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Mar. 01, 2004
It was not that long ago that
the term makeover suggested little more than a new eye shadow
or a dye job. Now it is just
as likely to result in a straighter nose, larger breasts and
a brow that won't furrow when confronted by even the most noxious
odor. That attaining such features often involves anesthesia,
injections, incisions, blood and a professional with at least
seven years of medical training is a distinction increasingly
lost on the general population.
But plastic surgery does mean
going under the knife, and lately there have been plenty of
reminders of the risks involved. From May 2003 to January 2004,
five people in Florida died following cosmetic plastic surgery,
prompting the state's board of medicine to open an investigation.
All five, ranging in age from 38 to 63, had their operations
done in doctors' offices. One had a breast augmentation; another,
surgery on his eyes, chin and neck; another had liposuction
and a fat transfer; and two, liposuction and tummy tuck. Citing
an "immediate danger to public health," the board issued a
90-day moratorium on the two procedures being performed together
in a nonhospital setting. A 54-year-old woman, the wife of
a cardiologist, died of complications from plastic surgery
last week while undergoing a procedure at one of New York City's
most prestigious hospitals, the Manhattan Eye, Ear and Throat
Hospital, run by Sherrell Aston, husband of socialite Muffie
Potter Aston. This is the same location where last month, in
a case that made national headlines, The First Wives Club author
Olivia Goldsmith, whose work often celebrated and satirized
plastic surgery, died after seeking a cosmetic procedure. Both
women died of complications from anesthesia.
The vast majority
of cosmetic procedures — both surgical, such as face-lifts
and liposuction, and nonsurgical, like Botox and collagen injections — conclude
without incident. But with the number of these operations growing
— 8.3 million in 2003, a 293% increase from 1997 — things
can end
badly more often. Part of the problem may be that it is not
necessary, from a legal standpoint, to be trained as a plastic
surgeon to practice plastic surgery. All a person needs is
a medical degree. Doctors can choose to become certified by
the American Medical Association — recognized American Board
of Plastic Surgery. For that, they must complete seven years
of training, including a three-year residency in general surgery
and at least two additional years of a residency in plastic
surgery. But many doctors don't bother with the special training
and practice the surgery anyway to supplement their incomes.
Only two of the five doctors in the fatal Florida cases were
board-certified. The woman who died after a breast augmentation
was operated on by a doctor who specialized in dentistry.
Since
doctors have the right to perform such operations, it is up
to the patient to monitor their backgrounds and decide whether
he or she feels comfortable with their training. A patient
should also investigate the facility where a procedure would
be performed. Technological advances have made it possible
to perform intricate surgeries in nonhospital settings on an
outpatient basis. Some are done in private, freestanding surgical
centers, others in doctors' offices.
Patients often enjoy a
doctor's office because it feels more personal; many doctors
prefer it because they exercise complete control over their
surroundings and costs. That can be perfectly safe as long
as the offices maintain safety precautions, but some state
and local governments do not monitor whether they do. The task
can be left to accrediting agencies. States may require offices
to be accredited, but the agencies perform inspections and
give the seal of approval. The one considered the gold standard
is from the American Association for the Accreditation of Ambulatory
Surgery Facilities (AAAASF). To receive its blessing, doctors
must be board-certified in their field, and their facilities
must prove they have the means to handle emergency situations.
The problem is that getting inspected for accreditation is
done on a voluntary basis. Says Michael McGuire, a Los Angeles
cosmetic surgeon and the AAAASF's president: "Facilities open,
and nobody knows on a state level that they are there."
Why — or
whether — the liposuction — tummy-tuck combination is particularly
hazardous in a doctor's office is a question the Florida board
is investigating. It is not uncommon for people to have multiple
procedures performed at once, and when the patient is in good
health, it is not especially perilous. But generally, undergoing
more than one procedure not only prolongs recovery but also
increases the time a patient is anesthetized, which can be
risky. "I personally don't believe in procedures that go beyond
five or six hours," says Dr. Robert Bernard, who operates in
his Westchester, N.Y., office and is the president of the American
Society for Aesthetic Plastic Surgery, whose members are all
board-certified. "If somebody comes in and wants their face,
eyes and nose done, that's O.K. But if they want that as well
as breast reduction and a large amount of liposuction, I'd
prefer to divide it into two procedures."
In one of the Florida
cases under investigation, a combination of surgeries may have
proved fatal. James McCormick had decided to go to the Florida
Center for Cosmetic Surgery in Fort Lauderdale to nip and tuck
his crow's feet. His doctor recommended a brow job as well
and offered to throw in a chin implant at a discount. McCormick
agreed to all the procedures and was at the facility less than
four hours. By the next day, he was dead. Citing patient confidentiality,
Dr. Jeffrey Hamm, medical director of the facility, declined
to discuss the case.
Bernard reports that he has received more
requests for combination surgeries since the premiere of Extreme
Makeover, a phenomenally popular reality show on ABC in which
subjects undergo as many as six surgeries at a time to remove
any perceived flaws on their bodies. He says the show has generated
good p.r. for the field, but he is worried that it raises unrealistic
expectations. "People don't realize that subjects on the show
are preselected," he says. "They're in excellent health, screened
by psychologists and analyzed by the best plastic surgeons
in the country to ensure that their transformation has the
potential to look like a home run." Bernard points out that
the subjects also work with dermatologists, cosmetic dentists
and hair stylists.
Sometimes a patient can appear to do everything
right but still end up paying the ultimate price. For her chin
tuck, a procedure generally characterized as routine, Goldsmith
chose the best board-certified plastic surgeon royalties could
buy and had the operation at a respected hospital but still
had a bad reaction to anesthesia. Her death was not necessarily
related to plastic surgery; it might very well have happened
during an emergency appendectomy. It did, however, cause a
momentary flutter in the plastic-surgery community. Doctors
across Florida, California and New York said they received
a few concerned calls from patients that week. But virtually
no surgeons reported any cancellations. And the phones kept
ringing for new appointments.
With reporting by Jeanne McDowell/Los Angeles and Siobhan
Morrissey/Miami
Copyright © 2004 Time Inc.
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