The lovely young woman on my medical rounds has
a gaping hole on her forehead. The hole is deep and there is pus brimming from
the side. The edges look macerated and discoloured and the stench emanating
from it is noticeable.
She looks
like the victim of a vicious accident until we discover that this is the result
of a cosmetic procedure gone wrong. She is flustered and angry, but mainly
worried about the possibility of permanent disfigurement.
The
plastic surgeon duly arrives, his response one of unmitigated dismay: “Oh God.”
Over the
next week, the woman receives powerful antibiotics and one round of surgical
debridement. The surgeon advises that the repair process will take several
months.
When she
knows us a little better she produces consecutive images capturing the
unfolding catastrophe. The final picture is from Instagram before intervention.
Her skin is smooth and young and her features look nice, but all she notices is
the blemish of a mole.
“See
that? I couldn’t bear it, but now I am positively ugly.” Then she bursts into
tears.
We
console her as best we can but there is no escaping the fact that in the quest
to fix a small perceived defect she has attracted a lot more trouble than she
bargained for. She seems nonplussed when the plastic surgeon questions her
about the qualifications of her provider. “He was a doctor,” she says
defensively. “What else did I need to know?”
This
woman may sound naïve but qualified plastic surgeons say that she is typical of
uninformed patients who belatedly realise the consequences of their decision to
have “routine” cosmetic surgery.
Cosmetic
surgery clinics have long operated with impunity but they have recently been in
the spotlight with reports of widespread shoddy procedures including unsafe
anaesthetic practices and inadequate infrastructure to monitor serious
complications.
Beauty
clinics that once offered safe services now perform a ubiquitous trade in laser
procedures. “Getting a Brazilian does not involve nearly the same level of risk
as laser resurfacing,” says a dermatologist, who sees examples of interventions
gone wrong.
But
unregulated cosmetic clinics are thriving, offering everything from Botox,
laser and fillers to breast and nose jobs, tummy tucks and facelifts. Slick
websites promise the world: quick and painless makeovers that will restore
patients (mostly women) to their pre-baby self or sculpt the confident, trim
and taut body they have always dreamt of having.
The word
“cosmetic” is affixed to doctor, physician, surgeon, plastic surgeon and
dermatologist. Of these, only the latter two have undergone years of specialist
training and accreditation by a professional college. While clinics claim that
other cosmetic providers may have a basic medical degree, their training in
performing complex cosmetic procedures is variable and unscrutinised.
According
to plastic surgeons who end up picking up the pieces after cosmetic surgery
gone wrong, many providers know that patients don’t have the sophistication to
question the difference. They describe removing botched breast and nose
implants, treating disfiguring scars and resuscitating patients who suffer
large fluid shifts after aggressive liposuction. Many of them have taken place
on a “luxury” overseas holiday that combined tourism and surgery at a fraction
of the price. The corrective procedures are painful, time-consuming and place
an extra burden on the public healthcare system.
But
“cosmetic” does not mean “unimportant”, as one dermatologist rightly says. It’s
naïve to think that appearance doesn’t matter. It matters in every walk of
life. Even the ancient Egyptians, free of the influences of social media,
regarded beauty as a sign of holiness, going to considerable lengths to procure
Kohl and malachite for their eyes and red ochre for cheeks.
A man
wants the red veins on his nose removed to remove the impression of being an
alcoholic. A woman feels that the permanent frown on her forehead makes her
look angry to her colleagues and is threatening her job security. A young man
says people can’t look beyond the large birth malformation on his face. Modern
medicine has the tools to help, and patients ought to benefit from them, but
they also deserve an honest discussion of the evidence underlying treatment.
When a
woman tells me she settled on a tummy tuck after a single phone call, I wonder
how uninformed buyers can be so easily convinced of the merits of expensive and
major surgery. Visiting various websites, I am struck by the glossy pictures
selling the attractive proposition that a tummy tuck is perfect for the woman
who wants to look more feminine, regain her self-esteem and nicer contours –
for someone who doesn’t mind the children but hates the resulting abdominal
baggage, for the woman who dreads the beach and who is at risk of sinking into
depression because her waist is larger than her hip.
There is
an outwardly sympathetic but sinister implication that sometimes, no amount of
healthy living can make a woman as beautiful as a round of surgery. The mention
of complications is notably sparse and that of cost virtually non-existent. You
could be forgiven for thinking that although the benefits are self-evident and
compelling, the risks are a side issue and the costs immaterial.
In a 2015
study published in the journal Plastic and Reconstructive Surgery, American
researchers reported on the outcomes of 25,000 abdominoplasties (tummy tucks) –
95% of patients were women, with an average age of 42. Two-thirds combined the
procedure with other cosmetic surgery. Tummy tucks can be undertaken alone or
as part of the “Mummy Makeover Package”, combining breast, abdominal and
vaginal work. Less serious problems managed in the clinic were not included in
the study but the rate of major complications was high at 4%, rising to an
alarming 10.4% for combined procedures. The commonest complications were
bleeding, infection, venous thrombosis, and lung injury, all potentially
life-threatening.
When I
call a popular cosmetic clinic on a Friday afternoon and ask to speak to a
patient advisor, demand is high and the wait is long. I introduce myself as a
mother enquiring about cosmetic surgery for the first time and am immediately
asked which one of the extensive menu of procedures I want. An abdominoplasty,
I venture, and am rewarded with the knowledge that it’s “incredibly popular.”
“I’d like
to know who this procedure is right for,” I ask.
“It’s
right for anyone who wants it’.
I am
astounded by this claim, and from a nurse too.
Her
advice contradicts professional guidelines that advise surgery in cases of
massive weight loss (that leaves redundant skin behind), documented serious
infection or skin necrosis due to overhanging fat or functional limitation with
walking or hygiene, and only when non-surgical management has not worked.
After
hearing a slick promotion about the tummy tuck that will iron out more than the
abdominal sags, I ask about side effects and costs and am told this requires a
discussion with the doctor. I concede this as reasonable but can’t help
noticing that the anticipated benefits have already been aggressively impressed
upon me without the same doctor’s input.
“Do women
decide so quickly?” I enquire, considering I am none the wiser about the
provider’s qualifications, cost or complications.
“Most of
our women have already decided and they walk out of here with a date.”
Research
into the preferences of first-time cosmetic surgery recipients finds that
viewers of plastic surgery reality television are more likely to be influenced
by the shows, believe themselves to be better informed, but have more
unrealistic expectations of surgery.
Experts
say that cosmetic surgery is a sign of our times and here to stay, which is why
qualified plastic surgeons and dermatologists, who might previously have
avoided the field, want a hand in the game. They say that while most patients
are satisfied, cosmetic surgery providers are obliged to screen out those with
depression, psychosis, body dysmorphic disorder and minimal deformity who need
other forms of help instead of surgery they can ill-afford. But many openly
admit that the multimillion dollar cost of running a modern cosmetic clinic
causes ethical obligations that clash with the financial imperative.
“When you
have bought a six-figure laser machine and are spending tens of thousands in
maintenance fees, there is a perverse incentive to suggest a procedure instead
of reassuring a woman that her nose looks just fine,” a clinic owner tells me.
If patients are to be adequately protected, the cosmetic industry will need to
be regulated rather than customers relying on a voluntary code of conduct.
In
today’s aggressive world of cosmetic surgery, the patient’s role can’t be
ignored. The patient can’t afford to be naïve and trust the most polished
advertising. Before committing to cosmetic surgery, there is a personal
obligation to reflect a little on what it will actually accomplish.
Disappointingly,
research shows that when it comes to almost every form of healthcare, with every
pill we swallow and procedure we subject to, we consistently overestimate the
benefits and underestimate the harm.
Combine
this with an unchecked industry, and the potential for tears is as boundless as
our longing to look good.
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