dr. Gordon. The best way to maintain a natural look that ages well is to go for subtle, timeless tweaks that dovetail with your anatomy and identity.