Makeover Nation
Americans are opting for cosmetic surgery in record numbers. But do they know the risks?
Indeed, it matters not just who's doing the surgery, but where it's taking place. More than half of all operations in the United States are now performed outside of hospitals, either at free-standing surgerycenters or in doctors' offices, because the procedures are cheaper there, and physicians often profit. But nonhospital surgery is ill-regulated, with only 22 states providing oversight. A study in last September's Archives of Surgery found that death and injury is 10 times more likely in office surgery, compared with free-standing surgery centers. Julie Rubenzer, 38, stopped breathing during breast augmentation surgery performed by Sarasota, Fla., physician Kurt Dangl in his office last September. She went into cardiac arrest and later died. State records indicate that Dangl administered anesthesia himself and that he waited five minutes after she stopped breathing before starting chest compressions. The state has placed an emergency restriction on his license.
Injuries are more likely to happen in unaccredited facilities with no qualified anesthesia provider, according to Vila. A study in this month's Plastic and Reconstructive Surgery found that if an office facility is accredited, the risk of death is no greater than that in surgery centers or hospitals. People considering surgery should make sure that the facility is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or the Joint Commission on Accreditation of Healthcare Organizations. (See plasticsurgery.org, surgery.org, or yestheyrefake.net for advice.)
Jeff Harris, a 38-year-old lawyer from Dallas, had liposuction, eyelid surgery, and fat injections to smooth out his laugh lines last year. "It was alarmingly easy," he says. "It wasn't nearly as painful as I thought." Harris carefully chose a board-certified surgeon and paid for an overnight stay in the hospital because he felt it provided an extra margin of safety. "There are no blue-light specials in cosmetic surgery."
Anesthesia always poses some danger, no matter what the setting. Even the finest facilities can run into trouble. Manhattan Eye, Ear, and Throat Hospital is considered one of the best in the nation, yet the state found 10 safety violations related to the two deaths there. People with health problems such as diabetes or high blood pressure are more at risk, and even seemingly innocuous things like taking herbal supplements can cause unexpected complications. "The name of this game is vigilance," says Roger Litwiller, president of the American Society of Anesthesiologists. "If someone says he's going to have his office nurse do this, run. You only get one life."
Although this tally of perils may be more than someone eager to eliminate love handles wants to confront, the risks won't evaporate, as long as Americans'romance with surgical enhancement continues unabated. "Beauty shouldn't matter in the world, but it does," says Jeff Harris. Cosmetic surgery, he says, "is a metaphor for change."
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