The Real Deal with Cosmetic Surgery

2007-11-14
By Rani Whitfield, M.D.

In the age of Nip Tuck and the reality show Extreme Make Over, many people have become quite comfortable with pursuing cosmetic surgical procedures.  Cosmetic procedures have increased almost six-fold since 1997 when at that time, only 2 million procedures were done.  The recent and untimely death of Dr. Donda West, former English professor at Chicago State University and mother of hip-hop superstar Kayne West however, has brought much needed attention to this practice of medicine.  Dr. West died this Saturday after undergoing two cosmetic procedures by a non-board certified plastic surgeon in California.  So what’s wrong with this picture?

Plastic surgery is done for three main purposes:  cosmetic enhancement, where aesthetics are more important than functionality, to restore function, and to improve physical appearance.  Plastic surgeons are the medical specialist trained to use surgical and non-surgical techniques to change the appearance of a person’s body.  The American Society of Plastic Surgeons (ASPS), founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery.  All members of the ASPS are board-certified, meaning that they have been well trained and tested. The ASPS reported that in 2006 nearly 11 million cosmetic plastic surgeries were performed in the United States.  Botox injections, a procedure where botulinum toxin is used to reduce or eliminate frown lines and wrinkles in the face, was the most common non-surgical procedure done in 2006, while liposuction, the removal of fat deposits using a vacuum, was the most common surgical procedure. 

Most cosmetic procedures, including mammaplasty (breast reduction or breast enhancement) and liposuction, both performed the same day on Dr. West, are safe and should be performed by a plastic surgeon.   All of these procedures have associated risks and thorough discussion and consultation should be done before they are performed.  Liposuction, which can be done on the cheeks, hips, buttocks, and the stomach, is generally associated with bruising, swelling, and pain, but one of the most feared complications is the development of an embolus:  a moving blood clot or collection of fat that can lodge in the lungs or brain and cause death.  Liposuction of large areas of the body can take up to 3 hours and requires general anesthesia, meaning the patient will be sedated for an extended period of time.  The longer a person is sedated, the more likely he or she is to have complications:  prolonged hospital stays, blood clots, infection, excessive bleeding and death.  Follow-up news stories indicate Dr. West’s surgery was an eight-hour procedure, after which she was sent home. Any surgical procedure that requires anesthesia for longer than 4 hours should be given strong consideration to hospital observation after the surgery for at least 24 hours.  The patient can then be sent home with instructions to call the nurse or physician for chest pain, shortness of breath, fever, nausea or vomiting which are possible signs of infection and/or an embolism.  Mammaplasty, a procedure that either reduces or enlarges the size of the breast, can take up to 2 hours and is also associated with pain, bruising, scar tissue formation, and infection.

The unfortunate death of Dr. West runs deep as I am also very close to my mother.  With details surrounding the event still undisclosed, it is hard to say exactly what caused her early demise.  Though cosmetic surgery has become more or less routine, potential complications are always possible. Not only is there risk involved, such procedures are also costly and, in most cases, are not covered by insurance.  Second opinions are encouraged, but some patients seek help outside of the country to get cheaper prices and will use physicians who are not board-certified increasing the chances of poor cosmetic outcomes and possibly death.  Before you consider cosmetic surgery, please consider these points:

-   Ask your primary care physician for a referral to a plastic surgeon.
-   Choose a surgeon that is board-certified by the American Board of Plastic Surgery
-   Ask how many procedures the physician does each year.
-   Inquire about lawsuits, disciplinary actions, and re-certification.
-   Make a list and ask lots of questions; if you are not comfortable, find another doctor.
-   Remember, this is an elective procedure and you do have time to change your mind.

The overall experience with cosmetic surgery can be a positive one, however, if in the hands of the wrong surgeon, it can be one you will regret forever.  Educate yourself about the procedure, the surgeon, and in most cases you will be fine.  For more information shoot me a question at drrani@h2doc.com or visit the web site www.plasticsurgery.org. 

Dr. Rani Whitfield (aka "Tha Hip Hop Doc" ) is a board certified Family Practice and Sports Medicine Physician who lives in Baton Rouge, LA.  He can be reached at DrRani@h2doc.com.