Safety In Cosmetic Surgery
David M. Stone, M.D. F.A.C.S.
Almost everyone
knows of a friend or family member who has had some type of cosmetic surgery. The interest
and popularity in cosmetic surgery is only increasing as the baby boomers age, and as
newer techniques and training allow more qualified surgeons to be available.
Why would a healthy person seek out an elective surgical operation that
is not required for strictly medical purposes? The answer is to improve the quality of
their lives and to enhance appearance, self-esteem and self image. Many of us feel much
younger than we look and almost all of us want to look our best. The American consumer
spends billions of dollars on clothing, makeup, weight reduction plans, health clubs and
exercise equipment. Why not have a nip and tuck, or take care of an unwanted fatty bulge?
This article will touch upon several important requirements a smart consumer should look
for to give the highest likelihood of a safe and successful outcome when considering
plastic surgery.
The first thing to understand is that cosmetic surgery is surgery, and
it should not be equated to a beauty parlor visit. Any operation has some degree of
inherent risk, such as anesthetic reactions, bleeding, infection, prolonged numbness or
scarring. Fortunately, serious or life threatening complications are very uncommon when
cosmetic surgery is performed by competent and well trained surgeons in the proper
location and environment. A patient needs to be counseled pre-operatively about what to
realistically expect from the proposed surgery.
A cosmetic surgeon needs to get to know the individual in a relaxed
atmosphere to truly understand the patient's goals, and make sure they are realistic and
achievable in his hands. This may take two or three visits, but it is time well spent. I
always feel that a knowledgeable patient is a good patient.
An ethical physician can never guarantee an exact surgical result, nor
imply that the patient will be happy afterwards. It is not uncommon to have to perform an
occasional revision procedure if results have not lived up to the pre-operative goals set
by patient and surgeon. Hopefully this will occur infrequently, and will be relatively
minor in extent. If an individual cannot accept a minor degree of imperfection and will
only be satisfied with the elusive perfect result, then he or she is not the best
candidate for cosmetic surgery. Surgeons have an obligation to give an honest and thorough
informed consent to patients.
Some individuals are simply not good candidates for cosmetic surgery
due to medical or psychological reasons, The ethical surgeon will turn down these people
for surgery, or postpone it until the medical and/or psychological problem is dealt with
and resolved.
A surgeon should never push the envelope of safety in cosmetic surgery.
For example, if an individual wants liposuction performed on multiple body areas that
would entail massive fat extraction, then the procedure should be split up into two or
more separate operations. The maximum fat and fluid extraction should be kept under
400OCCS or 8.8 pounds per operation in an ambulatory surgery setting,
The location of the planned surgery is also very important. The
consumer should make sure the operation is to be performed at an accredited surgical
suite. One of the most prestigious accreditation organizations is the AAAHC (Accreditation
Association for Ambulatory Healthcare). The AAAHC sets standards, measures performance,
provides consultation and education when needed, and ultimately awards accreditation to
those organizations that are found to be compliant with its standards. These standards
relate to areas such as quality of care, clinical records, pharmaceutical services,
environmental safety, governance, administration and professional development. An
individual is taking chances if extensive cosmetic surgery is not performed in an
accredited surgical facility. Furthermore, California law requires that if deeply sedative
anesthesia is to be given, it must be administered in an accredited surgical facility.
All surgeons and their anesthesia personnel should he up to date and
certified in advanced cardiac life support (ACLS), and have contingency plans in case of
medical emergencies. The bare minimum includes running emergency drills quarterly and
having a transfer agreement in place with a nearby hospital,
Of course, a fine reputation of the surgeon points the prospective
patient in the right direction. Board certification of the doctor with a proven track
record of performing many successful operations is assuring, and is a minimum requirement
of the savvy consumer. Surgical specialists have the coveted F.A.C.S. after their names,
which signifies membership in the prestigious American College of Surgeons. Find out if
the doctor has completed additional subspecialty training, usually by means of a
fellowship after completing residency training. One can also check out the physician's
credentials through the local county medical association. Most reputable surgeons have a
teaching commitment and appointment at a nearby medical school, and are dedicated to the
education and training of younger surgeons. The consumer should always be wary of doctors
making extraordinary claims of unrealistic results, using unethical forms of advertising,
or charging basement bargain fees.
An ethical physician always puts the safety of the patient paramount
when it comes to cosmetic surgery. The envelope of safety must not be breached, nor
routinely approached. Conservatism and good judgment should outweigh aggressiveness and
risk. Surgeons are fortunate to be held in high esteem by the public, and we must prove to
the consumer that we deserve this privilege. All plastic and cosmetic surgeons should
constantly strive for excellence, be dedicated to continuing their education and training
and maintain the demeanor expected of a medical professional. Although cosmetic surgery is
very safe when performed by competent and qualified physicians in a safe environment,
continued vigilance is needed to keep unqualified practitioners from harming the public.
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