DC Medical Malpractice & Patient Safety Blog

“Everyone’s a critic,” the saying goes. Applied to the practice of medicine, that sentiment might become “Everyone’s a cosmetic surgeon.”

And unless someone is board-certified in plastic/cosmetic surgery, that’s a far more threatening reality than the mere annoyance of opinionated people who can’t refrain from spouting off.

As reported in USA Today, only 21 states require that offices where doctors perform cosmetic surgery be accredited or licensed. Such practices must have certain life-saving emergency equipment and drugs, must adhere to strict safety procedures including record-keeping, anesthesia and cleanliness and must be subject to inspection.

The problem is known as “practice drift” — physicians who work outside of the areas in which they're trained and board-certified. As quoted in USA Today, "This is on the radar of many state boards," says Humayun Chaudhry, a physician and CEO of the Federation of State Medical Boards (FSMB). "What doctors should or shouldn't do when they change their area of focus is a concern for everyone."

As insurance payments to practitioners decline, many seek other avenues of income. Although insurance companies and hospitals generally prohibit doctors from practicing outside of their specialties, office surgery facilities are unregulated in more than half of states. And some clinics that do employ board-certified plastic surgeons have been accused of aggressively marketing less expensive alternatives to traditional plastic surgery, and minimizing their risks. We wrote about one such procedure, liposuction, that had tragic results for a client of our firm.

The spokeswoman for the North Carolina medical board told USA Today, "With cosmetic surgery, procedures are almost always done in the office, often without necessary and appropriate arrangements for emergencies. Doctors who drift typically do not have hospital privileges to do the procedures they are doing in the office [so] if complications do arise, the doctor often cannot even accompany the patient to the hospital."

The medical boards of individual states can discipline doctors for “unprofessional conduct” who practice medicine outside of their training and qualifications, or who put patients at risk because their facilities are insufficient. But most patient advocates say what’s really required to solve the problem are laws that codify what’s acceptable and what’s not. They say you can’t leave it open to interpretation.

Opponents say laws restricting practice drift could stifle doctors' abilities to innovate and impose unfair costs.

But when it comes to patient disfigurement or death, what cost is too high? As Dr. Sidney Wolfe, director of Public Citizens’ Health Research Group, points out, if a state doesn't have formal guidance or a law covering office-based surgery, "more people are going to get injured. States should want to expand their existing authority."

If you are interested in having, or are planning to have, cosmetic surgery, you should:

• Find out if your doctor is board certified in plastic surgery.


• Find out if your doctor is licensed and has any disciplinary actions on file.


• Locate accredited surgery facilities for your procedure.

The FSMB and/or your state’s medical board are resources that can answer your questions. Others include the American Association for Accreditation of Ambulatory Surgical Facilities, Inc. and the Accreditation Association for Ambulatory Health Care.

You can find more about cosmetic surgery malpractice, especially about the dangers of anesthesia in a non-hospital operating room, on our firm's website.

Here’s another chapter in our ongoing (never-ending?) story of media complicity in spreading fake health “news.”

As noted on HealthNewsReview, a website that examines, exposes and debunks junk health news, last month MSNBC.com committed an act of disease-mongering in a story headlined “Plastic surgeon wants to fix your ‘runner’s face.'"

Like every human we've met, runners have faces, but there’s no such thing as a disorder whose symptoms are purely aesthetic and ascribed solely to people who run. Tellingly, the term was coined by … a cosmetic surgeon who is marketing a “treatment” for what isn’t a medical problem.

But when you’re selling something, especially something you made up, you have to use florid language that draws attention and stimulates response. But do the news media have to spread the colorful message in mindless repetition completely devoid of critical thinking?

Instead of calling out “runner’s face” for the bogus condition it is, MSNBC promoted the cosmetic surgeon’s treatment for the condition he invented. As HealthNewsReview commented, “This is what is called ‘advertising’ – not ‘journalism.’”

The story offered no information on the potential harm of the surgeon’s treatment, nor any sense of what it costs. The story offered no scientific data to underpin the story because there isn’t any. But it did pretend to be authoritative:

“Runner's face generally occurs in both men and women ages 40+ who exercise to improve their body, and in doing so end up with a skeletal and bony face,” pronounced MSNBC.com. “When exercising, an athlete burns off fat beneath the layers of his/her skin. The marked loss of fatty tissue results in a loss of volume which leads to a prominent appearance of the bones, accelerated development of skin laxity and deepening of wrinkles. Though you may look like a 20-year-old from the neck down--your face will easily give away your age.”

The “treatment” for the non-disorder effects a purely cosmetic result -- inject a combination of Botox-Restylane to smooth wrinkles and plump up the face.

If this is a health-care intervention, if this is a news story, then Kim Kardashian is a marriage counselor. With an advanced degree.

Article first published as The New "Disease" of Runner's Face on Technorati.

A pioneering new study of the popular liposuction surgery finds that the fat which a surgeon sucks out from one part of the body gets added back in elsewhere by Mother Nature.

The study published in the journal Obesity found that within a year, all the fat suctioned out in a liposuction was regained by the body -- not in the location of the liposuction but in other places such as the upper abdomen and shoulders.

Obesity researchers say that the body "defends" its fat, carefully regulating the total amount of fat in the body. So fat removed by surgery in this respect is no different from fat lost by dieting -- the body's natural mechanism tends toward putting that fact back on.

No one quite knows why liposuction fat doesn't come back in the same place, but researchers told the New York Times it may be due to the way that liposuction disrupts the fishnet structure under the skin where fat cells reside.

Since liposuction has been around since the 1970s, why hasn't a carefully controlled study like this been done before? It has a lot to do with surgeons who rely on anecdote to prove that their methods work, rather than careful statistical studies.

A new style of cosmetic liposuction leaves patients fully awake with only local injections of lidocaine to control their pain at the site where the doctor is suctioning their body fat. It's a bad idea all around -- dangerous, painful, and a potential tragedy to boot.

The "Awake" treatment is touted as a way for patients to experience their liposuction fully awake. But why would anyone want to? It's not better for patients. It only allows the operating doctor to skip the extra charge of having an anesthesiologist or nurse anesthetist present to keep the patient sedated safely.

Lidocaine, the local anesthetic drug typically used in so-called "tumescent liposuction," is no cakewalk drug. Too much injected into a patient's system can travel to the heart and numb the nerve fibers that transmit the electrical impulses that make the heart fire -- causing a rhythm disturbance or complete cardiac arrest.

A client of mine went into cardiac arrest and suffered severe brain damage before her heart could be restarted, in a liposuction procedure a few years ago in Montgomery County, Maryland. Her heart stopped for this very reason: too much lidocaine injected too quickly into her body fat. We brought a successful malpractice lawsuit for her against the plastic surgeon, but nothing could restore her health.

Lesson for patients: Anyone undergoing any type of surgery whatsoever should insist on at least the presence of a certified nurse anesthetist, and a doctor specializing in anesthesiology should be present too in the building to provide backup for any emergencies.

A chapter in my book, "The Life You Save," details this issue and other points about how to get the safest surgery.

Here is a news article alerting consumers about the dangers of the "Awake" technique.

LipoDissolve is the brand name for an injectable drug that is supposed to melt fat. The patient gets a series of injections that supposedly dissolve the bonds between fat cells, and the body then flushes the fat away. Sounds great, doesn't it?

Patients who've had these injections have told the Food and Drug Administration that they've developed painful knots under their skin, scarring, deformities and other bad outcomes. What's worse, the drugs used -- chemicals caled phosphatidylcholine (PC) and deoxycholate (DC) -- have never been proven to be effective for these promoted purposes.

The FDA has tried to crack down on these treatments. Last spring, it sent warning letters to various "medspas" -- usually run by well credentialed dermatologists or plastic surgeons -- telling them that they were making false and misleading statements on their websites. For example, here's an excerpt of one letter sent to a dermatologist in the tony Washington suburb of Chevy Chase, Maryland:

Although intravenous phosphatidylcholine has been approved in some countries for the treatment of a variety of conditions, it has not been approved in the U.S. Currently there is no FDA approved injectable PC or DC, and therefore, your claim that PC and DC have been FDA approved individually for medical conditions is false or misleading. In addition, FDA is unaware of evidence to support the safety claims for your Lipodissolve products.

As explained above, the claims made for your Lipodissolve products are false or misleading in that they are not supported by substantial evidence or substantial clinical experience.

Read the full letter here.

Despite the FDA's efforts, LipoDissolve is still widely available. Lots of patients assume that someone in a white coat with an MD behind their name wouldn't offer to inject something into their body unless it was absolutely safe and legal. And the idea that you can lose weight effortlessly, and look better too, makes it all the more irresistable.

A good rule for patients to follow applies in other walks of life too: If it sounds too good to be true, it probably is.