Treading a thin line with cosmetic surgery

MONEY talks.

Even when it shouldn’t, even when it’s the last thing you should be thinking of — like when you’re considering a tummy tuck or breast augmentation or getting the hollows under your eyes filled or the lines around your mouth erased.

According to expert observers of the cosmetic surgery industry here, Irish patients are being seduced into private clinics by offers of free initial consultations and two-for-the-price-of-one deals.

“The recession has caused a shift in the way people are shopping for cosmetic procedures. In the same way people are looking around for cheaper groceries and insurance, they’re looking for cheap cosmetic work. It has led to a lot of poorly qualified practitioners setting up shop and portraying themselves as fully recognised clinics operating with high standards, when this isn’t true,” says Dr Kambiz Golchin, consultant ENT and facial plastic surgeon, who practises at Beacon Face and Dermatology.

In a country where there’s no law preventing any doctor from doing whatever cosmetic procedure he wishes, even if he’s not trained in it, we really should be doing our homework. When it comes to asking someone to do something as potentially life-impacting as adjust a facial feature or amend our appearance, we really should be thinking beyond our pocket.

In an unregulated environment, Irish cosmetic patients are at risk, says Dr Patricia Eadie, president of the Irish Association of Plastic Surgeons (IAPS).

“They’re at risk of inappropriate surgical procedures being chosen for them and of surgery being done in inappropriate facilities, where there’s insufficient back-up in the unfortunate event of a problem. They’re at risk of poor follow-up — some doctors fly in and out of the country and aren’t available if there’s a post-operative problem.”

The Irish cosmetic surgery market is down from its estimated boom-time value of almost €50m (this in early 2009) but it’s still flourishing, according to an IAPS spokesperson.

Dr Golchin agrees: “It’s still growing in Ireland on a yearly basis. Client profile has changed. During the Celtic Tiger, a lot of people had it done just for the sake of it. Nowadays, those who get it done are quite serious about it. In my practice, I see celebrities and ‘ordinary’ people, who save to get work done.”

In Golchin’s experience, the most popular non-surgical cosmetic treatment is Botox (average cost €250-€350 for one facial area). In terms of most popular surgical procedure, he sees a gender bias. Men like rhinoplasty (nose reshaping), costing on average €5,500-€7,500. A lot of women opt for the ‘angel lift’, a rejuvenation treatment combining laser, platelet injection and fat grafting — prices from €3,500.

IAPS secretary Peter Meagher recently wrote about how in some private cosmetic clinics operating across Ireland, a patient’s first consultation “is with a nurse who will encourage cosmetic surgery prior to extolling the virtues of the surgeons at the clinic and arranging an appointment with one of them. There’s no guarantee that the surgeon with whom the patient has consulted will actually perform the surgery… sometimes the patient only meets their surgeon for the first time on the morning of surgery”.

Just how dangerous this is was highlighted by a British Association of Aesthetic Plastic Surgeons survey earlier this year. The internal poll of BAAPS members found one in five potential clients are ‘unsuitable’ for cosmetic surgery and revealed how “dangerously misinformed people undergoing cosmetic surgery can be when their consultations are held with salespeople, customer advisors or even other medical professionals rather than with the surgeon who’s performing the operation”.

More than three in five BAAPS members turn away between 10%-30% of their patients. Well over one-third turn away one in five. The top three common reasons for turning patients away are:

* Procedure unsuitable/unnecessary (e.g. too young for a facelift)

* Unrealistic expectations for surgery (e.g. wanting to look like a particular celebrity)

* Medical reasons (being obese, a smoker or having a heart condition).

BAAPS president Dr Rajiv Grover says surgeons are trained to spot such contraindications, but “salespeople — even nurses who may be working on commission — are neither equipped to properly identify nor subsequently deal with [them]”. The association has asked the Government in England to regulate against consultations taking place with anyone other than the operating surgeon.

The Medical Protection Society (MPS), which provides indemnity cover to doctors in Ireland, confirms that between 2008 and 2012 over one-third of claims by Irish members — practising predominantly in plastic surgery or cosmetic medicine — related to breast procedures, with abdominal procedures the next most commonly reflected in the claims. Settlement costs ranged from €2,000 to €900,000.

“Our experience highlights the importance of identifying whether a patient’s expectations are realistic and ensuring they give valid consent to the intended surgery as essential steps prior to any cosmetic procedure,” says MPS medical risk manager Dr Chris Godeseth.

Cosmetic surgery can be positive but when things go wrong they can go very wrong, as Dun Laoghaire woman Kate Murray discovered after she went for breast augmentation surgery in 2008. Then aged in her early 20s, she developed severe infection in both breasts and, even after her surgeon, Dr Marco Loiacono, removed both implants, her pain returned and she became extremely ill. The surgeon was struck off the Medical Register here in 2011.

Just last month, the High Court ordered the winding up of Dublin-based Harley Medical Group (Ireland) Ltd, a cosmetic surgery clinic being sued by a number of women who claim the clinic fitted them with allegedly defective silicone breast implants. The women, who allege they received Poly Implant Prothese (PIP) implants through the company, took the action after they discovered that implants manufactured by French company PIP could leak toxic industrial-grade silicone into their bodies.

Meanwhile, Dr Golchin warns about another PIP-sized scandal coming down the line here. A European trainer for some companies that manufacture dermal fillers, he confirms he’s seeing an average of one patient a week with complications due to fillers carried out in clinics here. Dermal fillers are used to refresh appearance and to reduce crow’s feet and frown lines. Effect lasts six to 18 months but, when not done to standard, they can leave problems ranging from lumps, nodules and infection to injury to major facial blood vessels.

“Over the last 18 months, I’ve seen a lot of complications relating to fillers that have gone badly wrong. After PIP, dermal fillers will be the next big scandal of the cosmetic industry. To meet demands of providing cheaper treatments, practitioners are cutting corners — using poorly-made products that sometimes don’t even have the CE mark.”

But Golchin says CE endorsement — confirming the product is manufactured to a certain standard — falls short of what’s desirable. “The CE mark doesn’t tell if the product’s safe to use in the body. There are 190 dermal fillers available in Europe — less than five are safe to use.”

Last November, BAAPS said more than two-thirds of their surgeons saw patients with problems stemming from temporary fillers, while over one-quarter reported that in the previous year between one and three patients required surgery to correct damage caused by these fillers. Practically all BAAPS members believe fillers should be treated as medicine — as in the US — and not as a medical device requiring just a CE endorsement.

“It’s not just about who can wield a syringe but who will have the capabilities to deal with any complications,” said Dr Grover.

There’s no formal system in Ireland for dealing with botched cosmetic surgery, says Dr Eadie. “If a patient gets an unsatisfactory result, it’s up to them and their GP to get a referral to another practitioner to see if anything can be done. Patients with acute problems have ended up in the public health service because there wasn’t adequate post-operative follow-up.”

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