Beauty surgery failing its hype
Plastic surgeons hope a new accreditation scheme will help consumers avoid cowboy operators. Denise Cullen reports
THE before-and-after photographs in cosmetic surgery advertisements make it all seem such a cinch. A typical promotion parades snaps of patients with their fat rolls vanishing, saggy jowls firming and droopy lips lifting. It then boasts, with a whiff of used-car salesman vernacular, ‘‘ No pain, no downtime.’’
But try selling the risk-free message to the family of Lauren James, 26, a Melbourne property valuer who died in January last year after undergoing liposuction, a procedure which siphons off unwanted fat, particularly from thighs, stomachs and buttocks.
Prior to her death, James reportedly suffered three days of intense pain and bleeding after the walk-in, walk-out procedure at a clinic in one of Melbourne’s inner southeast suburbs.
The matter remains under investigation by the State Coroner’s Office of Victoria, and has re-ignited debate about regulation of the booming cosmetic surgery industry and the dangers and complications that can arise from what many consider routine procedures.
As the 1000 plastic surgeons from 68 countries attending this week’s Congress of the International Society of Aesthetic Plastic Surgery (ISAPS) in Melbourne would doubtless be keen to point out, deaths in Australia due to complications following cosmetic surgery remain rare.
But as the number of doctors entering the lucrative field and the number of patients demanding procedures have soared, so too have the risks, complaints, and horror stories.
‘‘ Some of the experiences people have relayed to me have been very concerning,’’ says Roberta Honigman, a Melbourne-based researcher and clinician who provides preand post-surgery counselling to cosmetic and plastic surgery patients.
Along with issues such as facial scarring and mismatched breasts, cases Honigman has encountered include a patient whose nose collapsed after a procedure and a woman whose tummy was tucked so tight she could no longer stand straight.
‘‘ It seems the doctor removed too much tissue and then had difficulty sewing the wound back together,’’ Honigman recalls. ‘‘ The way the wound has healed means there is no stretch in her skin, and she must now have major reconstructive surgery — that’s if the problem can be fixed at all.
‘‘ Now she doesn’t want to go out, it’s affected her relationships, her sex life, her family life — basically, it’s wrecked her life.’’
Plastic surgeons themselves are also aware that there’s a problem.
ISAPS president Bryan Mendelson says it’s not unusual for advertisers to digitally manipulate photos to convince potential customers of the transformation they can expect. In some cases, these photos don’t depict their own patients.
This is so misleading, says Mendelson, a Melbourne plastic surgeon, that the practice ‘‘ should be a criminal offence’’ as it is in some other countries. ‘‘ Germany, France and Japan have prohibited the use of before-and-after photos in advertising because (the practice is) so open to fraudulent misrepresentation.’’
No one knows, exactly, how often surgery goes wrong. Getting the negligence claim figures from the various medical insurers (which provide insurance cover to doctors) and professional associations to agree is a near-impossible feat.
But according to some, the incidence is rising significantly. Research last year from the Medical Indemnity Industry Association of Australia (MIIAA), which represents insurers that collectively cover 85 per cent of Australia’s private medical practitioners, revealed that plastic and cosmetic surgeons bucked an industry-wide trend towards fewer claims and falling premiums.
It showed the three-year average level of claims against plastic and cosmetic surgery practitioners increased 41 per cent between 1995-98 and 2003-06, from 238 claims per 1000 doctors to 335 claims per 1000.
Ellen Edmonds-Wilson, CEO of MIIAA, says this led to a steep rise in premiums of 425 per cent over the same period, more than any other specialty, including obstetrics (for which premiums rose 375 per cent).
‘‘ An increase in claims against practitioners generally results in an increase in premiums paid by that specialty — this is a basic insurance principle,’’ she says.
Figures from leading South Australianbased insurer Medical Insurance Group Australia (MIGA) are even more disturbing, suggesting a staggering 70 per cent rise in claims among its 7500 members in the state over the past five years.
But David Nathan, CEO of Australia’s biggest medical insurer, Avant — which has 38,000 members — argues these figures are too high.
He says various state governments’ moves to reform tort laws, designed to rein in spiralling litigation rates by making it harder to sue and to cut back likely payouts when cases are successful, have made the increase in cosmetic claims seem more dramatic than it really is. This is because when such reforms are mooted, patients and lawyers typically respond by rushing to lodge potential claims which in ordinary circumstances might not have surfaced for months or years. They do this to ensure any eventual case is treated under existing rather than possibly less generous future rules.
Over the past three years, he points out, the average frequency of claims made against plastic surgeons has dropped from one in every two having a claim made against them each year, to one in three.
Those are slightly better odds, but still quite confronting, and many people will understandably want to know how they can tip them in their favour.
ISAPS is trying to help consumers to pick good cosmetic surgeons by introducing its own accreditation scheme that will apply across the world.
A Sydney clinic recently became the first in Australia to earn the badge of approval, which is intended to provide a guarantee not only that the clinic is clean and up to scratch, but that the doctors working there have the necessary skills and qualifications.
ISAPS director of communications Tony Staffieri claims too many doctors in Australia without specific qualifications in plastic surgery are trying to set themselves up as cosmetic surgeons, and blames these ‘‘ medi- cal cowboys’’ for the increase in negligence claims.
‘‘ I would bet . . . it’s not that plastic surgeons are screwing up — it’s that doctors are practising plastic surgery without training,’’ he says. ‘‘ Just because you take a weekend course doesn’t mean you are qualified to practise breast reduction. It’s happening everywhere . . . but an aesthetic plastic surgeon has to go through years and years of training.’’
Staffieri says the accreditation scheme is the ‘‘ beginning of a very important trend in
plastic surgery’’ and that in due course the message to consumers will be ‘‘ if you are going to a clinic, make sure they are accredited.’’
‘‘ Just because someone has an MD after their name doesn’t mean they are qualified to be a plastic surgeon,’’ says Staffieri (referring to the postnominal used by US doctors. In Australia a medical degree is usually indicated by the letters MBBS). ‘‘ People don’t understand that.’’
Yet lack of transparency is precisely the problem, says Howard Webster, president of the Australian Society of Plastic Surgeons.
Webster says the current regulatory regime makes it impossible for people to obtain the right information about a potential surgeon’s training and qualifications. What isn’t clear to the average patient is that plastic surgeons undertake an additional 8-10 years of specialist training on top of their medical degrees, he says, while ‘‘ anyone with a basic undergraduate medical degree’’ can put themselves about as a cosmetic surgeon.
‘‘ A lot of these people do procedures that are outside their knowledge and training and build their businesses through a lack of disclosure,’’ he explains. ‘‘ It is not illegal, but many doctors use non-accredited qualifications in very prominent ways.’’
Webster says he regularly sees patients who need to be patched up after undergoing invasive procedures at the hands of unqualified surgeons — such as the woman two weeks ago who’d previously had a suture, or thread, lift to tighten her face. The procedure involves using a long, fine needle to insert threads covered with small hair-like barbs into the face.
‘‘ She’d been told it was a non-invasive procedure, that it wasn’t surgery, but she was cut behind her ears and was in constant pain,’’ he says. ‘‘ She’d just been given a local anaesthetic and (the procedure) was done in the chair in the surgery, and then she was put in the cleaner’s cupboard to recover. She says it was the worst experience of her life.’’
Getting a picture of precisely what goes on behind the surgical curtains is complicated by the fact that there is no national data collection on how many Australians go under the scalpel or laser each year.
Australian figures can only be extrapolated from American statistics by adjusting them for population and, based on this, the guesstimate is that more than 1.1 million procedures were performed in 2006, including 22,351 breast augmentations, 20,849 nose jobs, and 9,923 tummy tucks.
Overall, this represents a jump of 20 per cent on the previous year’s figures.
Some in the industry blame the increase on aggressive advertising featuring before-andafter images. This situation has come about because medical board regulations restricting doctors to small-print advertisements listing their address and what they practised were scrapped in 1994, when the Australian Competition and Consumer Commission (ACCC) declared that doctors should be able to advertise like anyone else.
‘‘ The aim was to increase competition, but the net effect has been the burgeoning cosmetic surgery industry,’’ says Webster. ‘‘ It also provided a method whereby a patient could access the surgeon without the filter of a GP.’’
But Honigman rejects the notion that cosmetic surgeons are to blame for rising complaints and claims.
Rather, she says, popular culture and various forms of media, including shows such as ExtremeMakeover , have created a climate of such unreasonable expectations that sometimes the work of even the most skilled surgeons cannot possibly meet with favour.
A study Honigman co-published in the Medical Journal of Australia (2002;176(12):601-604) further concluded that if a person views a procedure as a panacea for his or her life problems, the psychological outcome is ‘‘ more likely to be poor’’. Additional reporting: Adam Cresswell
False image: Plastic surgeon Bryan mendelson says before-and-after advertising by cosmetic surgeons should be banned