Renaissance Plastic Surgery | Dr. Joseph Fata

Headline: Family physician jailed after cosmetic surgery disaster
Headline: Beverly Hill Radiologist investigated for liposuction mishap, leaves country.
Headline: Yellow Page publisher liable for misleading board certification in plastic surgery.

Don't each of these headlines sound like an over-the-top "Nip and Tuck"-like plastic surgery TV show. They did to me but the sad fact is that they are all true, as recently reported in the newsletter for the American Society of Plastic Surgeons.

The case of the family doctor occurred in Canada, and after causing deformities in two women by performing facial cosmetic surgery, he was found guilty of assault and jailed. The radiologist (a doctor who reads x-Rays) was performing liposuction procedures without any formal training in his office, an establishment generously named "Beverly Hills Liposculpture". He was investigated by the state medical board after allegedly causing disfigurement in multiple patients but by then had relocated to South America. The third case was that of a physician advertising cosmetic surgery and describing himself as "board certified", omitting his specialty and the fact that it was not the American Board of Plastic Surgery, an omission suggested by the publisher's sales rep.

The answer to the question in the title is: YES but you have to do your homework. Just because someone is willing and anxious do perform a cosmetic procedure on you does not mean that he or she is either trained or qualified. Unfortunately it often becomes a case of "Let the buyer beware." This is not the way it should be; it is merely the way it is.

If you want to have cosmetic surgery, go back to the basics. Why not have surgery in a certified surgery center or hospital and why not choose a plastic surgeon certified by the American Board of Plastic Surgery. It's not a guarantee for success or a suggestion that we are the only ones who can do these procedures, but plastic surgery is what we were expressly trained to do.

You can be sure that the unfortunate victims in these hard-to-believe stories wish that they had been more careful.

You would have to be living in a cave not to know that the economy is in bad shape. No one has been spared from this collective pain and in case we forget about it for a minute, someone on the news is there to remind us.

It is therefore only natural to want to get the most out of the money we do spend and "get a good deal", and why should cosmetic surgery be any different? There are certainly deals to be had as plastic surgeons struggle with decreasing patient volume, thus giving birth to the "plastic surgery discount." Some the these opportunities are a genuine recognition of the more limited resources of their patients, and others are born of desperation. So how does a prospective patient sort this out?

To help guide you through this potential minefield, the American Society of Plastic Surgeons has published a list of guidelines helpful when choosing a plastic surgeon. Here is a condensed summary of the highlights:

Is my surgeon certified by the American Board of Plastic Surgery?
Where and how will my procedure be done?
Who will be performing the procedure and who will take care of me after surgery?
What are the qualifications of the anesthesiologist and other medical personnel involved?
How many of the procedures have you (they) done?
What can I expect from the procedure?
Can I see before-and-after photos that illustrate the procedure?
What are the risks and complications?
What are my restrictions and the recovery time?
How long can I expect the results to last?
Are there alternative procedures I could consider?

Some questions to ask yourself:
Am I basing my decision on credentials of the medical professional and not the price?
Does this sound too good to be true (if so, it probably is)?
What do I expect from my procedure?
Are my expectations for results realistic?
Have all my questions been answered?

If you bring this list to your consultation and just listen, most plastic surgeons will answer most of these questions before you take out your list. If this is not the case, proceed with caution. Good luck.

It has been widely believed by both plastic surgeons and the non-medical community that breastfeeding is the main cause of later breast sagging, a condition known as breast ptosis. A recent study, which appeared in the Aesthetic Surgery Journal (published by the American Society For Aesthetic Plastic Surgery) , showed results that surprisingly challenged this long-standing belief. The study evaluated 93 women who came to plastic surgeons requesting the procedure of Breast Lift to correct breast sagging (breast ptosis). The results showed that the main factors that contributed to post-pregnancy sagging were higher age at pregnancy, overweight patients, larger cup size before pregnancy, the number of pregnancies, and smoking. The biggest surprise was that breastfeeding alone was not a factor. The good news is that women who are contemplating breastfeeding do not have to worry about the effects of sagging and can be more open to this option. There will continue to be women who do develop post-pregnancy breast sagging, but it is not just because of breastfeeding and the surgical procedures of breast lift (mastopexy), breast augmentation, and the combined procedure of breast lift/augmentation remain safe and effective options to correct the problem of breast sagging or breast ptosis.

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.

#1 Wrinkles are mostly caused by aging.

False. While aging is a factor in the formation of wrinkles, it is the least important one up until about the age of 60. In younger patients, the main causes of wrinkles and other signs of aging are smoking, excess sun exposure and excess muscle activity around the eyes and forehead. Prevention, a prescription-based skin care regimen and selective use of Botox are all effective tools to delay this process.

#2 A sunscreen with a high SPF gives complete protection.

False. Sunscreens protect only against UVB (Ultraviolet B) rays but do not block UVA (Ultraviolet A) rays. Also, most sunscreens block less than 90% of the UVB light so limiting excessive sun exposure through avoidance or protective clothing is still beneficial.

#3 Over-the-counter skin care products are as effective as prescription-based products.

False. Over-the-counter skin care products sold at hair salons and high-end department stores contain most of the same ingredients but at a much lower strength. One example is hydroquinone, a bleaching agent used for sun and age spots. The concentration of hydroquinne in over-the-counter products is 2% but the concentration in our private label Lightener is 4%. The same is true for glycolic acids and alpha-hydroxy acids.

#4 Acne treatment can accelerate aging.

True. Cleansing agents that contain benzoyl peroxide or hydrogen peroxide can produce free radicals, which break down collagen and speed up aging. Sun exposure also increases the presence of free radicals and so an anti-oxident, such as Vitamin -C, should be part of a balanced skin care treatment regimen.

#5 Skin damage and aging cannot be reversed.

False. The typical signs of aging skin are a rough texture, enlarged pores, brown spots and wrinkles. A new laser technology, known as fractionated treatment (Fraxel is one trade name), can stimulate the deeper layers of the skin to remove the pigment in brown spots and create new collagen to tighten pores and fill out fine wrinkles. It also stimulates the outer layer of skin to shed so it is replaced with a new and fresh layer of cells.

Although it has been over two months since the tragic death of Donde West, mother of hip-hop star Kanye West, it remains fresh in the minds of the public and has raised many questions about the safety of plastic surgery. My own read on the media coverage thus far is that there has been as much rumor as fact, and I would like to set the story straight as best I can.

The facts we know are that Donde West underwent the procedures of breast reduction and abdominoplasty, also known as a tummy tuck, possibly with liposuction on a Friday by Dr. Jan Adams, a plastic surgeon. The following evening, a little over 24 hours after her surgery, she was at home and found unresponsive. Paramedics were called, she was brought to a nearby hospital and she died later that night. An autopsy was performed but the results were inclusive.

We also know that Dr. Jan Adams was a high profile Beverly Hills plastic surgeon who has appeared on Oprah and hosted a show on the Discovery Channel. According to the American Society of Plastic Surgeons, he is not listed as a board certified plastic surgeon. It has also been reported that he was being investigated by the California Medical Board for multiple DUI convictions.

What we don't know is even more important. We don't know if Ms. West had a general medical evaluation prior to surgery by a doctor specializing in Internal Medicine, a routine practice for a 58 year old woman, although reports have surface that this did not occur. We don't know if the surgery was performed in a hospital, a licensed outpatient surgery, or the the surgeon's office operating room. We also don't know whether Ms. West had her surgery as an outpatient or if she was kept overnight for observation, and if so, where this post-operative observation occurred. The issue of post-operative observation is especially important because patients who undergo this combination of procedures are at some risk for post-operative bleeding and dehydration, which is easily treated but if left untreated could lead to cardiac arrest.

This tragedy is a cautionary tale and although all of the facts are not yet available, there is a great deal to be learned from it. First, being a celebrity plastic surgeon has no correlation to either one's skills or credentials. One could easily be a good celebrity plastic surgeon or a bad celebrity plastic surgeon. It has only to do with how well someone plays to the camera.

Board certification does not guarentee that someone is a good plastic surgeon either, but it does provide an independent and fair assessment of a surgeon's knowledge and competence. Why, one might ask, would anyone choose a plastic surgeon who wasn't board certified? Statistics from the American Society of Plastic Surgeons state that there are over 6,000 board certified plastic surgeons in the United States. The problem isn't supply and demand; it's the education of the public about the importance of board certification.

Perhaps the most important point is that while plastic surgery is extremely safe, it is not completely risk-free. There is not enough information to know if the loss of Ms. West could have been prevented. However, a thorough pre-operative medical evaluation by an internal medicine or family practice doctor, and having both the surgery and at least 24 hours of post-operative observation completed in either a hospital or licensed, accredited surgery center, are all steps that normally would have been taken in this case. If all of these precautions are taken in similar situations, then patients and their families can have the peace of mind of knowing that they have taken all of the necessary steps to ensure that their surgery will be as safe as possible.