The trouble with plastic surgery, say the plastic surgeons, is that it looks easy.
"The danger," says Dr. John Little, director of the Division of Plastic and Reconstructive Surgery at Georgetown University Medical Center, "is that it is a trap for the untrained. It appears simple to anybody who's had some training with a scalpel. Nobody's going to do brain surgery without adequate training, or open heart surgery, but to the untrained surgeon, plastic surgery procedures appear simple."
Little, who is also the president of the D.C.-Metropolitan Area Society of Plastic and Reconstructive Surgeons, and his colleagues are increasingly concerned at the intensified use of advertising by specialists purporting to be qualified plastic surgeons and promising, directly or indirectly, to make Olivia Newton John or Michael Jackson clones of us all.
Americans are hooked on youth and good looks. And if it seems as though an eye-tuck or a nose job can make the magical difference, then that's what Americans will seek. In 1984, there were 1.75 million cosmetic operations done in the United States. About a year ago, one soap opera star -- Jeanne Cooper, who plays Kay Chancellor on CBS' "The Young and the Restless" -- even permitted her face-lift to be integrated into the soapy plot, including the operation itself.
And these operations are by no means limited to either the old or the rich. About half of the cosmetic procedures -- done principally to enhance looks -- were done on people with incomes less than $25,000 a year. Nose jobs (rhinoplasty) are most popular among younger people. Face-lifts (rhytidoplasty) and eyelids (blepharoplasty) among the older. Tummy-tucks and breast reduction or augmentation are other popular procedures.
This popularity, along with the 1979 Federal Trade Commission ruling making it legal for doctors to advertise, has wreaked special havoc in the world of cosmetic surgery. Although New York and California have been hardest hit, says Little, the phenomenon is spreading.
Dr. Jeffrey R. Fischman, assistant clinical professor of plastic surgery at the Mount Sinai School of Medicine in New York, says people are "being bombarded" by ads that are persuasive and seductive but give no information about the qualifications of the surgeons.
Fischman, who also serves as a volunteer arbitrator on a New York state board dealing with malpractice cases, saw one instance recently in which a doctor "had a beautiful credential" from "a society or board of cosmetic or aesthetic surgery. It turned out he founded it and was its only member."
In another case, says Fischman, "I met a fellow who's been in practice one year and told me he's doing $4 million worth of business in a year." The "fellow" was not certified by the American Board of Plastic Surgeons, but he did advertise.
But most of all, Fischman says, he is seeing more and more patients "who were operated on by unqualified people" who come to him to undo mistakes that a fully trained plastic surgeon would never have made in the first place.
Many of these mistakes involve "taking too much tissue -- out of a nose, for example. A fully trained surgeon always leaves a little extra. You can easily remove the extra, if needed, but you can't put it back when it's gone."
There is also a question of keeping tissue alive after it is reshaped. For example, in some poorly done breast reductions, he says, literally, "you have to make sure the nipple doesn't fall off."
"There's a change happening in medicine," says Fischman, "that is not for the public good."
The change is the increasing use of advertising by doctors who may not be able to attract patients in traditional ways. As Little puts it: "It is a competitive field, and those who choose to advertise may be well qualified, but my reaction to seeing an ad in a medical area is to wonder, 'Why does he need an ad? Is it because he is unable to get referrals from other doctors? Or from satisfied patients?' "
Fischman feels so strongly about it that he has contracted with a public relations firm to help spread the word about the problems of plastic surgery advertisements. "My alternative," he reasons, "would have been to put an ad in the paper to tell people not to go to people who put ads in the paper."
To help consumers find their ways through the maze of advertisements, misleading or downright phony credentials and vague promises, Fischman has assembled a checklist for the consumer interested in plastic surgery. Georgetown's Little agrees, in the main, with the list, which suggests:
* Check credentials. If the doctor is not "board certified," says Fischman, it is analagous to "taking a plane flown by someone with no pilot's license."
* Plastic surgeons should be certified by the American Board of Plastic Surgery. About 98 percent of these are members of the American Society of Facial Plastic and Reconstructive Surgery.
Another professional society, the American Academy of Facial Plastic and Reconstructive Surgery, has members certified in other specialites such as dermatology, otolaryngology (ear, nose and throat) or ophthalmology who are also trained to perform related plastic surgery, limited to the face and neck. Purist plastic surgeons tend to sniff at members of this society -- "that," says Fischman, "is a war that goes back many years" -- but concede that many of them are well qualified.
* Check with your family doctor. "This is worthwhile," says Fischman. "He'll know at least two people and should be able to give some sort of opinion as far as their strong and weak points are concerned. Little adds that it has been his experience that "family doctors, like loved ones, will tend to be discouraging about cosmetic surgery, taking the opportunity to reassure the patient "that we love you just the way you are."
* Ask friends and acquaintances who have had surgery themselves. "Most cosmetic referrals come from satisfied customers," says Fischman.
* Interview several surgeons before selecting one. "It's worth saying again and again," says Little. "You don't go out and buy a car on the basis of one advertisment and one hard-sell salesman."
Adds Fischman: "If someone tells you, 'Don't worry, you'll be perfect,' it's time to find another doctor. You need someone who will give you an honest appraisal of what surgery will or will not do for you. That's the difference between a salesman and a doctor."
Both Little and Fischman do their own operations in major medical teaching hospitals, and Fischman feels strongly that it is safer to be in the hospital because dangerous complications can arise during any surgical procedure.
Little, however, suggests that a relatively new association, with the tongue-twisting title of the American Association for the Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF), guarantees at least that a private plastic surgery suite has met "minimal guidelines for safety," including maintenance of proper sterility, staff members trained in cardiopulmonary resuscitation with proper equipment, among other things.
A problem with some practices in private suites, says Little, "is that the person who operates only in his own office falls out from under the review of their peers and there is no way to know even if deaths occur." The AAAAPSF was formed to correct that problem.
"Finally," says Little, "advertising often preys upon the weakest members. Ads are pitched to appeal to the very people who may have the least realistic hopes . . . people whose egos are threatened on all sides, whose lives are in turmoil. They are the ones most likely to embrace the ads, and that's too bad."