Yesterday Michael Jackson was finally buried, 2 months after his death. He is gone but will not soon be forgotten, and his name is forever linked to plastic surgery. This link began the first time he had surgery on his nose (rhinoplasty). After the first surgery, his nose was smaller and less ethnic, but whatever you thought about it, everyone generally agreed that it looked reasonable and normal. Unfortunately for Michael Jackson, like many who become obsessed with plastic surgery, it was not good enough and would never be good enough. Even more unfortunately, there was always a surgeon who could not say no to Michael Jackson, which is probably a not too uncommon scenario when dealing with the rich and powerful.
Several rhinoplasties later, his nose was irreversibly deformed and it was hard to look at it and not feel sadness for him. There was also damage to the general reputation of plastic surgery, as Michael Jackson became a capsule summary of all that can go wrong with cosmetic surgery. Michael Jackson unknowingly became the poster child of how patients don't want to turn out. What to learn is difficult to say, but at the very least we all need to be able to say no to ourselves and others, and both patients and their doctors need to know that sometimes less is more and enough is enough.
The second intersection of Michael Jackson and plastic surgery is his cause of death, recently classified as a homicide. It appears that his private physician was administering a powerful anesthetic, propafol, that is used as part of a general anesthesia in almost all surgical procedures. This drug is very commonly used in plastic surgery procedures that require general anesthesia, such as breast augmentation, tummy tuck and liposuction, and it would be easy to think that using propafol must be risky if it could kill Michael Jackson. The truth is that propafol is very safe and short-acting, but anyone receiving it must be closely monitored and have breathing assistance available in a medical environment, which did not appear to be the case. It was never meant to be used as a sleep inducing medication as it apparently was for Michael Jackson. This appears to be yet another case of a patient and a physician who were not willing, or able, to say no.