Cosmetic, but still surgery


The desire to be more attractive can be so strong that people overlook the very real risks of anesthesia and cutting into the body, especially for patients who are not in perfect health


November 22, 2007|By Judy Peres | Judy Peres,CHICAGO TRIBUNE

Cosmetic surgery might look easy and danger-free on television programs. It might be readily available through the nearest doctor's office.

But it is still surgery, and surgery carries risk.

"On television, people are always having extreme makeovers," said Dr. David Song, chief of plastic surgery at University of Chicago Hospitals. "People don't understand it's real surgery with real risks."

On top of that, cosmetic procedures are a lucrative fee-for-service business. Insurance typically does not cover them, except for reconstructive surgery, so people pay cash if they want their face lifted or tummy tucked. As a result, tens of thousands of doctors who might be insufficiently trained are doing plastic surgery -- often in their offices.

"Surgery has moved more and more out of the traditional hospital setting," said Arthur Levin, director of the Center for Medical Consumers, a not-for-profit consumer advocacy group based in New York City. "Much of it is done in private physicians' offices because it's less expensive."

But it still is as dangerous as any comparable surgery. "People may not get that -- or may not want to get that, because they're so anxious to have the desired cosmetic effect," Levin said.

Dr. Peter Angelos, who heads the surgical ethics program at the University of Chicago, said the fact that cosmetic surgery is something the patient really wants puts an additional burden on the surgeon to make the risks understood.

"If I tell you you have thyroid cancer and I need to take out your thyroid, most patients are willing, but they're not eager," he said. "It's very different when they really want the operation."

Angelos said he has had the experience of telling a patient in detail about the risks of a certain procedure, only to have the patient come back when the surgery is scheduled and ask: "By the way, are there any risks?" In the case of cosmetic surgery, Angelos said, doctors should redouble their efforts to make sure the patient knows everything that might go wrong.

The surgeon has a responsibility to know the patient's underlying medical problems, he said, which means doing a medical work-up or making sure the patient's primary care provider does it.

Nearly any invasive procedure can be risky for someone with heart disease, blood clots or a lung problem, Song said. Likewise, doing several procedures simultaneously -- such as a tummy tuck, liposuction and breast augmentation -- significantly increases the risk.

Song said there are risks associated with the anesthesia and risks associated with the surgery itself. "Combine the two with an underlying medical condition," he said, "and things can go wrong quickly." He recommended that anyone interested in a cosmetic operation should look for a surgeon certified by the American Board of Plastic Surgery, which requires many years of specialized training.

"Anyone with an M.D. degree can hang a shingle and call himself a plastic surgeon," said Song. And seeing that someone is "board-certified" isn't enough, he said: "It's really important which board."

The American Board of Cosmetic Surgery, for instance, has no specialty training requirements. "My psychiatrist friend could join," said Song. On the other hand, members of the American Society of Plastic Surgery must be certified by the American Board of Plastic Surgery or another board affiliated with the American Board of Medical Specialties.

"A lot of people who have no business doing cosmetic surgery are doing it anyway," Levin said. "This is lucrative stuff for a doctor. ... Ask what kind of training they had -- a weekend in Hilton Head with a couple of hours of classes and a lot of golf? This is buyer beware -- be really careful."

Where the procedure takes place is also important. Levin said a prospective surgery patient should make sure the facility is licensed by the state (as traditional hospitals are) or accredited by an appropriate agency, such as the Joint Commission or the American Association for Accreditation of Ambulatory Surgery Facilities.

A well-run outpatient surgical center can be just as good as a well-run hospital, Levin said. But doctors' offices are totally unregulated. That means they don't have to have a crash cart or anyone trained to administer anesthesia.

"So if patients get into trouble -- say, you go into anaphylactic shock or cardiac failure -- they call 911, just like you or me," said Levin.

Serious complications from cosmetic surgery in licensed or accredited facilities are infrequent. According to a study published in 2004 in the journal Plastic and Reconstructive Surgery, only about one case in 50,000 ends in accidental death, and about one in 300 patients has a serious complication, such as internal bleeding or infection.

Nevertheless, Levin said, "people have to understand it's always a big deal when someone puts a knife in your body and gives you anything more than minimal anesthesia."

Judy Peres writes for the Chicago Tribune.

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