Original subtitles

I'm feeling awful this morning.

I had all the ccs you could ever think of.

I'm ready to have a reduction.

I started to develop chronic back pain.

You know I'm angry.

I'm feeling flat chested right now,

and I'm very, very upset.

I was born with a condition called microtia,

which has ultimately left me with a keloid on my left ear.

The risk of you getting that keloid back

is still there.

There's no guarantee here.

I don't know if this is gonna work.

Again, no one's done this. Yeah.

♪ let's get it on ♪ ♪ jack up the bass line ♪

[woman] I'm a singer

and I've got my reality show.

♪ that's not enough ♪

you did reality tv?

Yes, in college. In college?

Keeping up with the balkjes.

It's very important to look good.

So I had 500cc filler

injected each butt cheeks.

Of hydrogel?

Yes.

Scary.

♪ I wanna be sexy ♪

♪ I wanna be hot ♪

♪ fix me, make me beautiful ♪

♪ I wanna be perfect ♪

♪ do it for the love of it ♪

♪ oh, oh, oh, oh, oh ♪

♪ never stop, never stop ♪

have no idea how much this chair helps my back.

If I could sleep here, I would. Yeah?

[sighs] taking all this weight off my breasts

for my back.

I'm feeling awful this morning.

My name is sheyla, and I am cuckoo for breasts.

I love breast implants, and I love big breasts,

but they cause me back pain.

Yeah.

John, you like little boobs like a orange.

No... Little boobs. I like melons.

Watermelons? Watermelons.

I just like big boobs.

I grew up in brazil.

I was unhappy with the way I used to look.

In 2001, at age 21,

I started going under the knife

every six months.

It became a habit.

It was like going to get my nails done

at a nail salon.

I think I was-- something wrong with me.

I think I was cuckoo crazy.

I have had 32 plastic surgeries in my breasts.

I had all the ccs you can ever think of.

I had 145 ccs,

245 ccs, 345 ccs.

I had 555 ccs,

650,

850, 1200...

...And 3500 and 5,500.

After that I didn't wanna stop.

I still wanna go bigger.

My goal were 8,000 ccs,

but unfortunately--

well, I had a blessing.

I got pregnant,

so that stopped me a little bit.

The doctor said, "we have to go back to this size

because you're gonna breast feed."

so got my breast reduction

from 5500.

I went all the way down to 750.

So after victoria was born a healthy little girl,

I went back to brazil and I say to to the doctors,

"can you please make me bigger again?

I cannot live without my breasts."

I think the less that I have right now is 2500 ccs.

[kisses] I'm gonna miss my twins.

[laughs] I'm gonna them so much.

But it's time for them to go.

It's time to retire the boob business.

In 2017 I started to develop chronic back pain.

And I'm sure this has to do

with this unnecessary weight carrying around.

Couple years ago, if you ask me,

"sheyla, go small,"

I would say, "you know what? No.

You're crazy."

but today I'm ready to have a reduction.

If I can have my breasts reduced,

that will be a big help for my back.

I have to, you know, make it look better,

but the smallest I can go is a thousand.

I can't wait to see you without your boobies. Okay.

I'm ready to look sexy.

What's happening, dre? What is going on, man? Hey, eric.

How you doin'? Good to see you, man?

How about you? Have a seat.

What's up, best friend?

Hey, how ya doing?

Good. Good. You know what I like?

Uh, yes, sir. Yes, sir.

My name is andre. I was born with a condition called microtia.

It's when you're ears are deformed

and smaller than normal,

which has ultimately left me with a keloid on my left ear.

Some people say that it looks like a golf ball.

Some people say that it looks like

a snail,

but no matter what you call it,

I just want it gone.

Was it always that big?

Or did it just-- did it seem to grow?

It was pretty small when it first started out,

but then it got bigger each year.

Up until now.

So let's say, like, okay, a year from now

you're completely healed,

like, the keloid's gone and all that,

are you gonna, like, go and, like, start dating everybody?

Yeah, definitely.

I'd be more open to it.

The keloid definitely impacts dating.

I don't, like, pursue anyone

just because I think in my mind

I'm going to get rejected.

They're not going to want someone with this giant keloid on their ear.

Middle school was rough, I remember.

That was when, like, a group of guys

was just kind of, like, mean, right?

Was that eighth grade or seventh grade?

That was definitely eighth grade.

It's so sad how cruel kids can be.

I know.

When we were little I witnessed andre

go through quite a lot of bullying.

We had people even saying things to his face,

like, "what's on your ear? What is that?

You have cauliflower ear.

Why is your ear so ugly?"

but we made it. We made it.

We did.

-[dr. Nassif] come here. -[dr. Dubrow] what is that?

Put your hand in my back, upper back.

[buzzing] you're kidding me.

You have a thing to tell you to sit up?

So it's a little thing. You stick in the middle of your back.

Yes. Then you have to set your posture.

What are you-- by the way, my height actually increased

by about half an inch.

Why don't you just sit up straight?

The best way to get paul to stop slouching

is not by putting a device between his shoulder blades.

It's by putting an ice-cream cone

just above his head.

Aah.

So we have andre,

a young man born with microtia.

Had reconstruction,

and he's developed what?

Keloids.

Keloids. Oh, poor guy.

Let me show you a photo.

Oh.

In simple terms, a keloid

is overgrowth of scar tissue,

and when you just cut it off,

your body says, "hey, there's still a wound here,"

and it keeps growing.

So it's very hard to excise

and not have it grow back again.

Can you please send in andre?

[dr. Dubrow] andre. Hi.

This guy's tall.

Nice to meet you. Andre.

Nice to meet you.

Hi, andre. Terry dubrow. How are you? Hello.

Nice to meet you. Nice to meet you.

Hi, I'm his mom malika.

Malika? Uh-huh.

Dr. Nassif. Dr. Dubrow. Hi.

How are you? Hi, dr. Dubrow.

Nice to meet you. Come on in.

Have a seat there.

My mom, she was a single mother.

We have a very close relationship.

She was always encouraging me

to just make the most out of a bad situation.

I know that it's straining to her to maybe go through another procedure again

with the same results.

If dr. Nassif can't fix this,

then I'm just gonna have to live with it for the rest of my life.

So you're born with a problem with your ear.

Yeah. Okay.

It was a unique situation when he was born.

There was something wrong with his ear, and I'm like,

"is it something I did?" [dr. Nassif] no, you did nothing.

'cause I work at a pharmacy. It's like was it a medicine

I was probably exposed to before. Okay, listen.

Listen to me. Uh-huh.

You had nothing to do with this.

Okay. [dr. Nassif] it just happened.

This is something that happens randomly then? 'cause I always blamed myself.

Yeah. There is not one specific reason why microtia occurs.

Thank you. So if you've ever had any guilt...

I did. [whooshes] has nothing to do with you.

[dr. Nassif] microtia could be a congenital thing,

or it could be environmental.

Many factors can cause this,

but you can't really pick out one specific factor.

The children's hospital referred me to a doctor.

And he examined him. He's like, "we can't do any surgery until he's five.

[both] mm-hm. So we waited until he was five.

That was the worst surgery because they had to get cartilage from his rib.

From the rib. Do you remember it?

[andre] I do, yeah. I just remember I was in pain.

How old were you when you got that keloid?

Nine or eight I would say.

[malika] he was like, "mom, I don't want anymore surgeries."

but now, if you can see, it's like literally growing over his ear

to where it's covering some of his ear.

I can tell this bothers you just as much as it bothers him.

Definitely. No matter how much people say that

they don't look at the outside, they do. And they judge you by that.

As a mother, I just try to esteem in him, that he's loved,

he's accepted, that that's just the outside.

How you are on the outside doesn't reflect who you are on the inside.

But andre is kinda withdrawn a little bit.

I feel he is limited by the outside appearance.

Does it interfere with any glasses or any activities of any kind?

I wore glasses and the thing about it is

I didn't really have like pa-- yeah, rim. A rim?

So what would be your goal right now?

Really just to get it looking

as much like this ear as it could.

Oh, I would-- I would like it to look

exactly like that. Yeah.

We want perfection. Yes.

Bring it down a few notches, mom. Bring it down.

The doctors are in a business of making miracles

and mir-ear-acles.

You would be okay with not perfection, right?

I would be okay if it-- if we get close to it.

No big deal. Yeah, of course. No big deal.

[woman] the incision was very blue. [dr. Dubrow] red.

Oh, you know what that means. Blood supply's not good. And-- yes.

I cried. It's like... I was dying.

[woman]

that I can kiss my career bye.

Kiss your butt goodbye.

Al

all right, so we're gonna take a peek here.

Okay, okay. So it's attached. Ohh.

You're missing the area up here. And that's right.

This is the reconstruction. [andre] mm-hm.

We got really lucky here because andre's keloid

is attached to a small pedicle to the top of his ear.

It's not engulfing and eating his ear

because if we had to remove a keloid

that is eating your ear, then we're lopping off the top third of his ear.

What is our goals for where you both want it?

You said, "can you remove the keloid

and make your left ear look like your right ear?"

mm-hm. Right?

Yes. Correct. Okay.

Probably not going to make them look exactly alike.

Yeah.

No matter what.

Okay.

At all.

So a plan would possibly be

doing a keloid excision

with possible rib reconstruction.

Okay.

Assuming that the keloid doesn't grow back.

A thought that's entering my mind is,

if I put rib in between the keloid and the skin,

is that going to act as a barrier

to prevent further regrowth

of a new keloid?

And, yes, I just thought about that myself.

Are there other treatments that can stop the keloid?

There is one thing.

There is something called 5-flurouracil.

It is an injectable.

It helps prevent the buildup of scar tissue.

There is a possibility

that this modulator,

which means it tells things to stop growing

may be effective.

I would inject the 5-flurouracil

at the end of surgery and every week

until hopefully that initial healing stage is over.

Ears are basically either there or not...

Yeah. ...Generally.

Name me an actor or actress

who has great ears?

Can't think of any.

You know, it's just not a thing.

[both laughing] [dr. Nassif] there we go. All right.

♪ let's get it on ♪ ♪ jack up the bass line ♪

♪ I know it ♪ ♪ drop off my waistline ♪

♪ nobody-- that's not enough ♪

my name's kasia and I'm from amsterdam.

I'm a singer

and my bass is way too low.

Everyone knows you, you know?

"kasia, yeah, the one with the nice butt."

[kasia] I was always a fan of the butts,

especially like j.Lo

and beyoncé and then kim.

And I thought this is like a whole evolution

of the butt is getting bigger and bigger and bigger.

I walk and I twerk.

It's very weird

what butt can do with your life.

My career was blown up more than my butt.

Hello!

I look like ballerina?

I've got my reality show

with two of my girlfriends,

call it, keeping up with the balkjes.

Notice I have cellulite on my buttocks?

I remember performing on the amsterdam gay parade.

For 13, 14,000 people.

And I'm about to release my new album.

Yeah, I'm out there.

Sounds funny, but my butt goes with my career.

Okay, so you see this side, it doesn't look very nice.

Kasia is real known for her music in amsterdam

but also for her, uh, beautiful body.

[kasia] and also the back,

like you can see all the fillers, literally hanging.

Instead of going up, it's going down.

When I was 22,

I had fillers.

Then I feel excited. I went back.

And I got my boobies.

So I thought it's amazing.

It's like I became a different person.

It was like more or less like this.

And that's how it was looking in the beginning.

Yeah.

So after the implants,

I had 500cc filler injected each butt cheeks.

Your looks are important.

My butt going to be literally into my knees.

It started eight months ago.

Then I can kiss my career bye.

Kiss your butt good-bye. Kiss career--

kiss your butt--

I'm doing my music video.

It's very important to look good.

I hope that dr. Dubrow and dr. Nassif

find a safe solution

to remove the filler

and keep the implants

but also keep my butt nice in shape.

I hope dr. Dubrow is going to fix it for you.

He's married, I think. Huh?

Oh... You know how handy it would be

married to a surgeon?

-[dr. Dubrow] sheyla. -[sheyla] hello.

So where you guys from? Brazil.

Is that where you've had most of your plastic surgery?

Yes, I want the big breasts, the tiny waist,

but my doctor told me I had to a couple of surgeries

to get that size

'cause I was flat chested.

Okay, so what did they put in the first time?

145.

[dr. Dubrow] that's very, very small.

They're almost like a baby breasts.

Yeah, how long did you wait

before you went to the next bigger size?

I was like every six months.

[dr. Nassif] surgery every six months--

that's not something I would recommend.

The more times you have a surgery,

the higher the frequency of encountering

a surgical or anesthetic complication.

So then after that I had to have a special implant made.

And how big were those?

5,500 ccs. Wow.

But I was pregnant and I didn't know.

Okay. So I had to go back into surgery

to reduce the implants.

So then you delivered,

and you, what, you go back in

and have big ones put back in again?

I wasn't able to get those implants

that I had custom made.

They no longer fabricate those implants.

So he took a 1500 implant and stacked two in each breast.

Okay.

[laughs] I told them, "this is so common,"

and I say, "they do all the time."

stacking?

Yeah, I lied.

Yeah, you lied. ...To get away with my big breasts.

Okay. So I show him a little video from nip/tuck

because seen on the show.

From the tv show?

[dr. Nassif] yeah. That's fiction.

That's fake.

So you convinced him

based on fiction.

The fact that sheyla

was able to convince a plastic surgeon

to do something unorthodox

by showing him a video

tells me two things--

one, she's very persuasive,

and two, it must've been a really good show.

These double stacking implants was so swollen.

It was infected,

and the incision was very--

[dr. Dubrow] red. ...Blue.

Blue? It was turning blue.

Oh, you know what that means?

Blood supply's not good.

Yes, I cried.

It's like I was dying.

The area inside my breasts was black.

Yeah. Complete,

so they had to remove grafted skins from the side

and leave me without the implants.

So when I woke up... Oh, yes.

...And I had no implants,

and you already know what happened, now?

You freaked. I freaked out.

I didn't look in the mirror for a long time.

I'm really interested in helping sheyla.

The problem is, is that when you take a patient

who's had a history of so many previous operations, like sheyla,

it makes you wonder whether you can ever truly make her happy.

And then got these put it in.

So that was the last surgery.

This was the last surgery. How long ago?

2012.

So what are your goals now?

A thousand.

Why do you want a thousand?

With the 2500 now

I was okay. I was fine.

But, uh, 2017 I was working at a psychiatric hospital.

I was doing program with a patient.

He got out of control,

and he grabbed me, threw me across the room.

So I land on my back,

and then I got back pain.

So the breasts became an issue.

So now you have a functional issue.

And I have this big gap,

and you're going to see later, after the exam,

and you're gonna see the defect.

My breasts have deformed.

They don't even look normal anymore.

To take the weight off

will require a lot of skin removal.

The question is,

how risky is it?

So you had a 360 cc implant

and 500 ccs of filler. Yes.

Scary.

[dr. Nassif] okay, so this is what the keloid looks like. [woman] wow, it's huge.

[dr. Dubrow] all right, take a look.

Okay.

It's a mess.

Okay, let me see something for a second.

Are you sure these are 2,500 ccs?

They seem a little smaller than that.

My doctor told me 2500.

Okay. That's okay.

So all right,

you do have some breast tissue hanging off here.

We call that a dissociation.

But the good news is you have a lot of breast tissue.

It's pretty thick. Yeah, that's good.

Although I have several concerns

about a patient who's had 32 previous breast surgeries.

The main focus is on blood supply

to the tissue

and how much internal scaring there is.

This is what could be done. Okay.

We could take the breast implants out. Okay.

We would have to close down the pocket

to put a smaller smaller implant. Okay. Okay.

If we don't close down the pocket,

they'll just fall down into your armpit.

Yeah, please do whatever you have to.

So you have to close down the pocket,

put the new saline breast implants in.

Whether it's 800, 850 or a thousand,

that's all about the same.

And then-- a thousand.

[laughing] a thousand--

and then you're gonna have a lot of excess lose skin.

Correct? A fair amount, yeah.

So that has to be removed

and everything has to be tightened up.

So you need a significant breast lift.

I think I sort of have to take your case

because it's very high risk.

Yay... [speaks portuguese] he's gonna do it.

The number-one goal is to take care of the pain.

The pain.

And the functional problem.

The number-two goal is to make them look good.

Yes, yes, yes.

Once he does this,

you're gonna be a lot smaller.

Are you-- you-- you sure mentally

you are ready for this?

I am hundred percent ready.

I can't wait.

[dr. Nassif] hello, everybody.

Let's talk about the plant for today.

The goal is to remove the keloid,

inject it with 5-flurouracil and steroids

to prevent it from coming back.

However, the risk of you getting that keloid back

is still there.

There are no guarantees in any of this.

Yeah. With what you have.

There's no guarantee here.

For andre's surgery,

I will start by making an incision

along the left ear

and excise the keloid from his ear.

The I will harvest two small pieces of rib

and stitch them to the tissue on top of his ear.

I will then use piece of skin from the keloid

to make a skin graft to cover the rib

and shape the ear before stitching the area closed.

Finally I will inject andre's ear

with 5-flurouracil

to prevent the keloid from coming back.

I'm incising, which means making a incision

along the keloid

but making sure I have extra skin

so we can close ear together again.

Okay, so this is what the keloid looks like. [woman] wow, it's huge.

Let's just carve a piece of rib

while the rib is still left in the chest.

We don't need the whole rib,

but not-- we're not doing a nasal reconstruction.

Since we need two relatively small pieces of rib cartilage,

we're gonna carve out the rib

while the rib is actually left in the body.

We're not gonna take out the whole rib.

And this is more less invasive.

In addition it should cause andre less pain.

So this is the piece of rib.

And I'm gonna--

trying to stitch the skin on top of that ear.

And I don't know if this is gonna work.

Again, no one's done this. [woman] yeah.

We're trying to see if somehow

there's a signal in the cartilage

to the scar saying,

"stop making scar."

and we may need to use the little skin graft

because it's pretty--

you know, it's-- actually need more tissue.

Because I ended up building the ear up so much in height

to almost match the right ear,

the skin I left behind, which was a lot,

is not sufficient to close it.

I need a skin graft.

So I'm gonna take a piece of skin

from the keloid that I excised,

stitch it all together,

and hopefully everything will survive nicely.

I'm gonna do a little "injecciones'

of this.

0.65 ccs

out of the 5-fu.

Look at that.

Can you wear a pair of glasses there?

Damn right, baby. [woman] yep.

This is why terry and I do what we do.

We help those who need us the most.

Andre is a young, good-looking guy

with the rest of his life ahead of him.

He should not have to feel that he's being held back.

Hopefully that skin graft doesn't die.

Yep.

[dr. Nassif] what do you have going on here?

This is an interesting, difficult patient

who has a buttock problem.

Her name is kasia. Pretty girl but obviously likes to do enhancements.

Yeah. She has foreign material

in her buttock.

I don't know exactly what's been injected,

what procedures she's had.

So let's bring in kasia.

Can you please send in kasia?

Kasia. Hello.

How are you, kasia? Dr. Nassif.

I'm fine.

We kiss.

That's how we do in holland.

Terry dubrow. Pleasure to meet you.

Hi. Hello, my name is cindy. Please.

Nice to meet you. Have a seat.

Wait a minute. What did you say?

Those are free kisses from where?

Holland. From holland.

Holland.

My wife's parents

lived in holland for 11 years.

How do you say "hospital" in... Ziekenhuis.

Ziek-- is that great? Ziekenhuis.

My wife and I always say,

when I don't feel well, I go,

"I need to go to the "sicky-house."

sicky-house. Sicky-house.

Feel sicky. I need to go to the sicky-house.

So, kasia, what do you do?

Came from, like, reality show tv programs

and then finally I fall in love with the music.

So you're a singer.

Yes. So wait.

You did reality tv?

Yes, in holland. In holland?

What was it?

Keeping up with the balkjes.

How was that? It was cool.

It was, like, five seasons.

Five seasons. Yeah.

You were really famous in holland.

Everyone more or less, yeah. Many people knows me, yeah.

Wow. Did the keeping up with...

The balkjes. The balkjes

reality show come to you

because of the buttock, or did you have the buttock

done because you saw the keeping up with the... Show here?

Yes. We found all the pop stars... Yeah?

...All the movie stars and reality stars.

So I start with j.Lo. Then I saw beyoncé.

Ah... Right? So I went, like, larger.

Then I saw kim.

So you had it done.

360...

360. ...Ccs.

And they look good.

Yeah, back then, yes. Good.

But then along the road I thought, "okay..."

ah, here we go. More is better.

Yeah.

How can I have larger butt, right?

And I went, like, to injecting permanent fillers.

Permanent.

Hydrogel, 500 cc each.

Of hydrogel? Yes.

In each cheek? Yes.

So now you have-- that's huge.

So you have a 360 cc implant.

And 500 ccs of filler. Yes.

Scary.

Hydrogel is a very common filler in europe

that's used to cause soft tissue expansion.

But I've never seen someone have 500 ccs injected

in one anatomical area.

So that could really predispose you to very significant complications.

Let's look. All right? See if we can help you. All right.

Okay. Thank you.

Sure.

Can't just make an incision and go [makes raspberries sound]

like it's a zit.

You have to cut the whole section out.

Okay, here it comes.

Does this look like 2500 ccs to you?

No. Exactly what I was worried about.

God damn it!

Welcome to our sicky-house.

[cindy] ziekenhuis,

...Ziekenhuis. I like sicky-house better.

Sicky-house. [kasia] yeah.

[laughs]

all right, let's get serious. So do me a favor.

Stand up. Yeah.

And let me see what's going on.

All right.

Turn this way.

The buttock implant is here,

and it's obviously on top of the muscle.

You're just lucky it hasn't moved around too much.

And then you have this area that's starting to change color.

It's the area where gravity has its greatest effect.

Okay, so have a seat.

Do you know what that's indicative of?

A reduction in blood supply.

I think the shape change we're seeing

in kasia's buttock is due to the hydrogel moving around.

Over time that reduction in the blood supply,

due to that large volume

could lead to very significant problems,

like infection, necrosis,

and, unfortunately,

loss of large segments

of her buttock skin.

You can't just make an incision

and go [makes raspberries sound] like it's a zit.

You have to cut the whole section out

because the fillers

incorporated into the tissue,

so the way I've treated these things

is I remove that, I do some tucking,

to take up the loose skin,

but I also do a buttock lift

to bring it up,

which means a scar across your back.

What's the, um...

The healing time? The healing time.

It could be three to six months.

Okay.

What do you think?

What do you wanna do?

I'm really gonna just take a moment,

finish the things that I'm working on.

[cindy] you cannot do this right now,

I think, because of the music

and the videos and everything.

When I would be able to take

enough time to rest and heal...

Mm-hm.

Come to me. I will work some magic

on this. Okay? Yeah.

Kasia should never have had

500 ccs of hydrogel

put into her buttock,

but sometimes celebrities

get whatever they want.

The good news is she can come back to us

and get the proper solution.

Let's go get some wine, okay?

I'm really looking forward to it. Okay.

Wining, wining.

Can we take those one with us?

Yeah.

[female singer] ♪ what I wanted, what I needed ♪

♪ are different things to me ♪

[dr. Dubrow] hi, sheyla. How are you?

Hello, dr. Dubrow. Good to see you.

Nice to meet you. How do you feel?

I feel a little bit nervous.

You do. Mm-hm, yeah.

Today's my 33rd breast surgery.

I have mixed emotions.

Because, honestly,

I need to get a breast reduction,

but I wish I could've kept them.

I love them.

Downsizing should relieve you of a lot of pain.

Okay, so we think you have 2500 ccs.

It's possible that I get in there,

and there's not 2500.

In fact it's possible I get in there,

and there's substantially less.

Okay.

If there's substantially less,

I'm gonna have to work with what it is

and what I need to go down to get enough laxity

so that I can lift you up.

But my goal is a thousand.

So let me ask you this, finally.

I may freak out when I wake up.

Well, let me tell you this. I go in there,

all you have left is an 800 cc silicone.

If I take 800 and put 500...

You're gonna have crazy person getting up surgery.

Hold on a second, sheyla. Okay.

If I reduce you by only 300 ccs,

you're still going to have all that back pain.

What I want is a thousand, but if it gets that

and a thousand's not possible,

you're the professional, you're the doctor,

do whatever it takes.

Have you ever said this to a doctor before?

No. The first time.

Although I've operated

on someone who's had multiple previous operations,

this is the first time I've done someone who's had 32.

This could be a much more difficult operation

than I'm even suspecting,

and I'm suspecting a very difficult operation.

For sheyla's surgery today,

I'm going to make incisions

under her areolas

and remove her old implants.

Next, I will access

the breast pockets,

downsize her implants,

and manipulate the breast tissue and skin

to give her a better overall cosmetic result.

All right, let's find out what's going on inside.

Okay, here it comes.

Pull-- oh, my god.

It's just a super overfilled saline implant.

Does this look like 2500 ccs to you?

[man] no. Nuh-uh.

That's exactly what I was afraid of.

Oh, my god.

So I need to know how much is in here.

What-- what was I worried about?

What if there's only 1500 ccs.

What if it's much smaller?

[woman] yeah. What if it's a thousand,

and I have to move it down to 500. Yeah.

Yeah. Remember that?

This could be 900 ccs.

Thousand, tops.

[sighs] thousand, tops.

I'm calling that 900.

This is silicone.

It's silicone? Yeah.

It's no saline?

No, it looks like there's a valve on the inside.

Do you see that?

This made be a weird european double lumen.

Double-lumen implants were originally designed

to have a silicone inner shell

and a saline outer shell

that allows you to change the size of the implant

intra-operatively

so you can adjust for any breast asymmetries.

All right, so that part is silicone.

Yeah, this part has saline. Look at that.

[woman] what?

[dr. Dubrow] it's unusual that sheyla has

an outer silicone lumen

and an inner saline lumen.

This totally defeats the purpose.

I've never seen that before,

and the only thing I have to say about that is

it's kind of weird.

Okay, so a thousand.

So w-- it's a 400-cc implant.

660 ccs of saline, right?

Yeah. So it's a thousand--

it's basically a thousand-cc implant.

We're gonna put the same thing.

Sheyla has about a thousand-cc implants,

which is what she wanted to be reduced to.

If I don't reduce her any further,

she won't have the functional improvements

in terms of the back pain.

And if I do,

will she freak out on me?

It's exactly what I was worried about.

God damn it!

Okay, so now what?

[woman] uh... [bleep]

I started to clean up the ear with the peroxide.

Mm-hm.

The peroxide on tissue, it actually kills it.

You're 20 hours out from surgery,

and you're already asking for bigger implants

just because of a number? Please, dr. Dubrow,

I'll do whatever you tell me. Let me see what they look like.

I'm feeling flat chested right now,

and I'm very, very upset.

[dr. Dubrow] it's basically a thousand-cc implant.

Okay, so let's do this.

Do me a favor. Get me a 560 extra full

silicone implant. Okay.

Let's put it in and see what it looks like.

Let's just test it.

By the way, going from a thousand to 500

is proportionally about the same

as 25 to a thousand, right?

So it's the same thing.

So we're essentially achieving the same thing. I'm in.

[woman] I just don't want her to freak out because of that.

Yeah, well, you know, we're here to do a job

that's based on safety and aesthetics,

and this allows us to do both.

See, that's a much healthier implant-to-pocket relationship.

The only concern I have

is will she freak out

or-- yeah, she's gonna freak out.

Sit her up, see what it looks like.

Okay, so they're symmetrical.

They're lifted.

They're actually really pretty.

This actually should give her both.

It should give her pain relief

and it gave her much better cosmetic appearances.

So this achieved both of our goals.

We'll just have to wait and see

if sheyla's happy or not.

One thing's for sure,

sheyla will let us know.

All right, let's close.

[malika] hello, dr. Nassif. [dr. Nassif] how are you?

Good, how are you?

Andre. Hi.

Hi, how are you? Nice to meet you. Hey, buddy.

So I haven't seen andre in a month,

and we did his surgery,

his post-op checks were great.

After the keloid was removed,

and I put two nice pieces of rib in there,

so really would be a lot easier

for you to wear your glasses.

We have to be careful about making sure that skin graft lives

two, I want you to keep that dry.

Just leave it alone. Don't touch it, don't instrument it.

Two days ago he sent me a photo

which showed that his skin graft

was separating from the top of his ear.

So what's happening?

Well, um, I was in the shower, and then I got out,

and then I started to clean the ear with the peroxide.

Mm-hm. And then scab peeled off completely,

and then that's when I yelled, like--

I was like, "mom!"

peroxide. Yeah.

Is that bad?

Or-- yeah.

But peroxide on tissue, it actually kills it.

Well, let me take a look. Okay?

Okay.

It looks like there's a piece of rib

that dr. Peng can work with

to prevent the keloid from growing back.

Okay. Okay?

So we're gonna prep it, give you a little shot there,

numb it out, and then stitch it.

It's not gonna take long.

Okay.

When the skin graft came off

after the shower,

I was petrified

because a keloid

does have potential to grow back.

Hopefully we can just get this under control

and it just stays away for good.

The first part I'm looking at

is kind of the piece of cartilage.

Uh-huh.

I'm gonna see how much of it

we can save,

but I took out the top layer of it.

We're all done.

[andre] oh, really? Yeah.

Let's take this off.

What's happening?

You know I'm angry.

Uh-oh. [laughs]

how are you?

First of all, you're not happy.

I'm sad. I already cried so much--

okay, let me ask you a question.

What's upsetting you? I saw the card.

You sent me with a card to carry with me.

Okay, so you saw the card.

So you're concerned that I took you

all the way from 2500 down to 560, right?

I'm feeling flat chested right now.

And I'm very, very upset.

There is no way in hell

that I will keep 500 ccs.

2500 to a 500-- that's a lot.

It is but what if you had 1060,

1,060 ccs in this one

and a little bit more in that one?

How do I know?

'cause we measured it

extremely carefully.

Remember this discussion?

I actually anticipated this possibility.

Do you remember I said, "hey, what I've been thinking about, sheyla,

is that what if I go in there and you actually don't have 2500--

no. We never spook about any--

it's possible that I get in there,

and there's not 2500.

In fact it's possible I get in there,

and there's substantially less.

I couldn't have done the lift.

I couldn't have shaped your breast

because it was too tight.

In addition,

you told the reason to downsize them now...

To fix them. ...Is because you're having pain.

Yeah, back pain.

So I did exactly what I needed to do.

I don't like 500 ccs.

These are just numbers. Forget the numbers.

But the end-- numbers--

I know but can you still make these big a little bit more?

Don't go there.

You had to have this operation.

I assume that sheyla's previous surgeon

knew she was obsessed with size,

so that's why they told her what they told her.

But that's not the kind of doctor I am.

I want to relieve her of her back pain,

but I'm gonna do that

and tell her the truth.

You're 20 hours out from surgery,

and you're already asking for bigger implants

just because of a number?

Please, dr. Dubrow.

I'm really sad now. Let me see what they look like.

I mean-- they look pretty amazing.

Will you come here, my man?

Take a look at that. I don't wanna look.

This part is more beautiful than before.

Beautiful-- so it's beautiful. [dr. Dubrow] look at the shape.

Dr. Dubrow, please put in more.

Please?

[john] dr. Dubrow, he did the best job.

When I saw the real boobies,

she looked great.

It's amazing.

Dr. Dubrow,

can you do me something?

Make this smaller because, you know,

hold on a second. ...I used to have skin here,

so now it's flapping because the blood was poor.

Are you trying to talk me into doing a tummy tuck on you now

to make your breasts look bigger? No tummy tuck.

No, just some lipo I want a little bit around here so

my breasts look bigger.

You recover without a complication,

and we'll talk about it.

We'll talk about it.

I love you. [dr. Dubrow] I love you.

It's okay. Bye-bye, ciao. Ciao.

Thank you.

[andre] this is the first time in my life

that I have two normal looking ears,

and it's just kind of like a rebirth.

Oh, here's andre. Hi. Hi.

[sheyla] the last time I saw dr. Dubrow,

I was pretty upset,

and I still have a lot to say to him,

and he's gonna hear it.

I wanna talk to you.

[male singer] ♪ in an instant life can change ♪

♪ your world can get rearranged ♪

♪ and you know that things will never be the same ♪

[andre] this is the first time in my life

that I have two normal looking ears,

and it's just kind of like a rebirth.

Growing up with microtia

and the keloids

and being bullied constantly.

It's always been a factor

and something that's held me back.

This is my first spring break,

that I'm going on a trip.

For now I'm just feeling optimistic

about meeting new people,

maybe even find myself a date.

I am so excited for this trip.

I cannot believe we're finally going on it.

I feel like I can let go now.

Yeah. Yeah. Yeah.

I feel relieved. [alana] yeah.

Seems, like, unreal. Like, really. [woman] yeah.

Yes, it does. It's like a dream come true.

Got to have fun and play. For both of us.

Oh, here's andre. Hi! Hi!

[women cheering] hi, andre.

Hi! Look at my baby.

Oh, my god, you look so good. You're still my baby.

Hi.

Are you ready?

I feel so excited.

I get to go on spring break

with a brand new ear. Yeah.

[alana] a difference that I have seen in andre

is the way he carries himself.

Before the surgery was "I want to be able to do this,"

"I wish I could do this."

now I'm seeing and hearing

a lot more "when I do this,"

"I'm doing this,"

"let's go do this."

his whole demeanor has honestly changed.

I have a little something for you.

Oh, wow. Oh, boy, let's see what it is.

Open it, open it.

Aw. Oh!

That's so nice.

Try them out. Try them out.

Oh, wow, look at you.

Ooh!

[women cheering]

okay, now we're jiggy. Yeah. Now you can go.

[andre] before my surgery,

I had a big, horrible snail-looking keloid

on my left ear.

I would constantly get stares

and questions about my keloid

that made it impossible to forget about it.

And I couldn't even wear glasses,

but now, thanks to dr. Nassif, I'm keloid free,

and instead of feeling ashamed of people staring,

I'm now wearing my shades all day.

Now look at me.

[woman] wow. [woman 2] oh!

Damn! Who is that?

I'm just really excited

that I get to go to beautiful cities

like paris, looking beautiful

for the first time.

Have fun! Bye.

I miss you. Oh...

[andre] yeah. Call me five times a day.

No.

♪ we don't know where she come from ♪

♪ yeah ♪

♪ whatever thing she do, so cold ♪

[sheyla] it's been weeks since I had my surgery,

and I had some unexpected results.

I never thought I would be walking around

with the small breasts like this.

The last time I saw dr. Dubrow,

I was pretty upset.

He says heal, rest, recover.

Then we'll talk.

Well, I'm healed.

And I still have a lot to say to him,

and he's gonna hear it.

Okay. All right, thanks.

You expecting a sheyla, one of your patients? Yes.

[dr. Nassif] uh-oh. [laughs]

I wanna talk to you.

I owe you an apology.

Aw. Oh, this is gonna be good.

I'm rockin' my world with my new breasts,

and I love it, and I'm--

you love it? I love it.

You're not totally unphappy?

I'm not, actually.

Okay, I can go on with my day now.

I'm super excited that I actually got through to sheyla

that huge breasts don't need define her.

Sheyla looks really good,

and I'm really happy for her

but much happier for me.

It was kind of like shock for me at the beginning.

Then I came to realize

how many doctors I've been through.

And you were the only one

that ever said no to me.

And my back thanks you so much.

Your back pain's gone. It's gone.

That's so awesome.

I look so nice and beautiful.

Before my surgery,

my breasts was a hot mess.

They were disfigured

and so large,

they made my back problem worse.

I was so obsessed with surgery

and make my body perfect

that I didn't realize

the impact it was having

in my health.

And my life.

But, thanks to dr. Dubrow,

now my breasts is the size

that they should be.

I love the shape

and my back pain is gone.

I don't need huge breasts

to feel sexy anymore.

I feel sexy.

Let's go, dr. Nassif, because--

[dr. Dubrow] by far, yeah. Where am I going?

...We have something to talk about.

Yeah, you're gonna do a face-- have a facial consultation. No, you're not.

Yeah, yeah, go for it. She's a great patient.

Really, I recommend her highly.

Bye. Bye.

Mwah, yeah, I'll see you--

you know, I'll see you when I see you.

Buh-bye, sheyla.

See ya.

[woman laughs] [woman 2] plastic surgery

is exactly what I need.

[dr. Dubrow] dr. Nassif and I are back.

[barking] ow!

Whoa!

You know what that looks like to me? Death.

[dr. Nassif] with tougher cases...

Wait a minute, I can't even wrap my brain around it.

Gets you a little nauseated, doesn't it?

I wouldn't be surprised if the thing falls out

while you're sitting here.

Don't say that!

[dr. Nassif] the emotions run high.

It's not fair.

I was dysfunctional. I couldn't take care of my kids.

[dr. Dubrow] surgeries get even scarier.

Oh [bleep]. Full blown rupture.

[dr. Nassif] the nose completely collapsed. [bleep]

[dr. Dubrow] but it's all worth it in the end.

[speaks spanish]

thank you.

You're welcome. He's my super hero.

This is what happens

when you go to the a great surgeon.

Oh. [kissing]