Beauty surgery fail­ing its hype

Plas­tic sur­geons hope a new ac­cred­i­ta­tion scheme will help con­sumers avoid cow­boy op­er­a­tors. Denise Cullen re­ports

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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

Pic­ture: David Crosling

False im­age: Plas­tic sur­geon Bryan men­del­son says be­fore-and-af­ter ad­ver­tis­ing by cos­metic sur­geons should be banned

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