Surgery gone wild: Oral surgeons perform breast implants, OB/GYNs do tummy tucks
Sep 27, 2011 Posted by Martha Drezin
Greed and vulnerability meet to create a perfect storm
Mark, anesthetize, prep, drape, incise, lift, snip and sew. Cosmetic surgery is a skillful mechanical exercise for the well-trained plastic surgeon, operating in a state-of-the-art facility on a patient who is medically appropriate and has realistic expectations. The patient should also have a calm, deliberate approach: “I want it, I can afford it, results look great on my friend and my plastic surgeon and his surgical facility are top of the line.”
But if you think changing your appearance will change your life then caution goes out the window. The desire for surgery rages. It speaks to the part of you that is screaming for more……more love, attention, approval, money, sex, youth, invitations and connections. If you also have limited economic means, you are prone to throw caution out the window and become a “mark,” vulnerable to the advertisements of a charlatan. On September 13, 2011, USA Today published a story about three such “marks” who were found dead as a result of plastic surgery procedures at the hands of poorly-trained doctors.
Cosmetic surgery has become a commodity, with some procedures advertised half price on Groupon and LivingSocial. Medspas can be like fast food courts; choose from a menu and make a selection. Instead of meeting with a plastic surgeon, you meet with a sales person. Doctors are not required to report complications to medical authorities, states don’t break down deaths by the type of doctor involved and physicians aren’t required to report that they are doing surgeries outside of their specialties. And I could go on.
Obviously, this specialty needs a lot of regulatory legislation. But, by the time it passes, you’ll be ready for embalming, not plastic surgery. Until then, you’ll have to take care of yourself. Before surgery, take these steps to guarantee safe surgery with optimal results:
• Make sure your doctor is board-certified in plastic surgery by the American Board of Plastic Surgery, the only certification Board in plastic surgery recognized by the American Board of Medical Specialties.
• No matter where your surgery is performed, make sure your surgeon has operating privileges in an accredited hospital to perform the surgery that you will undergo. Here’s why: before granting operating privileges, hospital review committees evaluate a surgeon's training and competency for specific procedures.
• Make sure your doctor is licensed and has no in-state disciplinary actions.
• Spend the money and order a full physician profile and disciplinary history report.
• If your surgery is not scheduled for a hospital, make sure it occurs in an AAAASF Facility. That mouth full of A’s will guarantee your safety; it means the facility has been given the AOK by the American Association for Accreditation of Ambulatory Surgery. Cosmetic surgery can safely be performed in a hospital, a surgicenter or an office-based surgical facility as long as that facility is accredited.
• It’s not over until the fat lady sings. Your surgical experience must include follow-up visits to make sure there are no complications and that you’re happy with results. Ask your doctor about his policy for doing revisions. Get all the facts before the surgery, not after.
The cautionary article in USA Today reports on Sant Antonio, who is not board-certified in any area, completed a medical residency in general surgery and positioned himself as a cosmetic surgeon, filling the need for discounted surgery in Miami. He chose to specialize in liposuction, a big attraction for overweight, skin-exposed Floridians. Kellee Lee-Howard, 32-years-old and a mother of six, was 5’5 and weighed 205 pounds. She told her husband that she had found a “safe” way to lose weight with surgery. She was found dead on her couch the day after undergoing liposuction with Sant Antonio. The cause of death was lidocaine (a painkiller) toxicity.
Howard was not the first patient to lose her life in the hands of Sant Antonio. Maria Shortall, a housekeeper and mother of two, died of cardiac arrest after liposuction and a fat transfer procedure this past June.
Rohie Kah-Orukotan, the third patient who recently died from lidocaine toxicity following liposuction, was operated on at Weston Medspa where she got manicures. Her doctor, Omar Brito, was trained in occupational health.
There are good reasons why plastic surgery has become the wild west of medicine, attracting untrained practitioners operating out of in ill-equipped facilities. Plastic surgeons had a higher median income − $270,000 – than 12 of the 22 medical specialties in a 2010 Medscape survey by WebMD. Plus there’s limited oversight and almost no interference from insurers because elective cosmetic surgery is typically not covered.
On the one hand, there are the takers, desperate to change their appearance and enticed by bargain basement prices. On the other hand, lurking in the wings, are untrained, greedy practitioners. Together, they tango….until the casualties build up. What is missing in this picture is a responsible adult.
One such adult is Florida senator Eleanor Sobel. She plans to reintroduce a bill that had no traction last year; her goal is regulating Medspas as medical clinics, which would subject them to inspection. According to Sobel, “with the increase in the number of deaths, the bill should be a priority this year.” She is also fighting for a requirement that a trained anesthesiologist be present for all liposuction procedures.
Without such a regulating bill, there is a nasty confluence of events: a practitioner with inadequate training who is not allowed to practice in accredited facilities, lowered overhead resulting from local, instead of general, anesthesia and a facility that may even double as a manicure salon. Without benefit of anesthesiologist, hospital or accredited surgical facility, you can charge bargain basement prices. In Florida, as in other states, this scenario was an accident ready to happen.
California, which is another plastic surgery mecca, is not without its problems. Anil Gandhi of Cerritos, who trains doctors to do cosmetic surgery while patients are awake, also performs eye lifts, liposuction and tummy tucks. Gandhi taught himself how to do breast augmentation surgery after failing eyesight made it impossible for him to do anything other than “superficial” surgery. He was previously a general surgeon who did amputations, appendectomies and gunshot wounds.
Gandhi trained an OB/GYN, Lei Chen, to do breast implants. As an OB/GYN, Chen developed a trusting bond with his patients, so it was easy to segue from pap smears to breast implants. He was sued by Rhonda Stankavich, one such trusting patient, who felt significant pain during her breast implant and wound up with scars three times the typical size and in the wrong locations. Chen no longer practices medicine in the United States.
In California it took a celebrity fatality to effect changes. Donda West, rapper Kanye West’s mother, died following surgery in 2007 by a plastic surgeon that was not board-certified. Now, California patients are required to get a physical exam and written clearance from a doctor before they undergo cosmetic surgery.
Illinois State Senator Jacqueline Collins is trying to adapt this law and expand it to include cosmetic procedures in offices and spas, which is where nonplastic surgeons typically operate. This is a beginning, but it does nothing to address training requirements for doctors and facility requirements for offices and spas.
Actually, most states have made it easier to jump into the pool and practice plastic surgery. Sixteen states now allow dentists trained in oral surgery to perform facial cosmetic surgery and the New York state legislature is considering a similar bill that would require oral surgeons to have hospital privileges to perform surgeries at hospitals. It is notable that the New York State Dental Association contributed more than 2.5 million to New York legislators from 2004 to 2010. California passed a similar bill in 2006; its state dental group contributed more than 5.7 million to legislators from 2003 to 2010. Am I implying that money can drive legislation? You bet.
Cosmetic surgery is an area in which the greed and vulnerability meet to create a perfect storm. Dentists perform breast implants, OB/GYNs do tummy tucks: everyone is invited to play. Our culture with its emphasis on youth and beauty reveres youth and disdains old age. The media is right on board, wetting appetites with ravishing images of the young and well-endowed.
Mark, anesthetize, prep, drape, incise, lift, snip and sew. Cosmetic surgery is a skillful mechanical exercise for the well-trained plastic surgeon, operating in a state-of-the-art facility on a patient who is medically appropriate and has realistic expectations. The patient should also have a calm, deliberate approach: “I want it, I can afford it, results look great on my friend and my plastic surgeon and his surgical facility are top of the line.”
But if you think changing your appearance will change your life then caution goes out the window. The desire for surgery rages. It speaks to the part of you that is screaming for more……more love, attention, approval, money, sex, youth, invitations and connections. If you also have limited economic means, you are prone to throw caution out the window and become a “mark,” vulnerable to the advertisements of a charlatan. On September 13, 2011, USA Today published a story about three such “marks” who were found dead as a result of plastic surgery procedures at the hands of poorly-trained doctors.
Cosmetic surgery has become a commodity, with some procedures advertised half price on Groupon and LivingSocial. Medspas can be like fast food courts; choose from a menu and make a selection. Instead of meeting with a plastic surgeon, you meet with a sales person. Doctors are not required to report complications to medical authorities, states don’t break down deaths by the type of doctor involved and physicians aren’t required to report that they are doing surgeries outside of their specialties. And I could go on.
Obviously, this specialty needs a lot of regulatory legislation. But, by the time it passes, you’ll be ready for embalming, not plastic surgery. Until then, you’ll have to take care of yourself. Before surgery, take these steps to guarantee safe surgery with optimal results:
• Make sure your doctor is board-certified in plastic surgery by the American Board of Plastic Surgery, the only certification Board in plastic surgery recognized by the American Board of Medical Specialties.
• No matter where your surgery is performed, make sure your surgeon has operating privileges in an accredited hospital to perform the surgery that you will undergo. Here’s why: before granting operating privileges, hospital review committees evaluate a surgeon's training and competency for specific procedures.
• Make sure your doctor is licensed and has no in-state disciplinary actions.
• Spend the money and order a full physician profile and disciplinary history report.
• If your surgery is not scheduled for a hospital, make sure it occurs in an AAAASF Facility. That mouth full of A’s will guarantee your safety; it means the facility has been given the AOK by the American Association for Accreditation of Ambulatory Surgery. Cosmetic surgery can safely be performed in a hospital, a surgicenter or an office-based surgical facility as long as that facility is accredited.
• It’s not over until the fat lady sings. Your surgical experience must include follow-up visits to make sure there are no complications and that you’re happy with results. Ask your doctor about his policy for doing revisions. Get all the facts before the surgery, not after.
The cautionary article in USA Today reports on Sant Antonio, who is not board-certified in any area, completed a medical residency in general surgery and positioned himself as a cosmetic surgeon, filling the need for discounted surgery in Miami. He chose to specialize in liposuction, a big attraction for overweight, skin-exposed Floridians. Kellee Lee-Howard, 32-years-old and a mother of six, was 5’5 and weighed 205 pounds. She told her husband that she had found a “safe” way to lose weight with surgery. She was found dead on her couch the day after undergoing liposuction with Sant Antonio. The cause of death was lidocaine (a painkiller) toxicity.
Howard was not the first patient to lose her life in the hands of Sant Antonio. Maria Shortall, a housekeeper and mother of two, died of cardiac arrest after liposuction and a fat transfer procedure this past June.
Rohie Kah-Orukotan, the third patient who recently died from lidocaine toxicity following liposuction, was operated on at Weston Medspa where she got manicures. Her doctor, Omar Brito, was trained in occupational health.
There are good reasons why plastic surgery has become the wild west of medicine, attracting untrained practitioners operating out of in ill-equipped facilities. Plastic surgeons had a higher median income − $270,000 – than 12 of the 22 medical specialties in a 2010 Medscape survey by WebMD. Plus there’s limited oversight and almost no interference from insurers because elective cosmetic surgery is typically not covered.
On the one hand, there are the takers, desperate to change their appearance and enticed by bargain basement prices. On the other hand, lurking in the wings, are untrained, greedy practitioners. Together, they tango….until the casualties build up. What is missing in this picture is a responsible adult.
One such adult is Florida senator Eleanor Sobel. She plans to reintroduce a bill that had no traction last year; her goal is regulating Medspas as medical clinics, which would subject them to inspection. According to Sobel, “with the increase in the number of deaths, the bill should be a priority this year.” She is also fighting for a requirement that a trained anesthesiologist be present for all liposuction procedures.
Without such a regulating bill, there is a nasty confluence of events: a practitioner with inadequate training who is not allowed to practice in accredited facilities, lowered overhead resulting from local, instead of general, anesthesia and a facility that may even double as a manicure salon. Without benefit of anesthesiologist, hospital or accredited surgical facility, you can charge bargain basement prices. In Florida, as in other states, this scenario was an accident ready to happen.
California, which is another plastic surgery mecca, is not without its problems. Anil Gandhi of Cerritos, who trains doctors to do cosmetic surgery while patients are awake, also performs eye lifts, liposuction and tummy tucks. Gandhi taught himself how to do breast augmentation surgery after failing eyesight made it impossible for him to do anything other than “superficial” surgery. He was previously a general surgeon who did amputations, appendectomies and gunshot wounds.
Gandhi trained an OB/GYN, Lei Chen, to do breast implants. As an OB/GYN, Chen developed a trusting bond with his patients, so it was easy to segue from pap smears to breast implants. He was sued by Rhonda Stankavich, one such trusting patient, who felt significant pain during her breast implant and wound up with scars three times the typical size and in the wrong locations. Chen no longer practices medicine in the United States.
In California it took a celebrity fatality to effect changes. Donda West, rapper Kanye West’s mother, died following surgery in 2007 by a plastic surgeon that was not board-certified. Now, California patients are required to get a physical exam and written clearance from a doctor before they undergo cosmetic surgery.
Illinois State Senator Jacqueline Collins is trying to adapt this law and expand it to include cosmetic procedures in offices and spas, which is where nonplastic surgeons typically operate. This is a beginning, but it does nothing to address training requirements for doctors and facility requirements for offices and spas.
Actually, most states have made it easier to jump into the pool and practice plastic surgery. Sixteen states now allow dentists trained in oral surgery to perform facial cosmetic surgery and the New York state legislature is considering a similar bill that would require oral surgeons to have hospital privileges to perform surgeries at hospitals. It is notable that the New York State Dental Association contributed more than 2.5 million to New York legislators from 2004 to 2010. California passed a similar bill in 2006; its state dental group contributed more than 5.7 million to legislators from 2003 to 2010. Am I implying that money can drive legislation? You bet.
Cosmetic surgery is an area in which the greed and vulnerability meet to create a perfect storm. Dentists perform breast implants, OB/GYNs do tummy tucks: everyone is invited to play. Our culture with its emphasis on youth and beauty reveres youth and disdains old age. The media is right on board, wetting appetites with ravishing images of the young and well-endowed.