| gospa68@aol.com 2005-08-07, 6:04 pm |
| When it comes to surgery, a second procedure is a repair of a failed
initial procedure. However, as this article highlights, repair
procedures in cosmetic surgery (and refractive procedures) have been
given a new name - "enhancement(s." The term makes a repair sound like
something good when, in fact, it is a cover-up for something bad.
For those investigating refractive procedures and refractive surgeons,
make sure you ask the surgeon/practice what their repair (enhancement)
rate is. Do not settle for a top of mind response. Ask to see the
practice data.
Repair rates can run as high as 20% in some practices.
WK
New York Times....August 4, 2005
After Cosmetic Surgery, the 'Do Over'
By SUSAN SAULNY
DENISE KUMPEL knew something was wrong as soon as the swelling went
down. Her right nostril just didn't have enough substance to stay up.
Within six weeks it had collapsed, and she was back in surgery again to
fix what turned out to be a botched nose job.
A few weeks after the second rhinoplasty, she realized that her latest
nose was abnormally flat, as if it were sinking into her face. She
looked for a new surgeon.
Not one, not two, but three more operations followed over the next
three years at a cost of more than $30,000. Finally, nine months ago,
using cartilage from her ears, Ms. Kumpel said, she got the results she
had originally sought.
"I thought I was going in for something fairly simple: I had a bump on
my bridge and didn't like my profile," Ms. Kumpel said. "But it became
a never-ending cycle. I was like, 'Is this ever going to be over?' "
While Ms. Kumpel's case might sound extreme, her experience is not that
rare. As the number of people electing to have plastic surgery
continues to rise across the country, the number of corrective revision
surgeries, or redos as they are often called, also appears to be
increasing at a rate that is high enough to cause concern among some
prominent surgeons.
"I'm seeing more than I think we should, given the number of primary
procedures being reported," said Dr. Steven J. Pearlman, a facial
plastic surgeon in New York and president of the American Academy of
Facial Plastic and Reconstructive Surgery.
To be sure, some patients have multiple surgeries on a single body part
simply because they want to. For another group, however, revision
surgery is seen as necessary after complications from sloppy work or
from problems that could not have been anticipated.
While anecdotal evidence seems to suggest an increase in the number of
revision cosmetic procedures, it is nearly impossible to quantify how
many are being done - or to say if they are necessary - because the
major medical associations do not keep statistics on redos, and doctors
are not required to disclose information about revisions of their work.
These cases usually fall short of malpractice, but they still leave
patients unsatisfied and determined to risk surgery again, if they can
afford it, patients and experts said.
"Revisions and complications are underreported, and there's no easy way
to access that information," said Dr. Robert Goldberg, the chief of the
ophthalmic plastic surgery division at the Jules Stein Eye Institute at
the university of California, Los Angeles, which sees patients seeking
revisions from all over the country. "It's not something people talk
about."
If faulty cosmetic procedures are on the rise, it would be hard for the
average patient to know. Cosmetic surgeons, advertising for largely
cash business, have no incentive to disclose information about
revisions of their work or to track the long-term satisfaction of their
patients. And strong patient interest groups that might push for such
information are hard to find. Because so many procedures are elective,
some cosmetic surgery patients feel guilty about voicing even the most
minor complaints.
Ms. Kumpel, for instance, didn't want to talk much about her ordeal
until it was over. And she said she never even thought about suing the
doctors who made her nose worse. "When you go into plastic surgery, you
sign away that things can go wrong," said Ms. Kumpel, a 30-year-old
speech and language pathologist from Tuckerton, N.J. "You're not
guaranteed a good outcome."
Another cosmetic patient, Amy Longtemps, is awaiting an appointment for
a third abdominal procedure, after two operations - a tummy tuck, then
liposuction - failed to deliver the flat stomach she had expected. The
surgeries, instead of helping her postpregnancy belly look better, made
her midsection lumpy and disproportional, she said.
"It's been a learning experience," said Ms. Longtemps, 45. "I'm not
going to give up until I get what I want."
But once she gets that, Ms. Longtemps said, "I'll probably not have any
kind of cosmetic surgery again."
Unsatisfactory results may be one of the last aspects of plastic
surgery still seen as an unseemly topic of conversation for doctors and
patients. They undercut the field's image - portrayed glamorously in
countless television shows and advertisements - and bring harsh reality
home to people who would prefer to believe that dreams of ageless
physical beauty can come true.
But it is worth talking about, many doctors and patients say, because
risks increase, and the likelihood of pleasing cosmetic results
decrease, with every surgery, mainly because of accumulation of scar
tissue and the loss of cartilage. Revision surgeries are also more
expensive than first-time surgeries and usually take longer.
For instance Dr. Pearlman, who performed Ms. Kumpel's final surgery,
said a first-time rhinoplasty usually takes one to three hours. A
revision surgery could last up to six, he said.
Many plastic surgery practices have come to focus primarily on the
revision of other surgeons' work, while such practices were rare a
decade ago, experts said. Some patients said they sought revision
specialists only after doctors unskilled in working with altered tissue
made their cosmetic problems worse.
Dr. Goldberg said he sees about four new patients a day who are unhappy
with the cosmetic results from surgeries around the eyes, like eyelid
lifts. Those cases account for more than half his practice.
"The average patient I see has had three to five surgeries before they
see me," Dr. Goldberg said. "Once you have a problem with a revision,
then you're having a revision-revision surgery, then a revision of a
revision-revision surgery. It's a cycle and the problem only gets
worse."
Another facial plastic surgeon, Dr. Jonathan Hoenig, who practices in
Beverly Hills and Los Angeles, said it is not unusual to treat patients
who've had as many as a dozen revisions on one body part, all for
legitimate reasons. "We see people who've been to 10 doctors before and
had 15 surgeries," he said.
The frequency of revision ought to be the same as in the past, or
decrease because of the advances in plastic surgery. But those gains
might be offset by two things, experts said: more doctors vying to get
into the lucrative plastic surgery business while their training and
backgrounds are in other fields, and the dramatic rise in expectations
among patients for perfect results.
Regulations governing the practice of medicine vary from state to
state, but one thing is true across the country: Any medical doctor who
chooses to perform surgery may do so by virtue of having a license.
Dr. Michael Bermant, a plastic surgeon in Chester, Va., specializes in
revision gynecomastia, or male chest contouring, among other things.
Citing one extreme case, he said a man recently came to him for a
correction after having his chest sculptured by a gynecologist. Dr.
Bermant and others say only board-certified plastic surgeons who have
met strict training standards should be allowed to do plastic surgery.
"Having good primary surgery is a much better option than needing a
revision," he said. "Choose your primary surgeon carefully."
But when it comes to choosing a plastic surgeon, "success rate
information is hard to find," said Dr. Arthur Caplan, a medical
ethicist at the university of Pennsylvania School of Medicine. He said
patients, as consumers, are "shopping in a complicated world."
Some medical societies have also become concerned about an increase in
procedures being done outside hospitals in private settings like
offices and clinics, a practice that is not limited to cosmetic
surgery.
Two years ago the American college of Surgeons and the American Medical
Association urged states to develop guidelines for office-based surgery
according to the level of anesthesia used, among a host of other
things. Only a few states have responded to the suggestion, said Jon
Sutton, the manager of state affairs for the American college of
Surgeons.
And there is yet another obvious component to cosmetic work that makes
the world of plastic surgery so complex: the subjective evaluation of
beauty.
"For certain things in medicine you either kill the infection or you
don't," Dr. Caplan said. "In cosmetic, there's a negotiated outcome of
satisfaction between the patient and the doctor. It's far more
subjective than in most of medicine."
It is not unusual for doctors and patients to have different points of
view on what it means to look good, although that is usually the goal,
however vague.
"I saw a patient today who had a brow-lift and a facelift and who was
really unhappy," Dr. Hoenig said. "I thought she looked great."
Dr. Hoenig and other surgeons say they have encountered patients who
see problems with their looks that might be overblown or nonexistent.
Those patients, some of whom may suffer from an illness known as body
dysmorphic disorder, usually raise red flags during consultations,
doctors said.
Most of the surgeons interviewed said they had refused revision
services to potential patients who had unrealistic expectations or
problems beyond which plastic surgery could help. Dr. Bermant said he
refuses far more patients than he treats.
Some patients are initially pleased, but the problems develop later.
Diane Hennig, a painter and model from Dobbs Ferry, N.Y., thought she
looked great immediately after her first rhinoplasty in March 2003. But
during the healing process, her profile changed. She has since had two
more nose jobs.
Her reconfigured nose became so weak at one point two years ago that
the bridge collapsed. She said she's worried by the thought of another
surgery, so she's taking precautions.
"I'm paranoid to even touch the nose now," she said. "I deal with it
like crystal."
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