October 17, 2007 - The Council of the College of Physician and Surgeons of Ontario approved a four-point plan to address concerns about doctors who perform cosmetic procedures who are not registered as specialists in Ontario.
These included:
1. To assess physicians performing high-risk cosmetic surgical procedures where there is no evidence of adequate training.
2. To review the College’s Change in Scope of Practice policy to determine the best way to ensure compliance.
3. To evaluate and propose different approaches that could be used to oversee out-of-hospital facilities/clinics.
4. To develop a public information initiative to inform the public about cosmetic procedures, including their risks.
The CPSO has now identified members who perform cosmetic procedures through a variety of sources and they will be receiving a letter with a detailed questionnaire to complete about the cosmetic procedures they are providing to patients. This will help them understand where they practice, the services provided in their facility or facilities and the formal training and continuing professional development that has been completed. An explanatory letter and the questionnaire were sent to these physicians by mail on October 17, 2007. The Questionnaire must be returned by November 5, 2007.
A copy of the letter and the questionnaire are at: http://www.cpso.on.ca/Info_physicians/CL_Questionnaire.pdf
and
http://www.cpso.on.ca/Info_physicians/Questionnaire_cosmetic.pdf
Completion is mandatory for physicians performing cosmetic procedures.
The College is committed to having complete information about all physicians working in this field and ensuring that members are practicing only in areas where they have the knowledge, skills and training generally but in particular for medical procedures that involve significant risk.
The CPSO intends to assess all physicians who are performing high-risk cosmetic procedures where there may not have been adequate training. In addition, Council has approved the development of an implementation plan to require members to comply with the policy to report a change in scope of practice or re-entry to practice.
Dr. Jeff Turnbull, MD, FRCPC, the president of the CPSO said that this action is an extremely high priority for the College and he would appreciate the cooperation of the members of the College. He said that he would keep members informed of any new initiatives particularly after our Council meeting in November when additional measures will be considered to ensure adequate oversight of high risk procedures in out-of-hospital facilities.
Monday, October 22, 2007
Monday, October 1, 2007
American Society of Plastic Surgeons Consumer Advice
Cosmetic Plastic Surgery vs. Medically Necessary Surgery
- Nearly 8 out of 10 patients (80% cosmetic plastic surgery/78% medically necessary surgery) surveyed were satisfied with their overall surgical experience.
- Nearly 40% of cosmetic plastic surgery patients and 29% of patients who had medically necessary surgery believe they should have been more proactive in learning about the possible side effects and complications of their surgeries.
- Nearly one-third of cosmetic surgery patients (28%) did not check their doctor’s credentials before surgery; 37% did not check if their surgeon was certified by the American Board of Plastic Surgery; 54% did not check if their surgeon completed an accredited residency training program in plastic surgery.
- The majority of patients believed their surgeons: answered all of their questions (90% cosmetic plastic surgery/96% medically necessary surgery); addressed how to properly prepare for the day of surgery (82% cosmetic plastic surgery/89% medically necessary surgery); and informed them of the details of their surgical procedure (77% cosmetic plastic surgery/ 74% medically necessary surgery).
- The majority of patients (82% cosmetic plastic surgery/86% medically necessary surgery) were satisfied/very satisfied with the overall quality of pre-surgical discussions with their doctors; however, nearly 30% of cosmetic surgery patients and nearly 20% of patients who had medically necessary surgery admit feeling uncomfortable asking their doctor or surgeon questions prior to surgery.
- Nearly three-quarters (73% cosmetic plastic surgery/75% medically necessary surgery) believed their doctor completely addressed potential side effects and complications before surgery.
- Before surgery, 91% of cosmetic surgery patients and 95% of patients who had medically necessary surgery said they knew what to expect in terms of post-surgical side effects and complications; however, fewer than half recalled being informed of some common side effects and complications such as nausea and vomiting (42% cosmetic plastic surgery/43% medically necessary surgery), blood clots (34% cosmetic plastic surgery/28% medically necessary surgery), or suture complications (34% cosmetic plastic surgery/25% medically necessary surgery).
- About 1 in 2 patients (57% cosmetic plastic surgery/56% medically necessary surgery) expressed some concern about the outcome of their procedure as it relates to post-surgical side effects and complications.
- 60% of all patients surveyed had outpatient surgery (released the same day as their surgery).
- Nearly one-third of patients (30% cosmetic plastic surgery/33% medically necessary surgery) who experienced post-surgical side effects or complications found them to be at least somewhat difficult to manage.
- Among those who experienced a post-surgical complication, roughly 70% of patients said it negatively impacted their daily life in such areas as an inability to accomplish necessary tasks (35% cosmetic plastic surgery/ 44% medically necessary surgery); a decrease in energy level (32% cosmetic plastic surgery/53% medically necessary surgery); and time away from work (27% cosmetic plastic surgery/39% medically necessary surgery).
- 35% of cosmetic plastic surgery patients and 39% of patients who had medically necessary surgery who experienced a post-surgical complication reported missing four or more days of work due to their complication.
¹Survey respondents were never directly asked about side effects at any point in the survey, but instead were asked about risks and complications, which in several questions included some well-known side effects such as nausea, vomiting and pain.
The survey was conducted online within the United States by Harris Interactive® for the American Society of Plastic Surgeons and Merck & Co., Inc. between January 15 to 29, 2007, among 617 adults, of whom 301 had cosmetic plastic surgery under general anesthesia in the past two years and 316 had non-emergency medically necessary surgery under general anesthesia in the past two years. Please see press release for full methodology statement.
The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
Thursday, September 27, 2007
Cosmetic Surgery Books from Barnes & Noble
Vanity knows no bounds in this breezy account of Americans' love affair with physical enhancement. New York Times Style reporter Kuczynski injects her experiences as both participant and observer into these revelations about the costly and painful business of fighting off age and battling imperfections through cosmetic surgery. With incomparable portraits of obsessive patients and the equally obsessed doctors who cater to their dreams, BEAUTY JUNKIES examines the hype, the hope, and the questionable ethics surrounding the advent of each new miraculous technique. Lively and entertaining, thought-provoking and disturbing, BEAUTY JUNKIES is destined to be one of the most talked-about books of the season. NPR interview with author
Concise Manual of Cosmetic Dermatology is a one-stop, step-by-step guide to precisely what readers need to know in order to successfully perform cosmetic dermatologic surgery. Readers will get clear, consistent, and well-illustrated coverage of each surgical technique written by four of the field's leading experts. Each templated chapter begins with key points and goes on to include indications and contraindications, set-up, choice of agents/technique, a step-by-step description of the technique, and pitfalls.
Monday, September 17, 2007
Liposuction death in Toronto
On September 17, 2007 Krista Stryland, a healthy 32-year-old Toronto real-estate agent decided to cancel her future appointment for a tummy tuck with a renowned plastic surgeon. Instead, she told her friend in an e-mail that she was going to the Toronto Cosmetic Clinic (TCC) for a laser liposuction procedure. The device as it turns out was just approved by Health Canada a few months before.
It was hyped on American TV health and news shows earlier in the year with absolutely no negative statements or warnings. It was touted as the "lunch-time" tummy tuck with no down-time. One woman made a comment on News 8 Austin, Texas that it was like watching her cheeseburger go down the drain as she had her tummy worked over by a plastic surgeon.
The problem with the laser liposuction procedure was that the device that may have been used at the TCC was in the hands of a medical doctor who never earned certification as a specialist in dermatology, plastic surgery, or for that matter any surgical specialty. In fact, she had two years of family medicine training after medical school, and never earned certification by the Canadian College of Family Practice (CCFP).
For whatever reason, after a few years as a general practitioner, she elected to move into a lucrative new field called "cosmetic surgery". The trouble was then, as it is now, that there is actually no recognized specialty called "cosmetic surgery" in Canada.
To become a "cosmetic surgeon" was actually quite simple. All she needed to do was to place a fancy sign in the office, make a few changes to business cards, and then convince the Yellow Pages that you have that designation (as if they really care anyway).
There were then, as there is now simply no regulations in Canada that prevent anyone from making those claims. In order to pump up her status as a "cosmetic surgeon" Yazdanfar's name was added to a prestigious web site called LocateADoc.com (see column on right of this page).
You can search for specialist physicians across North America. Almost all of them have their specialty in dermatology, ENT, or plastic surgery. The training for these recognized specialties can take up to five years or more of hospital-based training followed by rigorous examinations. Yazdanfar had none of that training and yet she calls herself a "cosmetic surgeon".
But, somehow, Yazdanfar made it on this list.
In fact, anyone with an MD, or DO can get a FREE LISTING on LocateADoc.com. I don't know if LocateADoc.com has any method of screening out those who don't have actual specialties.
Cosmetic Surgeons In North York, Ontario Canada with Basic Listings:
Procedures available may include: Breast Augmentation (Breast Implants), Liposuction Surgery (Lipoplasty), Tummy Tuck (Abdominoplasty), BOTOX® Injections Treatment, Breast Reduction Surgery, Laser Hair Removal, Blepharoplasty (Eyelid Surgery), Breast Lift Surgery, Hair Transplants / Restoration, Cellulite Treatment, and more.
Her web site and advertisements in magazines and billboards around Toronto brought patients to her Yonge Street clinic from far and wide. There didn't seem to be anything in her advertising that would distinguish her from those who really had certification in a recognized specialty. In fact, the words "plastic surgery" was actually used for a long time on one of her web pages.Over the last few years, reports surfaced that complaints were filed from doctors and even a lawyer with the College of Physicians and Surgeons of Ontario (CPSO). But, to no avail, this regulatory body allowed her to practice whatever she did, without apparently inspecting her private clinic, even after complaints were filed.
The CPSO's Policies on Advertising were ignored. Even though there were restrictions on who could use the words "plastic surgeon", it didn't keep Yazdanfar from using that term.
On November 20, 2006 her web site actually said this:
"Falling under the broad category of plastic surgeon, a cosmetic surgeon in Toronto is a certified doctor who performs surgical procedures that alter the aesthetic appearance of a patient."
Krista Stryland had no idea that her doctor with the fancy web site, and slick ads in the plastic surgery magazine, was NOT a plastic surgeon, despite the fact that the diplomas, certificates and pictures on the walls of her office would have the average potential patient believe otherwise.
The bottom line is that this beautiful young woman placed her life into the hands of a doctor without a recognized specialty, who apparently just started using a new laser liposuction machine in her practice. According to news reports, her life ended shortly after the liposuction was terminated because she had a cardiac arrest.
Any sudden and unexpected death in Ontario demands an examination by a medical examiner, and whether or not the case will be deserving of a full inquest may take a few more weeks. An actual inquest itself might take years to actually start.
Meanwhile recognized specialty groups have paraded out their big guns on TV, radio and in every major news media organization in Canada. With eyebrows raised, and thumbs down, their spokespersons have openly criticized not only the doctor who did the procedure, but they threw slings and arrows at the CPSO, too.
LipoWatch will summarize the significant articles and media coverage and provide links to the associations, professional regulatory colleges, and others who have something to say about this case.
Feel free to leave your thoughts here. They will be monitored. If you have a story to tell, just leave it here and we will review them.
Thanks,
LipoWatcher
BOOKS FROM BARNES & NOBLE
Dr. Perry's empowering book guides you through the seductive and somewhat slick world of cosmetic surgery. He offers criteria for selecting good doctors and facilities. In short, he has written an essential book for anyone who is contemplating cosmetic surgery or other skin-care procedures.
This issue presents many of the most influential techniques and concepts introduced in the field of lipoplasty by surgeons who created or modified the techniques and who represent different facets in this burgeoning field. In addition to an overview of liposuction techniques and guidelines, other variations are discussed including VASER, Power-Assisted Liposuction, Subdermal Liposuction, Liposuction and Tumescent Surgery, Serial Suction, Fat Injection, Abdominoplasty Combined with Lipoplasty without Panniculus Undermining, Low-level Laser-Assisted Liposuction, Liposuction Anesthesia Techniques. Dr. Illouz, one of the founders of liposuction, presents a discussion of Complications. The Guest Editor, Dr. Toledo, offers a discussion of Complications of Body Sculpture: Prevention and Treatment.
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