CosmeticSurgery.com Staff Report
Medically Reviewed by Paul S. Nassif, M.D.
When Lynn Dugan, now 62, went in for a facelift, she never dreamed she would wind up with a case of what was basically gangrene of her whole body.
Nonetheless, Lynn spent two months, including one month in intensive care, in the hospital recovering from Necrotizing Fasciitis, the so-called “flesh-eating disease” after a botched cosmetic procedure.
“I made some very basic mistakes when I had my plastic surgery and am telling my story so other women can learn from my mistakes,” Lynn told CosmeticSurgery.com. “If I can save another woman from an hour of what I went through, I’ll be happy.”
It started seven years ago when Lynn, who now works in ticket sales at L.A.’s Greek Theater, contracted for a facelift from a surgeon who, she says, had his medical license yanked by the state of California.
”I felt like I was starting to look like my mother and was anxious to have a more youthful look, so I interviewed only one doctor before going ahead with a facelift,” Lynn recalls.
“Several things from that first visit stuck in my mind. The doctor didn’t take my blood pressure, an EKG or any blood tests before the procedure. He did give me a prescription for antibiotics to take before the operation but the pills made me sick and, when I complained, he told me to forget about the antibiotics.
The operation took place in the doctor’s office. She later learned the assistant was the surgeon’s 22-year-old daughter and had no training in medicine. Afterwards, that Tuesday, Lynn went home, developed a fever in the evening and went to bed, feeling miserable. By the following Thursday, she was still suffering chills and fever, fuzzy thinking and weakness. She returned -- via a wheelchair, due to weakness -- to the doctor who told her she only had a case of the flu and to go back home. But her general malaise continued unabated.
By the following Saturday, her husband Doug, was beside himself with worry and concern and took Lynn to the emergency room of a local hospital. There, the attending physician removed the bandages, clipped the stitches on Lynn’s face and found pus oozing from the wound. A medical team then swung into action, fighting a massive infection that was diagnosed as Necrotizing Fasciitis, the dreaded flesh eating disease.
While Lynn remembers nothing about her 34 days in intensive care in the hospital, she later learned most of her internal organs began to fail, her toes were marked for amputation and her chest was opened on both sides for draining and air circulation. Later, operations were performed to take skin from her legs to replace the necrotized skin on her chest. Still later, she saw a more competent cosmetic surgeon who, over three more operations, stopped the infection, repaired the damage, removed the scars and made her look good again.
Is Lynn’s case rare? Absolutely. But can it happen? Yes. Cosmetic and plastic surgery have become so popular, the procedures are often served up as prime time theater – with medicine’s part standing somewhere backstage with the extras. Thus, many of us are caught up with the heady end results of a person’s new enhanced appearance that we overlook the fact that most plastic and cosmetic procedures are first and foremost surgeries. And, as with any surgery, there are small risks involved, even in the best of hands.
“Cosmetic surgery is real surgery even with the world’s best surgeon and there is always the potential for complications,” says Dr. Christopher P. Godek, M.D., a plastic surgeon in Toms River, N.J.
While some estimates figure about ten million Americans will go ahead this year with the cosmetic enhancements about which they have always dreamed, more than a few patients are reporting less-than-desired outcomes.
The range of botched cosmetic procedures today can run from the sublime to life threatening cases like Lynn’s.
“We’re seeing many more cases in emergency rooms of people returning from overseas with botched procedures that were done on the quick and by insufficiently trained surgeons,” says George Orloff, M.D., the physician who treated Lynn.
While some miffed patients in plastic surgery hotspots like New York, Florida and California report being displeased with, say, the tips of their noses or the number of remaining crow’s feet around their eyes, other serious cases are periodically reported. For instance, Boston University Medical College noted a rash of emergency room cases in which undocumented workers suffered serious injuries by quacks and quasi-surgeons working in bedrooms and garages trying to carve a more “Westernized” look onto the faces of their hapless patient-countrymen. One E.R. case in Boston eventually cracked a large ring of fast buck medicos from Cambodia preying on illegal immigrants.
Statistics of botched cosmetic and plastic procedures are hard to find, experts say.
Stanley Frileck, M.D., a Los Angeles plastic surgeon and member of the American Society of Plastic Surgeons, surveyed his practice and found about 25 percent of his practice involves fixing incomplete procedures. And, according to a survey by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS,) complications from inferior surgeons are so widespread that, of the more than 150,000 Rhinoplasties (nose jobs) done each year, nearly 21 percent are corrective procedures. AAFPRS has additionally jumped into the fray with a public report, “Reports of Botched Surgeries Not to be Taken Lightly”
and lists guidelines for choosing a surgeon who is most likely to do the job right, the first time. The American Plastic Surgery Association and others also help prevent bungled jobs with additional handouts on how to more wisely choose a qualified surgeon.
While the average American patient – on U.S. soil, at least -- is not likely to wind up in her local emergency department after, say, a chemical peel, experts say the best way to prevent a flubbed, or even unsatisfying, outcome is by doing on your own more basic research on the procedure you want and the surgeon who may eventually do it. The good news is – cases of flesh eating disease nothwithstanding -- most botched jobs can be fixed.
“Among my revision patients, the biggest mistake I see is considering surgeons only by the lowest possible price,” says Angelo Cuzalina, MD, DDS, a cosmetic surgeon and assistant professor at the University of Oklahoma and Alabama.
“Let me give you just a couple of quick for-instances what happens in an operating room when a procedure is done on the cheap, “Dr. Cuzalina says. “Some cut-rate practitioners also handle the anesthesia during the operation. That means they have twice the work to do and their attention is divided.”
Another common dodge is when the surgeon works too long. A basic, safe operation for a typical plastic surgeon usually lasts no longer than four and one-half to five hours.
“But in bargain basement offices, I’ve seen some cases where the practitioner operates for 11 and 12 hours,” says Dr. Cuzalina.
Liposuction is art as well as science, physicians say. But a practitioner who has taken only a weekend course before seeing patients for liposuction services often leaves, not a smooth contour in the body, but “divots” in the flesh, spots where too much fat was removed.
Most professional organizations recommend your practitioner be board certified. That means he or she has had a year of hands-on experience at the side of an established, older surgeon.
Once you’re in a doctor’s office, it’s perfectly O.K. to ask how many times he or she has done a certain procedure, if he has before-and-after pictures of his previous patients and, finally, if you can actually contact some of his patients and inquire about their experience under his knife. Virtually all reputable physicians encourage patients who want to become better educated about cosmetic surgery.
“If you get any pressure about a low, low price being good for today only, a huge red warning flag should go up,” says Dr. Cuzalina.
When Rosanna Perez, a Los Angeles HMO salesperson, wanted a cute nose that looked just like her mother’s, she saw a cosmetic surgeon recommended by a co-worker. That concluded her shopping.
“But my nose collapsed two years later, the tip turned up, one nostril faced outwards and soon I had breathing problems,” Rosanna says. She complained to the surgeon about the muffed job and says he finally dismissed her, saying “Quit whining, the nose looks fine.”
Before making an appointment to repair the first job, she spotted a surgeon on television, then read his website, interviewed him and asked about his results on former patients, all before discussing price.
“I once asked a surgeon about his training and he only replied: “You’re kidding,” says Rosanna. “That alone should serve as handwriting on the wall. So find a doctor who will listen to you.”
Says Thomas Romo, M.D., a reconstructive surgeon in New York City: “By far, the most bungled cosmetic procedures are Rhinoplasties. We estimate such a high failure rate because the nose is a three-dimension structure so the surgeon must also think like an architect and make sure there is sufficient ‘scaffolding’ or supporting structure left inside the nose.”
But many surgeons remove too much of the nose’s interior and – like a building without good support – the proboscis soon bends, twists or collapses, leaving the patient with , a strange appearance and, often, breathing problems.
“Choosing a well-trained, certified practitioner means you have somebody who can handle unexpected complications,” says Dr. Orloff. “Lynn’s infection, for instance, could have been caught and cured early, with all that hospitalization and the risk of death prevented.”
The American Academy of Cosmetic Surgery in Chicago says prospective patients should also ask where the surgery will be performed. Cosmetic procedures are performed in hospitals, surgical centers and some offices. If the facility is accredited by the AAAHC (American Association for Ambulatory Health Care) or JCAHO (Joint Commission on Accreditation of Healthcare Organizations,) it must meet certain minimum standards of safety. While many people depend on friends for referrals, the surgeon who did a great breast augmentation on a coworker may not be the most qualified to do your facial rejuvenation.
Adds Michael Leadbetter, MD, a plastic surgeon in Cincinnati, Ohio: “If a plastic or cosmetic surgeon doesn’t want to show you any pictures of his patients, it’s because he doesn’t have any. A qualified surgeon will happily answer all the questions put to him by an inquiring patient.”
Advises Lynn Dugan: “If I had it to over again, I would have toured the first doctor’s office, not been so rushed, checked out his referrals and asked other experts who they would recommend for my surgery.
“I believe if you can improve yourself and look better to match the youthful way you feel inside, you should go ahead and do it.”
And if you also want to remain your healthy, the best road to safely looking better is better traveled if you start with a lot of homework and some probing questions for your surgeon.