Renaissance Plastic Surgery | Dr. Joseph Fata

National news agencies have reported the tragic death of an 18 year-old girl in Boca Raton, Florida, after plastic surgery to correct asymmetric breasts. The reported cause of death was Malignant Hyperthermia.

An event such as this one is a tragedy of proportions that are unimaginable outside the family of this girl and our heart and prayers go out to them. Beyond the immediate event, it once again raises the question of the safety of cosmetic surgery and the role of Malignant Hyperthermia, a rare anesthetic complication.

While I would not present myself as an anesthesiologist or an expert on this disorder, I would like to share some information. Malignant Hyperthermia is a rare defect of specific receptors of muscle cells which manifest when exposed to a variety of anesthetic agents. The result is a massive release of calcium which puts the cells into overdrive, using up all of the oxygen and producing large amounts of carbon dioxide. Heart rate and body temperature rise rapidly and unless treated promptly, it is fatal.

Many cases have been successfully treated and the key is early diagnosis.The drug Dantrolene can stop this reaction and is the mainstay of treatment along with treatment of secondary problems, such as excess carbon dioxide, calcium and potassium in the bloodstream.

Malignant Hyperthermia is rare and I have come across statistics ranging from 1 in 5,000 to 1 in 60,000. It does tend to run in families and if suspected the diagnosis can often be made ahead of time with a muscle biopsy. Unfortunately, up to half of the cases reported describe a prior anesthetic with no problems at all and many do not have a family history of this disease

Sadly, it is very unlikely that this patient and her family could have done anything to anticipate this tragedy. However, it does reaffirm the importance of doing your homework. In addition to finding a board certified plastic surgeon, be sure that you will have a board certified anesthesiologist and that your surgery will be performed in either a hospital or a fully accredited outpatient surgery center. None of these precautions will completely immunize you from risk, but it only makes sense to do everything you can to make your surgery as safe as possible.

I was recently interviewed by a local news network on the topic of teens and plastic surgery, and and I would like to share my thought on this topic with you. Today's teen has unprecedented exposure to the media and one of the hot topics has been celebrity plastic surgery. Although the percentage of plastic surgery performed on teenagers has remained steady at 3% over the past 15 years, the overall number of cosmetic plastic surgery procedures has increased dramatically and so the increase in teens having plastic surgery has followed this trend. The question that begs to be answered is if this is a bad thing.

Unfortunately, the answer is not a simple yes or no because it depends entirely on the circumstances. Plastic surgery can be a very positive experience that can build confidence and restore a fragile psyche. Procedures to correct protruding ears, large humps on the nose and boys who have developed breast tissue can be rewarding to both the surgeon and the patient. However, plastic surgery that is not well planned and thought out can have unintended consequences that may damage both appearance and self-esteem.

As parents or teens approaching this topic, there are some guidelines that should be followed to help insure that having plastic surgery is a the right decision. First, the idea of a cosmetic procedure should originate with the teen, not the parent. It is almost never a good idea for a parent to suggest cosmetic surgery to a teen unless it is in response to a problem that has become a struggle for them. If a teen is satisfied with his or her appearance, leave it alone.

A second principle is to avoid surgery on any part of the body that has not completed its' growth, unless of course it is a significant birth deformity. This means that breast and body contouring surgery (liposuction, tummy tuck) should be delayed in most cases until a teen in out of high school and has reached adulthood. It is reasonable to correct protruding ears anytime after the age of five or six because this is often a source of cruel teasing and growth of the ear is almost complete. Surgery to correct a large nasal hump is also reasonable but it is best to wait until the age of 16 to not disturb growth.

A third guideline is to remember that plastic surgery is real surgery, not a trip to the spa or health club. It has real risks that need to be considered regardless of the fact that they occur very infrequently. Teens are not known for giving thoughtful consideration to potential risks and consequences. They will need their parents' help understanding risk. Along the same lines, plastic surgery should be part of a discussion between parents and their children as a solution to a problem. It should not be packaged as a graduation present or a reward for good grades. These practices are well-intentioned but often trivialize a surgical procedure.

The last point is that teens are in constant change, both mentally and physically. A problem of crisis proportions today may be a small blip on the radar a few months later. If an issue of appearance comes up, consider it seriously but give it some time. If it doesn't go away, explore it more deeply, gather all of the information you need, and talk to a plastic surgeon, preferably two. At that point, if you have followed all of these guidelines and it still seems right, you will in all likely hood make the right decision.