Excerpted from:
The Real Risks of Plastic Surgery
by Nancy Serano

Teacher Gets Tummy Tuck and Dies the Next Day
Plastic Surgeon Sentenced in Death of Woman In Florida
Thirteen People Die After Plastic Surgery
Headlines like these are reason enough for most of us to dismiss even fleeting considerations of surgically enhanced thighs or breasts. We think it's simply not worth the risk. But the medical community says the media are misleading. "The plastic surgery mortality rates printed in news headlines are, in my opinion, grossly exaggerated. They satisfy the need for hype - that's it!" says Mark Gorney, MD, former president of the American Society of Plastic and Reconstructive Surgeons. What is the truth, and are there ways to gauge the risks?

Many doctors say that the fatalities cited in the news are the result of procedures not done on the up-and-up. For example, either the doctor wasn't properly trained, the facilities were not up to snuff, or anesthesia problems were involved. The truth is, just by their nature, plastic surgeries are low risk. "They're usually superficial, meaning they don't involve major organs or blood vessels, and they're typically done on relatively young, healthy people," says Michael McGuire, MD, a California plastic surgeon. "Right there, you've eliminated a lot of the complexities involved with almost all other kinds of surgeries. Most surgeons won't do plastic surgeries on patients who have health problems."

But cosmetic surgery is still surgery, which always involves risks. Many news-making fatalities involve complications with anesthesia. Too much or the wrong kind of anesthesia can literally cause a patient to drown in fluid or suffocate due to loss of reflex abilities (like breathing or swallowing). Because of this, some physicians don't use general anesthesia - just local with sedation - so that the patient never loses her reflexes. (But being awake during surgery is, needless to say, not the best option for every patient.) Talk to the anesthesiologist who will be on your surgical team. Divulge all medications (birth control, antibiotics, even herbal supplements) you take, and thoroughly discuss your medical history. And ask your doctor about his or her relationship with the anesthesiologist. "A good anesthesiologist - and - surgeon team can have complications like anyone else. What makes them good is that they recognize it and deal with it before anything happens," says Jane Recant, MD, a Manhattan anesthesiologist. (One doctor spoke of a novice anesthesiologist who was too nervous around the surgeon to chime in that the patient's vital signs were plummeting). "In the hands of a board-certified anesthesiologist who specializes in ambulatory anesthesia or routinely does the type of surgery that you're interested in, the risk of complication is small."

Other possible risks include a patient's existing health problems; scheduling late-day surgery or preholiday surgery, because you doctor may not be focused on the task; not having an anesthesiologist present for bigger surgeries (a tactic used by doctors who want to cut corners); and selecting a doctor who doesn't have hospital privileges and thus uses a nonaccredited in-office surgical facility. Expect that risks associated with specific surgeries, such as hardening of the breasts after augmentation or lids that won't close after an eye-lift, will be reviewed, in detail, by your doctor before surgery.

Is there one procedure that is the "riskiest"? Since there are no statistics compiled on a state or national level that record the number of complications or deaths related to each procedure, it's almost impossible to know. ( This might change in Congress passes President Clinton's recent proposal for a nationwide system of reporting medical errors.) However, liposuction has been the center of controversy. With so many untrained doctors suctioning fat in increasingly higher volumes, there have been many reports of serious complications. But when the prominent New England Journal of Medicine recently published what proved to be an incendiary study entitled "Deaths Related to Liposuction," the plastic surgery community rebutted. "The New England brouhaha was based on five cases in one city. That's not indicative of a trend," Gorney says. One doctor, who wanted to remain anonymous added, "They didn't even do autopsies in that study. They cited lidocaine toxicity as cause of death. Lidocaine toxicity is not only rare but very treatable.

There is one primary non-life-threatening risk - what if, horror of horrors, you simply don't like your "improved" face, or your new breasts feel like water balloons? Review the before-and-after shots of your doctor's work, and bring realistic pictures (not your high-school graduation photo) to your consultation so that your doctor understands what your beauty ideal is (don't assume you and she share the same aesthetic). The Doctors' Company, a medical malpractice organization, says the most dissatisfaction (which includes anything from a scar to not liking the results, but not death) is associated with breast augmentation patients. "The U.S. male's sexual obsession with breasts is stunning. Female patients think that after breast aug., men will fall at their feet," Gorney says. "When it doesn't happen, we have a dissatisfied patient. It's stuff like this that makes the numbers look inflated."

Finding a doctor you feel safe and comfortable with if the best way to avoid disappointing - or deadly - outcomes. He or she should be certified by an organization in the American Board of Medical Specialties (ABMS), the boards that set the standards for specialized medical training, in either plastic surgery, otolaryngology (ear, nose and throat, or ENT), ophthalmology, or dermatology. Though it does depend on each doctor's experience, as a basic rule, ENTs should be limited to rhinoplasties and, possibly, face-lifts, ophthalmologists to eye-lifts, and dermatologists to injections and other wrinkle remedies (chemical peels, Botox, and, for approximately 10 percent of dermatologists, liposuction.)

Adding to the confusion, would-be patients say surgeons often snipe at other surgeons during preliminary consultations. Statements to the tune of "That doctor is a butcher! His plan isn't the best for you. Here's what I recommend" are bouncing around with unprecedented speed, rendering informed patients utterly perplexed. "Patients tell me every day about surgeons saying negative things about each other," says John E Sherman, MD, a Manhattan plastic surgeon. "I say, beware the surgeon who is promoting himself at the expense of others. It's unprofessional and, for the most part, just marketing. The bottom line is that, more often than not in plastic surgery, there is more than one way to achieve the same end result. If there were only one legitimate way to perform a procedure, we'd all know about it." Stick with a surgeon who you feel best with and who acknowledges there are several alternatives. Those who try to put down other competent surgeons are putting their own limitations on display. Patients must recognize that medicine is not isolated from competition and, well, sales, like any business.

Speaking of sales, finding a bargain price should not be your motive. Doctors who charge more typically spend more time on fewer surgeries per day, can afford the most experienced anesthesiologists, and can maintain updated equipment and an excellent surgical facility. "Do you really want the lowest bidder?" asks David Sire, MD, a California dermatologist.

To protect yourself, ask lots of questions about qualifications and check up on them because, disheartening as it is to report, some doctors lie about credentials. Disciplinary steps taken against doctors are a matter of public record. While there is no central clearinghouse for this information, the Web site for the Federation of State Medical Boards (www.fsmb.org) lists the telephone numbers for the medical boards of all fifty states. Calls to a state's medical board can provide information on any disciplinary action taken against a doctor and confirm his or her license to practice medicine in that state (and tell you if the license has ever been suspended or revoked there). Selecting a doctor should not be a crapshoot. Qualified doctors - we hope - will be happy to share their records.