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Risky business: Pennsylvania has few laws governing cosmetic procedures

Tuesday, December 29, 1998

By Mackenzie Carpenter, Post-Gazette Staff Writer

Cosmetic surgery carries risks just like any other medical procedure. In Pennsylvania, as in most other states, any person with a medical degree can hang up a shingle advertising liposuction or other cosmetic procedures - even if the most training they have had was a three-day weekend seminar.

"There are dentists doing this stuff," says Dr. Bernard Cohen, a plastic surgeon affiliated with Allegheny General Hospital. "There are gynecologists. These people are doctors but have had no experience in surgery."

An increasing number of doctors are holding free seminars to lure in patients by demonstrating how they remove fat or sculpt a new face. Nationally, doctors are creating new "buzzwords" that attach offensive connotations to undesirable body shapes - terms such as "bat wing deformity" and "violin deformity" are used to describe flabby upper arms or heavy thighs, respectively.

While physicians locally said Pittsburgh has many well-trained plastic surgeons with years of experience, nationally, more and more doctors with no surgical background at all are opting to perform techniques such as liposuction, with disastrous results.

In a widely publicized study by the California Medical Board, it was estimated between 60 and 100 deaths occurred last year in the United States from liposuction, from complications out of 110,000 procedures.

By contrast, the board's doctors noted deaths from childbirth, once a leading killer of young women, range at about seven for every 100,000 births.

"This comparison illustrates how one procedure - a cosmetic procedure, not a lifesaving one - appears to have an unacceptable and, I think, certainly preventable, high mortality rate," Dr. Robert del Junco, the group's chairman told the San Francisco Examiner.

Kevin Shivers, a spokesman for the Pennsylvania Medical Board, says that while there are no state laws governing individual procedures, "there is an acceptable standard of practice that all doctors must meet. Competency is a critical issue," and if they fail to prove competency, then their license is revoked.

It's hard to know what cosmetic procedures ever reach that point. In Pennsylvania, as in most states, no records are kept on accidents or deaths involving cosmetic surgery.

And only four states, California, Nevada, Maryland and Georgia, require accreditation of office surgery units - where virtually all cosmetic procedures, including liposuction, are performed.

But there are signs of change.

Alarmed by the growing number of fatalities, California has recommended a moratorium on some types of "large volume" liposuction and New Jersey has adopted a lengthy list of office surgery regulations. Florida has gone farther. Acting after a string of deaths in recent years, the state's medical board is set to vote in the next few weeks on tougher rules on the procedure and other types of cosmetic surgery.

In turn, those regulations are expected to face a tough challenge from Florida's medical association, whose members are fiercely divided among themselves about who is best qualified to perform the procedure. Most plastic surgeons say they are, citing their certification by a board approved by the American Medical Association. What that means, besides a medical degree, is a surgical residency followed by a two- or three-year fellowship in plastic surgery, two more years of clinical experience and rigorous testing.

Other doctors say it's just a turf battle, and that board-certification is no sure-fire indicator of skill. Indeed, Cohen and Dr. Leo McCafferty, another Pittsburgh plastic surgeon, both noted that in several liposuction fatalities, the surgeon was certified by an AMA-approved board, one that requires extensive surgical training.

"In the short term, what people have to realize is that they have to check the credentials of their surgeon," says McCafferty. "They can't do it at the beauty salon, or rely on cousin Mary's friend of a friend. They have to ask questions. One thing to look for: does the surgeon have operating privileges at a hospital? Because if he does, chances are he has gone through a peer review process which is pretty strict."

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