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State regulations for cosmetic surgery found lacking

Robin Wulffson MD's picture
Face after cosmetic surgery

Throughout the United States, cosmetic surgery is popular for people ranging in age from the teens to seniors. Before-and-after pictures are widely touted on television and print media. Physicians performing cosmetic surgery vary significantly in their training and facilities where the surgeries are performed also differ in their degree of sophistication and technology. Fueling the problem is that currently only 21 states require the accreditation or licensing of offices where the surgeries are performed. Facilities that are accredited or licensed must have specific resuscitation equipment and medications, adhere to strict safety procedures in areas including recordkeeping, anesthesia, and cleanliness. In addition, the facilities must be subject to inspection.

The states that have accreditation and/or licensing are: Washington, Oregon, California, Arizona, Colorado, Kansas, Texas, Louisiana, Florida, South Carolina, Tennessee, Kentucky, Indiana, Ohio, Virginia, Pennsylvania, New York, Rhode Island, Connecticut, and New Jersey.

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The training varies widely for cosmetic surgeons. The highest degree of training can be found among those certified by the American Board of Plastic Surgery. These surgeons must complete a residency program in general surgery followed by additional training in plastic and reconstructive surgery. Physicians with less training in plastic surgery may be competent in certain areas. For example, ear, nose, and throat (ENT) physicians perform reconstructive surgery for a cleft lip or palate and rhinoplasties (nose reshaping). However, some physicians with no training pertinent to plastic surgery perform cosmetic procedures. For example, three patients of a former Phoenix emergency room physician died after having cosmetic surgery at his facility. Those incidents triggered the American Medical Board in early 2008 to publish guidelines regarding the degree of training doctors practicing outside of their specialties need to be competent in the procedures they perform. The physician, Peter Normann, was convicted of two counts of second-degree murder and one count of manslaughter and sentenced to 25 years in prison in September. He is appealing the conviction.

The North Carolina Medical Board indefinitely suspended the license of an ENT physician, Paul Drago, based on complaints from women who received "substandard" cosmetic surgery procedures and other evidence he was unfit to practice. In addition, the board temporarily suspended the license of a general practitioner who performed cosmetic surgery after discovering evidence that he prescribed drugs to himself and operated on family members. The two cases prompted the board's March 2011 decision to adopt a position statement that notes that physicians who expand their practices will be held to the same standards as more extensively trained physicians and must ensure they have enough education and training.

In addition to Arizona and North Carolina, at least nine other states spell out in statutes that doctors have to be competent in any procedures they perform.

If you are considering cosmetic surgery, the following steps should be taken:

  • Determine if the surgeon is certified the American Board of Plastic Surgery (the gold standard). The American Board of Cosmetic Surgery also has stringent training requirements.
  • Determine that your physician has a valid license to practice in your state and whether any disciplinary action is on file. This information is available on the state medical board’s Website.
  • If the surgery is to be done in a free-standing surgery center or a physician’s office, determine whether the facility is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAASSF) and/or the Accreditation Association for Ambulatory Health Care (AAAHC).