Showing posts with label awake procedures. Show all posts
Showing posts with label awake procedures. Show all posts

Sunday, January 23, 2011

The $6 Haircut

Some time ago, there was a television commercial for one of the larger office supply chains in which the proprietor of a small barbershop experiences what he perceives to be a threat to his business while sweeping the sidewalk outside his shop...

A large, national chain opens across the street to much fanfare and with a large banner that reads something like, "Home of the $6 Haircut"

The narrator explains that with the money he saves by purchasing office supplies at GigantoOffice, he is able to address the threat- and the spot shows him hanging his own banner- that reads, "We Fix $6 Haircuts"

(BTW,  I agree it is a bit funny that the ad was for a large, national chain of discount office supply stores...)

Soon, the large chain store is closing and he is victorious....

Cute- but what if the damage done by the discounter of services was not to your hair (which, of course grows back), but to another part of your body- and what if that damage required another operation to fix... or worse, couldn't be fixed. What if your visit to the discount provider of services resulted in your death?

The unfortunate reality is that there are at present a very large number of "providers" of aesthetic surgery who (in my humble opinion) have placed their financial well-being above the oaths they (and all doctors) took to protect patients and "First Do No Harm".

Among them are gynecologists, ER doctors, and even eye doctors- all advertising themselves as expert cosmetic surgeons- despite their full understanding of their lack of ACGME (American Council on Graduate Medical Education- the body that certifies training programs for specialities in medicine) training in the surgical discipline they are engaging in. Indeed, in most cases, their "training" consisted of a few hours, days, or at best weeks of watching someone from the company selling the equipment to them do the procedure.

Whether you were aware of it at the time or not, you've been exposed to them... They are the ones telling you that having liposuction in their office under local anesthesia is the safer way to go. That general anesthesia (as the plastic surgeon you saw recommended) is much more dangerous... That if they are capable of doing delicate eye surgery, they should be more than capable of liposuction. 

Imagine me telling patients that because I am trained to do delicate plastic surgery, I should be more than able to do their heart surgery.... Hard to imagine? It's happening all around you in the field of aesthetic surgery.

But the fundamental truth is that these doctors are not appropriately trained to do these procedures- fully explaining the deaths we all are reading about.

Previously healthy young women dying during procedures that should not have much risk of death. Dying because they chose poorly and prioritized their financial outlay higher than their safety or happiness. Dying because they fell victim to aggressive marketing campaigns designed to confuse you into thinking the eye doctor in the ad is a plastic surgeon. Dying because they believed the marketing pitch that local anesthesia is "much safer"- when the truth is that for procedures involving larger areas of the body local anesthesia is much LESS safe.

I see a great many women who have been injured and disfigured by these providers of discount or just poor quality services (indeed, an eye doctor in town actually charges MORE than any of the reputable and well trained plastic surgeons I know for liposuction). In some cases, I find myself telling them I can fix their "$6 haircut"- through another operation and at added expense to them of course. In others, I can only mitigate the damage.

And some, like the sister of Michelle Boone, my nurse practitioner, are never able to get this education about the providers of aesthetic surgery without adequate training. Because one of them took her life.

Be careful.

Plastic surgery can be a beautiful thing- restoring an appearance you thought was lost forever or not possible for you. But we should all insist that it also be as safe as possible and that the experience be positive. Be your own best advocate. Do your homework and place your safety and happiness only in the hands of a surgeon Certified by The American Board of Plastic Surgery with a track record of safety, success, and integrity.


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Wednesday, January 12, 2011

Surgery Under Local Anesthesia – The Safety Myth

When considering elective plastic surgery, most patients spend a great deal of time researching their surgical procedure. A slightly smaller percentage of patients will also carefully research their plastic surgeon. But an unfortunately small number of patients actually look into the two other variables that will determine the safety and success of any elective procedure- the anesthesia provider/technique, and the facility in which the procedure will be performed.

Quite often, because patients are nervous about having surgery under general anesthesia, they seek other options they believe will be safe and less intimidating. One procedure that might pique the interest of many is known as the “Awake” breast augmentation.

Right now, there are more than 100 doctors nationwide busy doing breast augmentations only under local anesthesia. These advocates believe that having the patient awake during the procedure will allow for a more satisfactory outcome because the surgeon can communicate with the patient during surgery and receive feedback from the patient regarding the desired breast size.

Because the surgery is done while “awake”, patients falsely believe that it must be safer than undergoing general anesthesia- Unfortunately, this couldn’t be more wrong.

The truth is that the majority of “providers” performing cosmetic surgery under local anesthesia (and telling their patients that it is “safer” than general anesthesia) are doing so because they simply are not able to offer other options legally.

In order to perform surgery under sedation or general anesthesia in most states, you must have a licensed anesthesia provider and be performing the surgery in an accredited facility. In order to satisfy the requirements of most state medical boards, surgery centers, and reputable anesthesia providers, you must also be able to prove that you have privileges to perform the same procedure in a hospital and that you have completed residency training in the procedure in question.

If you do not have, and cannot get, the credentials necessary to perform cosmetic surgery in an accredited facility under a safe level of anesthesia, but you (and your accountant) really want to do breast augmentation (or liposuction), your only chance is to offer to do the surgery in your office under local anesthesia. But you need to convince your patients that it is safer to do so…

Lawrence S. Reed, president of the American Association for the Accreditation of Ambulatory Surgery Facilities, is concerned that some doctors are using local anesthesia to get around having to be an accredited facility.

If your surgeon were a board certified plastic surgeon wouldn’t they want everyone to know that they were operating in an accredited surgical suite and not a makeshift operating room that also doubles as the office lunch room?

Overmedicating is also a great safety concern when doing major surgeries under local. Indeed, multiple women across the country have lost their lives over the past few years after experiencing local anesthesia toxicity- a problem for which there is no cure, and which occurs only many hours after the patient has left the doctor’s office.

Breast Augmentations are not the only surgery offered as “awake” procedures. Tummy tucks and liposuction are also being performed- and reported to be just as safe as when under the care of a licensed anesthesia provider- when in fact the opposite is most likely true.

At the end of the day, your goal should be to have a procedure that would make you look and feel better, but not at the expense of your safety.  Choose only surgeons Certified by The American Board of Plastic Surgery.


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