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'Botched' Doctors Paul Nassif and Terry Dubrow on Casting for the Show (EXCLUSIVE)

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Plastic surgery procedures gone wrong is the basic premise for the reality series Botched, but there's far more to the show than getting to see the before and after pictures. Each season, doctors Terry Dubrow and Paul Nassif are faced with increasingly tough cases to help people match their expectations to what is feasible when it comes to surgical operations. 

While some patients on the show are willing to do anything just to look more normal again, others live in a fantasy world where they think they can compromise their health in order to achieve a particular look.

Merging expectation with reality is one of the many tasks at hand for Drs. Dubrow and Nassif, and the surgeons often have to serve as counselors of sorts for their patients. 

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While the patients who appear on Botched are airing out the sometimes unflattering details of their messed up procedures, there's a perk to going under the knife on the show.

The Botched doctors spoke exclusively with Distractify about the casting process for the show, including how it has changed since it debuted in 2014, and what patients get for going on

Who pays for the surgeries on 'Botched'?

Many simple plastic surgery procedures can set someone back at least a few thousand dollars (and more reputable surgeons cost more). Cosmetic operations often aren't covered by medical insurance either, so patients frequently have to dip into their own pockets to get work done.

For people whose plastic surgery procedures didn't go according to plan, they end up paying multiple times for operations to fix the damage done. 

If you've ever wondered why Botched patients would go on national television to showcase their bad plastic surgery before they get it fixed, there are perks. 

Dr. Dubrow exclusively told Distractify that he will ask some of his patients who go to his regular practice if they would be willing to show their journey on Botched. Because many cases featured on the show — especially on Part 2 of Season 6 — will require multiple surgeries, he said that this can help these patients handle the cost. 

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"The patients on Botched get an appearance fee and their costs are handled by the show," he told Distractify. "The difference between Season 6 and the other seasons is it took me more than one surgery on several of the patients to get them fixed. In fact, they were so difficult and high risk, that I actually had to make them worse before I could make them better. That journey sometimes needs two or three more surgeries. We show that this season."

Dr. Dubrow also explained that many patients (and viewers) don't necessarily expect that when it comes to surgery.

"If you think about surgery in general, you understand that if a patient comes in to have a disease removed from their body, that you can remove it, send them to the hospital, and they can get very sick before they get better. That's understood, or even expected." 

But, he continued, that's also the case for many patients who are getting plastic surgery fixed.

"We warn the patients on Botched very carefully and say, 'I may send you down a road that will botch you, but in order to get you un-botched, I may have to make you worse before I can make you better,'" Dr. Dubrow said.  

Of course, this is standard practice for the Botched surgeons.

"Our bread and butter is taking someone who is possibly unrealistic or someone that we know can get some improvement, and bringing their expectations down to normalcy," Dr. Nassif said.

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Source: Instagram

Casting for the show often includes referrals from the 'Botched' doctors' practices.

When Botched first premiered in 2014, Drs. Nassif and Dubrow said that the casting process was different than it is now. Before, there was a pool of a few hundred applicants to choose from, and now, there are thousands of people who want to appear on the show.

"In the first season, we had 500 applicants for casting," Dr. Dubrow told Distractify. "By the time the show got known for the second, third, and beyond, we had around 10,000 applicants."

In addition to these applicants, the surgeons also refer patients who visit them at their regular practices to the show, especially if what they want done is likely to take multiple surgeries. 

"If a patient comes in and has a really unusual, difficult-to-fix, almost hopeless situation and I can tell that they don't necessarily have the resources or the funds to have the reconstruction, I'll say 'don't take this wrong or anything, but you might be able to get on the show if you're willing to show your journey to the world,'" Dr. Dubrow explained. 

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"Nine times out of ten, they say that they'll do it," he continued. "That one time out of ten is like 'absolutely not. I'm not willing to expose this to the world.' A portion of them now come from our own practices that we refer to Botched. "

As for those who do agree to be on the show, the Botched doctors certainly aren't taking things easy now that they're in their sixth season. 

"It’s getting harder and harder for some of the things that we’re doing," Dr. Nassif said. "When they talk about 'the stakes are higher,' it’s really true. It's just getting more and more difficult."

"That's the difference between Paul and I," Dr. Dubrow joked. "I can fix anything." 

Part 2 of Botched Season 6 premieres on April 13 at 9 p.m. on E!. New episodes air on Mondays.  

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