Wednesday, August 10

When it comes to cosmetic surgery, looks can be deceiving | Yael lefkovits

TOs I walked into the emergency department cubicle where Kate was sitting *, first the smell caught my eye. A faint, hauntingly sweet smell of bacteria, mixed with a musky perfume. With tears in her eyes, Kate unbuttoned her shirt, revealing one of the worst postoperative infections I have ever seen. She was painted in a kaleidoscope of colors, with bruises that completely covered her breasts. I had had a breast augmentation two weeks before. The incision in the lower part of her left breast was red, swollen, and oozing pus. The implant in the right breast appeared to have migrated laterally and there was asymmetry between the pair. Kate was distraught, rightly pointing out that “it’s sloppy work, not boob job.”

At first, Kate told me that she was delighted with her choice of plastic surgeons. I had found your page on social media. I had even had a colleague who had been to the same doctor for Botox and was delighted with the results. Kate was an educated and very intelligent woman. She felt she had done her due diligence before seeking surgery. She had extensively researched the risks of breast augmentation and had read the doctor’s glowing reviews. His office was clean and modern, the front desk staff was friendly. He had had friends who had made poor decisions, looking for the same operation in third world countries for a fraction of the price. She could afford the operation in Australia and was sure she was choosing responsibly.

On average, a breast augmentation in Australia can cost between $ 6,000 and $ 20,000 and is generally not covered by Medicare. Often times, a “lower cost” procedure can be performed if a patient is willing to seek a less qualified surgeon, such as a cosmetic surgeon without the recognition of the Royal Australasian College of Surgeons (RACS). Cheaper implant brands can be used and the operation can be performed in a clinic rather than a hospital with an experienced anesthesia team under proper general anesthesia. It is terrifying that many of these cheaper cosmetic surgeons also do not have admission rights to a hospital and if the operation does not go according to plan, they will have to call an ambulance to transport the patient, in the middle of the surgery, to an emergency department .

Despite her research, Kate did not understand the inherent difference between a plastic surgeon and a plastic surgeon. Anyone could be forgiven for thinking, as Kate did, that the two were the same and could be used interchangeably. I had no idea that the slightly lower cost of the procedure was a discount due to lack of training, experience, multidisciplinary staff, and adequate anesthetic support.

For those seeking a cosmetic surgical enhancement, there is an implicit belief that physicians who perform invasive surgical procedures are in fact trained surgeons. However, this is not always the case. Under current regulations in Australia, any doctor with general registration with the Australian Health Professionals Regulation Agency (Ahpra) can promote themselves as a cosmetic surgeon without any additional training. A pediatrician might perform liposuction, an ophthalmologist might perform your tummy tuck, a pathologist might offer you a rhinoplasty (nose job), and a psychiatrist might perform your Brazilian butt lift.

Kate’s plastic surgeon had no formal surgical training as a Fellow of the Royal Australasian College of Surgeons; He was not a plastic surgeon with more than a decade of rigorous supervised surgical training; and he had not developed the ability to delicately handle complex and unexpected complications or understand the subtle nuances of anatomical variations. All of his surgeries were performed in a specialized clinic, not in a hospital with access to an intensive care unit and advanced life support in the event of an emergency. Previously, Kate’s surgeon worked in a completely different non-surgical specialty. One day, they decided they wanted to be cosmetic surgeons. And then they were.

The cosmetic industry is booming. Australians spend over a billion dollars on cosmetic procedures each year. In 2017, more than 20,000 breast augmentations and 30,000 liposuctions were performed in Australia. Broadly speaking, the cosmetic field can be divided into cosmetic medicine and cosmetic surgery, and cosmetic medicine encompasses all non-invasive procedures and cosmetic surgery encompasses any invasive surgical procedure intended for cosmetic enhancement, including rhinoplasty, blepharoplasty. , breast augmentation and neck lift.

In 1998, the Australasian College of Cosmetic Physicians it was established to regulate the field of cosmetic medicine (as opposed to cosmetic surgery). As of yet, there is no formal Australian college of cosmetic surgeons. Cosmetic medicine only covers the practice of non-invasive medical treatments including dermal fillers, anti-wrinkle injections, laser and IPL machines, and management of scars, vascular defects, and rosacea. Many consumers will look to their GP, dermatologist, dermal doctor, or registered nurse to perform these procedures. In contrast, plastic surgeons are possibly the only surgical specialty specially qualified to perform risky and technically demanding invasive cosmetic surgeries such as tummy tucks and breast augmentation.

For years, the Australian Society of Plastic Surgeons (ASPS) has been calling for consistent national regulations of in-office cosmetic surgery, arguing that the current lack of oversight poses an objectionable risk to the safety of patients. patients. Currently, no regulations or credentials are required for a physician who performs cosmetic surgery in the office. Professor Hugh Bartholomeusz, former president of ASPS, has argued that “we are aware that consumers are ill equipped to discern whether the doctor they choose for their cosmetic surgery is adequately trained to perform their procedure.” A GP would be reprimanded for performing an appendectomy in his office, but for some reason a rhinoplasty or liposuction is acceptable.

As this topic gains publicity and traction, we have taken steps in the right direction. On 2018, the governments of the states of Victoria, Queensland and New South Wales passed legislation that restricts the type of facility that can perform cosmetic surgery. Additionally, in 2019, federal health minister Greg Hunt urged state and territorial health ministers to restrict the use of the title “surgeon.” However, these steps have not been sufficient to adequately safeguard the interests of the hundreds of thousands of Australians who seek cosmetic surgery each year and remain subject to this potentially dangerous ambiguity.

It’s a tragedy. But not one that is entirely unavoidable. As Kate has reflected, “If I had known the difference between a plastic surgeon and a plastic surgeon at that time, I would never have chosen them to operate on me. It’s completely misleading. “

Consumers spend a lot of time researching the price of a particular surgeon. However, they are often unaware of the potential non-cash costs.

* Pseudonym used to maintain confidentiality.

Dr Yael Lefkovits is a physician at Royal Melbourne Hospital.

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