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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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