(BlackDoctor.org) — Whenever you consult a physician, you have the right to expect responsible, ethical care. Yet some MDs are playing fast and loose with patient safety, taking shortcuts and pushing procedures and treatments that may endanger lives.
Which Surgeries Are Blacks Requesting?
Typically there are more requests from African-American women for thinner noses than any other procedure; in addition, there’s a desire for thinner stomachs and thighs, so liposuction and tummy tucks are popular requests as well. A few want breast lifts or reductions, as many naturally have ample busts and want them to be tauter. In addition, there’s an influx of Black women doing more non-procedural processes, or non-injectables. Since wrinkles don’t tend to be an issue until much later in life, there is a rise in Black women getting Botox around ages 40 to 60.
Who’s Holding The Knife?
Under the right circumstances, plastic surgery should be relatively safe; the American Society of Plastic Surgeons (ASPS) reports that death occurs in only about one in 50,000 operative procedures. But the growing popularity of cosmetic nips and tucks has made the field a breeding ground for exploitation.
Not surprisingly, cash is a huge factor. Last year plastic surgeons performed more than 1.6 million cosmetic surgeries worth almost $6.6 billion, a 9% increase over the year before. Other docs—OB/GYNs, emergency physicians—are also expanding into cosmetic surgery. A study published last year found that nearly 40% of liposuction practitioners in southern California were not trained as plastic surgeons. It’s not surprising: An OB/GYN might earn $2,000 for a C-section, while plastic surgeons on average charge more than $5,000 for a tummy tuck—typically paid for in cash, without the hassle of insurance company paperwork.
“Physicians are pressed harder to make their livings, and are looking for ways to augment their income,” says James Zins, MD, chairman of the department of plastic surgery at Cleveland Clinic. “More and more, they’re turning to cosmetic surgery.”
Of course, the way to make money as a plastic surgeon is to do surgery. For some, that’s an opportunity to layer on multiple procedures, try out an unproven new fads.
Untrained in the OR
“Anyone can call themselves a cosmetic surgeon, with very little training,” says Joseph Serletti, MD, chief of plastic surgery at the University of Pennsylvania. “It doesn’t mean they have the qualifications to perform surgery safely.” Felmont Eaves, MD, a plastic surgeon in Charlotte, North Carolina and immediate past president of the American Society for Aesthetic Plastic Surgery (ASAPS), says, “Doctors who are not board-certified surgeons are one of the biggest dangers in this field.”
A board-certified plastic surgeon must undergo at least five years of specialized surgical training post–medical school. Doctors must then pass both oral and written exams and fulfill ongoing continuing-education requirements. “It should be the minimum of what you want from your surgeon,” Dr. Zins says.
Yet none of that training is required by law. In most states, anyone with a medical license can perform cosmetic surgery. The results can be catastrophic. Dr. Serletti says he and colleagues have seen patients come in with improperly placed breast implants and damaged facial muscles after going to poorly trained doctors. And yes, people do die: A recent German study of liposuction deaths concluded that lack of surgical experience was a major contributing factor.
Money over Medicine
It’s true that even board-certified surgeons can pose a risk to patients. Multiple investigations have revealed that both unqualified doctors and board-certified plastic surgeons can be dangerous.
Sometimes, Dr. Zins says, refusing to perform surgery is the best medicine—if a patient is going through a divorce, for instance, or is dealing with depression. Other patients are simply physically unfit for surgery. Ideal liposuction candidates, for example, are relatively healthy, close to their ideal weight, with specific areas that need shaping.
But some doctors will operate on anyone with a checkbook and will never say no, and you should avoid a doctor who tries to talk you into more procedures than you came in for. Generally the longer the surgery and the more areas being operated on, the greater the risk.
“We see new devices and procedures all the time that have marginal
benefits, or may even be harmful,” Dr. Eaves says, noting the buzz about stem-cell breast augmentation, a popular new technique, in which your own fat stem cells are injected into your breasts. Despite all the hype, it actually has little clinical data showing it’s either safe or effective. It can take years to prove that a plastic surgery innovation works—or doesn’t work—as advertised. “But many doctors feel they have to use these new techniques in order to get more business,” Dr. Eaves says. “That’s a public safety problem.”
A Safer Cut
You don’t have to shun the plastic surgeon’s office. But you do have to be extremely careful about who is operating on you. To guarantee at least a base of training, oversight, and experience, seek out a board- certified surgeon. Look for a doctor who is certified in plastic surgery; in some cases one certified in otolaryngology (for cosmetic surgery on the head and neck) or ophthalmology (for cosmetic procedures in and around the eyes) may be appropriate. (You can verify board certification at certificationmatters.org). Check your state medical board’s website to uncover whether the doctor has ever been reprimanded or had his license suspended for something related to his surgical practice.
Once you’ve established these basics, you’re ready to dig deeper:
• First, you’ll want to know that someone has worked with your skin, meaning Black skin. It’s the same as hair; make sure they can work with your texture. Also, Google and research and do your homework. If the doctor has worked on patients that look like you, that is a sign this person is comfortable working with your skin type or body shape, and that has significant advantages post-surgery especially for Black women who are more prone to deal with keloids, dark spots, dark circles and scarring.
• Don’t be tempted by a discount or payment plan—you should choose your doctor based on medical expertise, not price. The surgeon should lay out the risks and possible complications, and should be able to offer satisfied patients for referrals, not just show you before-and-after pictures. Considering a new procedure? Ask if there are clinical data on its safety and effectiveness.
• Dr. Eaves points out that your surgeon should have a variety of techniques from which to choose to get your desired results—you don’t want someone who only does one procedure. He or she should outline the options and explain clearly why one might be better for you. Any good surgeon will also let you take your time making a decision, and even encourage you to get a second opinion. “You don’t want a doctor who talks to you for 10 minutes and then passes you to someone else in their office to seal the deal,” says Dr. Yuan.
The bottom line is to make sure you understand exactly how the surgeon learned his craft, and what he is going to do to you. And if you’re not satisfied with what you learn, just walk away.