For those who follow the cosmetic surgery industry, the wait for more comprehensive regulations can seem interminable. Meanwhile, although the percentage of patients suffering death during or soon after a procedure continues to be very small, it’s arguable that at least some of those deaths should not be happening.
Just a few months ago, the Virginia Board of Medicine failed to follow up on a suggestion from nine medical specialty groups, including the Virginia Society of Plastic Surgeons, to issue a “guidance document” covering cosmetic procedures. The nine groups urging this measure wanted the Board of Medicine to weigh in on who can perform which procedures in addition to where cosmetic procedures are performed. The specialty groups cited the fact that many physicians who offer cosmetic procedures, notably liposuction, have their formal training in another specialty. Without stricter regulations, it can be difficult for the average patient to wade through marketing ploys, evaluate the complicated credentials of a provider and make a sound decision with safety at the top of the priority list (Enns 1).
Just this past Sunday, an article published in the South Florida Sun Sentinel detailed 32 deaths that occurred soon after cosmetic surgery in the state during the last decade. What’s most disturbing about that number is that the death rate is about the same as in the previous decade, after the Florida Board of Medicine passed some of the toughest rules in the nation covering procedures performed in doctors’ offices (LaMendola and Kestin 1).
The article pointed out that there are various causes of the 32 deaths. Furthermore, the tremendous growth in the popularity of cosmetic surgery needs to be considered along with the rather consistent rate of death. More people of all kinds seek cosmetic surgery than ever—almost double the rate since 1997, when the American Society for Aesthetic Plastic Surgery (ASAPS) first began tracking numbers (ASAPS 1). And as the Sun Sentinel article acknowledged, Florida is one of the most appearance-conscious areas of the country (LaMendola and Kestin 1).
Nevertheless, the fact that the death rate has not improved in the last decade does concern many medical professionals in the state. Also worrisome is the fact that Florida’s Medical Board does not seem to know much about why there has been no improvement. One board member acknowledged that it could be that there’s a problem with non-compliance to the 10-year-old regulations, or it could be a more basic system failure—the board just doesn’t know (La Mendola and Kestin 1).
Dr. Randy Miller, the president of the Florida Society of Plastic Surgeons, is quoted in the Sun Sentinel article. Miller suggested that the state needs to look into these areas:
* Unregulated surgery offices where doctors can perform surgery, including liposuction, as long as only local anesthesia is used
* Liposuction, which accounts for nearly half the 32 deaths (14 of 32)
* Anesthesia practices – two thirds of deaths and complications in the last 10 years were related to general anesthesia
* Cost cutting to attract more patients, which often includes using an office setting and reducing the cost of anesthesia, meaning a measure of safety is almost always sacrificed, according to Miller
(La Mendola and Kestin 1)
Looking at these issues from an overarching point of view, it seems that the group in Virginia has it right. While the where factor is important in patient safety, and it makes sense that all surgical offices should be regulated no matter what kind of anesthesia is used, the who is equally if not more important.
State medical boards could make a dent in mortality rates by scrutinizing who performs liposuction. It is not unusual these days for doctors with no plastic surgery training to offer the procedure. Does it really make sense for any doctor to be able to add liposuction to their repertoire after weekend courses? This is not in the best interests of patients. While there may be less “cutting” required when compared with a procedure such as abdominoplasty, liposuction is still quite invasive. It causes pain and poses potential risks and complications just like any other surgery. It requires excellent judgment about a variety of points that dramatically impact patient safety.
One could argue that only surgeons who are certified by the American Board of Plastic Surgery (APBS) should perform liposuction. Yes, it is probably more expensive to work with an ABPS certified plastic surgeon rather than a non-board certified doctor. But there’s a reason for that—board certified plastic surgeons are required to perform five years of surgery during their training, with at least two of those years focused specifically on plastic surgery (ABPS 1). Those credentials are costly to obtain, but they can make all the difference in patient safety.
Consider this: the ASAPS undertook educational efforts to improve the mortality rate of liposuction after discovering a nationwide death rate as high as 1 in 5,000 for the procedure prior to 1998. Conducting a survey of their members in 2001, after the educational campaign, the organization pegged the liposuction mortality rate at just 1 in more than 47,000 (ASAPS 2).
The ASAPS’s educational efforts focused on improving safety through steps such as limiting the volume of fat removed and limiting the length of surgery. The survey shows that more than a third of the respondents had made changes in the prior year to increase liposuction safety in their practice (ASAPS 2). But perhaps the most salient point a prospective liposuction patient should take away is this: membership in the organization requires certification by the American Board of Plastic Surgery. There's that foundation of education and hands-on experience that helps keep a patient safe.
When it comes to protecting a patient’s well-being, cost should not be the first factor considered. And when it comes to safeguarding the health of their citizens, state medical boards should step up and do the hard work of gathering and analyzing data, then implementing whatever measures are needed to ensure that all deaths that are preventable are prevented.
Enns, Cathy. Stricter Cosmetic Surgery Controls? Not Today. EmpowHER. February 24, 2011. Web. June 26, 2011.
LaMendola, Bob and Kestin, Sally. Tougher rules fail to prevent tragedies from plastic surgery. SunSentinel.com. June 26, 2011. Web. June 26, 2011.
American Society for Aesthetic Plastic Surgery. Cosmetic Surgery National Data Bank Statistics, Twenty 10. 2011. The Mark of Distinction in Cosmetic Plastic Surgery. Web. June 25, 2011.
American Society for Aesthetic Plastic Surgery. Major New Survey Reports Turnaround in Lipoplasty Safety. The Mark of Distinction in Cosmetic Plastic Surgery. May 3, 2001. Web. June 26, 2011. http://www.surgery.org/media/news-releases/major-new-survey-reports-turnaround-in-lipoplasty-safety
The American Board of Plastic Surgery. FAQ. Web. June 26, 2011. https://www.abplsurg.org/ModDefault.aspx?section=Faq
Reviewed June 30, 2011
by Michele Blacksberg R.N.
Edited by Alison Stanton
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