Dr. Grenley Discusses Safety, Anesthesia and Plastic Surgery
A recent womenâ??s health article â??Nipped, tucked and wide awake?” on msnbc.com, is getting lots of attention from those in the cosmetic medical field. The article investigates low cost plastic surgery under local anesthesia, and presents some keen insight about this alarming cosmetic trend.Seattle plastic surgeon Dr. Robert Grenley responds to the article here with some advice about how patients should 1) approach the choices in anesthesia and 2) assess the physicians in their community who offer cosmetic procedures.
The most critical issue raised by the article is whether the physician is properly trained to perform these surgeries.â? Most patients are not aware that any licensed M.D. in any field can legally call themselves plastic surgeons. They may only have performed a one-year internship, and this does not even have to be in a surgical field. As a result of diminishing reimbursements by insurance companies for procedures in many specialties, more and more physicians are turning to cosmetic surgery, taking weekend courses, and experimenting on unsuspecting patients. Their office tells prospective patients that the doctor is board certified, not revealing that their board certification may be in Family Practice, Gynecology, or Radiology. Some have joined associations that sound official, but which require the doctor only to pay dues and have no requirements regarding legitimate training and experience.
Most of these practitioners, or self-designated “cosmetic surgeons,” perform their surgeries in their offices; they are unable to obtain medical privileges to operate in a hospital since they do not have legitimate residency training in plastic surgery.
Although most properly board-certified plastic surgeons also perform surgeries in their office-based surgery centers (as the costs to patients are significantly lower than for surgeries performed at the hospital) plastic surgeons have also been granted surgical privileges at their local hospitals. Therefore, their training and credentials in their field have been reviewed and approved. Legitimate plastic surgeons are required by their national society to have their office based surgery centers properly accredited by state and local agencies. This is a measure of protection for patients, for it guarantees that high standards of infection control, sterilization procedures, training of nursing personnel, etc. are being followed.
Many of the self-designated “cosmetic surgeons” perform their procedures under local anesthesia because they do not have operating facilities that are equipped for administering general anesthesia, they do not want to go to the expense of properly outfitting an operating room for safely providing general anesthesia, and most physician anesthesiologists and even nurse anesthetists are unwilling to work in under-equipped and under-staffed operating rooms where patient safety may be compromised. Therefore, with local anesthesia as their only available option, they advertise that these procedures are performed under local anesthesia as if this is an advantage.
Although small procedures may be safely and easily performed under local anesthesia, operations involving extensive areas of the body (for example, extensive liposuction) or deeper structures (for example, subpectoral breast augmentation) may require such a large volume of local anesthetic that the toxic dose may be life threatening. If sedation is given to help the patient tolerate the painful procedure, there is the risk that, without proper monitoring, breathing may be suppressed and serious complications or death could result. And in some cases, as described in this article, the patient may just be expected to suffer through a long and painful procedure.
Most legitimate board-certified plastic surgeons perform their cosmetic surgeries in certified ambulatory surgery centers (office based or freestanding), with anesthesia (whether general or IV sedation) performed by physician anesthesiologists or nurse anesthetists.
In the Seattle area, unfortunately, we also have cases where Ear, Nose, and Throat surgeons are inserting breast implants and psychiatrists are performing liposuction in non-accredited office operating rooms under local anesthesia. And since doctors and medical societies are helpless to stop these practices as long as they are being performed in private offices, this is a case where the buyer themselves must surely beware.