Guidelines for Safe Plastic Surgery--Reduce Risk with Research and Smart Selection

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    Mar 27, 2013
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    1368 Guidelines for Safe Plastic Surgery--Reduce Risk with Research and Smart Selection Photo by Dr. Darshan  Shah Md Facs

In the last year, a couple of tragic incidents involving patients undergoing cosmetic surgery have caught the attention of news sources. While these incidents are incredibly rare, especially given that over 11 million cosmetic procedures were performed last year, they have been broadcasted wide-scale by media outlets, thereby creating concern and confusion in the minds of those considering cosmetic surgery.

As a plastic surgeon, mentor, and patient-safety advocate, I believe it is our job to help the public understand what is behind these sad and senseless tragedies and how they can protect themselves against complications, to nearly ensure a safe surgical experience.

Under-Qualified Surgeons

Last November, news broke of the untimely death of Dr. Donda West, mother of musician Kanye West. After undergoing a breast reduction, tummy tuck, and liposuction performed by a COSMETIC SURGEON (not a plastic surgeon), West passed away the following day from what the LA County Coroner has called coronary artery disease and multiple post-operative factors due to or as a consequence of liposuction and mammoplasty (sic). This death immediately sent potential patients running scared, as they asked themselves questions regarding the safety of plastic procedures: Is surgery really that dangerous? If a celebrity surgeon can contribute to a death, who can be trusted?

To begin with, the doctor was not board eligible or board certified in plastic surgery, and even worse, had been sued numerous times for medical malpractice; furthermore, at the time of the incident, he was facing allegations of sexual battery. Finally, given West's age (58) and rumored history of heart disease, the doctor should have, quite possibly, never performed the surgery in the first place. It is an industry-accepted safety precaution to require patients over age 50, or those who have any health issues whatsoever, to receive approval from their primary care physician before undergoing surgery.

Underprepared Facilities

A second tragedy highlights the importance of not only thoroughly researching the surgeon, but of assessing the qualifications of the facility itself in providing emergency care.

In March of 2008, 18-year-old high school student Stephanie Kuleba passed away during surgery at an outpatient center in Boca Raton, Florida while attempting to correct asymmetrical breasts and an inverted areola. Nearly two hours into the procedure, she developed symptoms of the rare malignant hyperthermia (MH) and was rushed to nearby Delray Medical Center, where she died tragically 24 hours later.

Again, what makes this incident even more distressing is the avoidable nature of the outcome: MH is an extremely uncommon, inherited disorder in which certain agents found in anesthesia trigger a catastrophically elevated body temperature that can reach up to 110 degrees Fahrenheit. And while most surgeons have never encountered a case, if it is triggered, and the proper protocol is not followed, MH can result in rapid death.

However, the key word here is can. When cosmetic surgeries are performed in an outpatient setting properly certified in emergency procedures, the surgeon and staff are specifically trained to treat complications like MH for which there is a known antidote and the facility itself stocked with the proper dosage of lifesaving drugs. Had the center where Kuleba was located been certified by an ambulatory-accreditation agency, such as the Accreditation Association for Ambulatory Health Care (AAAHC), this tragedy would have almost certainly been averted.

Guidelines for Safe Surgery

While researching a surgeon's training and the certification of the surgical center are the cornerstones of keeping yourself safe, I share with potential patients the following comprehensive guidelines for undergoing cosmetic surgery safely and stress free:

1. Visit websites like the American Board of Plastic Surgery ( or American College of Surgeons ( to see where a surgeon stands in terms of qualifications. Make sure you choose a well trained PLASTIC SURGEON, someone who has had general surgery or OMF/ENT training, then a formal 2 or 3 year plastic surgery training program OR a full 6-7 year plastic surgery training program. Many cosmetic surgeons take weekend courses and are not board certified or eligible plastic surgeons. In fact, many cosmetic surgeons don't even have the background or training in surgery that makes a safe plastic surgeon. So research, ask questions, and be careful.

2. Meet the (wo)man!
While some may argue that you don't need to click on a personal level to have a safe surgical experience, feeling comfortable with your doctor is actually an important consideration: If you feel at ease, you are more likely to address your fears and ask the questions that will paint the fullest picture of the doctor's competencies. Furthermore, there are certain red flags to look for such as a doctor who seems to be persuading you to have a surgery or who actively pushes additional procedures. When meeting a potential surgeon, the vibe you should be getting is one of caution, no matter what the procedure. Ask questions like how many of this procedure have you done? Have you had complications? How many?

3. Ask about AAAHC or other ambulatory surgery center accreditation.
As discussed above, ensuring your safety is not just about the surgeon. Make sure to ask about a center's emergency (or ambulatory ) accreditation; either the AAAHC or the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) are the ones to look for, as both mean that the facility has met stringent regulations for providing emergency care, and it's surgeons and support staff have undergone intensive education and practice drills to ensure patients are protected should a complication arise. Be extremely wary about doing your procedure in a simple office setting environment. Without AAAHC, AAAASF or DHS accreditation and a certified anesthesia provider, you should be very hesitant to have a procedure performed in this setting.

4. A medical exam is a must.
Any qualified surgeon will require a patient to undergo a full medical evaluation prior to surgery if you have any health issues or are over the age of 50, and will review the results personally. If your doctor discredits the need for a full workup or simply takes your word that you are in good health, you need to find another doctor. And disappointing as it may be, if the results of your exam indicate you are not a good candidate for cosmetic surgery, heed the warning and don't go doctor shopping until you find a surgeon who'll agree to perform the procedure. Ignoring this warning is one of the most common causes of disaster.

5. Follow the doctor's orders.
There are good reasons doctors give instructions prior to surgery; ignore them and you may be putting your life in peril. Whether it's quitting smoking or avoiding alcohol or aspirin, when it comes to pre-operative orders, caution is king.

6. Be honest with your surgeon.
This should go without saying, but it is extremely risky to withhold information about your medical history in an effort to get your doctor to approve a surgery. Even if you think it's irrelevant, be sure to disclose all medical conditions (past or present), prior surgeries, and medications or drug use your doctor is bound by the laws of confidentiality, so disclose everything to avoid danger.

7. Be honest with yourself.
While this is not so much a matter of safety as it is psychological health, the best way to assure a positive outcome is to be honest with yourself (and your doctor) regarding your expectations. Cosmetic surgery is not to be taken lightly; make sure you identify the reasons you desire a procedure, assess what you feel will change as a result, and verify that your goals regarding the surgery are realistic. For example, liposuction or breast enhancement may boost your confidence at the beach, but they will not address underlying depression or solve interpersonal issues.

So what we tell patients is really three things: First of all, cosmetic surgery is not something that should be entered into haphazardly; it can provide enormous benefits for the right candidate, but requires serious consideration. Secondly, the best way to protect yourself is to do your own research prior to even meeting a potential surgeon. And finally, if you have followed the first two pointers, you can relax; plastic surgery itself actually carries minimal risk when you put yourself in the hands of a qualified, certified, plastic surgery specialist - someone who has trained and devoted their career to the field of plastic and reconstructive surgery.

Author's Profile

Dr. Darshan Shah, MD, FACS, (Beautologie Cosmetic Surgery & Laser Center, Bakersfield, CA world-renowned plastic surgeon, is an experienced professional dedicated to helping patients to look and feel beautiful. Learn more at Visit his blog at

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