At What Cost Beauty?

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Patients often enjoy a doctor's office because it feels more personal; many doctors prefer it because they exercise complete control over their surroundings and costs. That can be perfectly safe as long as the offices maintain safety precautions, but some state and local governments do not monitor whether they do. The task can be left to accrediting agencies. States may require offices to be accredited, but the agencies perform inspections and give the seal of approval. The one considered the gold standard is from the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF). To receive its blessing, doctors must be board-certified in their field, and their facilities must prove they have the means to handle emergency situations. The problem is that getting inspected for accreditation is done on a voluntary basis. Says Michael McGuire, a Los Angeles cosmetic surgeon and the AAAASF's president: "Facilities open, and nobody knows on a state level that they are there."

Why--or whether--the liposuction--tummy-tuck combination is particularly hazardous in a doctor's office is a question the Florida board is investigating. It is not uncommon for people to have multiple procedures performed at once, and when the patient is in good health, it is not especially perilous. But generally, undergoing more than one procedure not only prolongs recovery but also increases the time a patient is anesthetized, which can be risky. "I personally don't believe in procedures that go beyond five or six hours," says Dr. Robert Bernard, who operates in his Westchester, N.Y., office and is the president of the American Society for Aesthetic Plastic Surgery, whose members are all board-certified. "If somebody comes in and wants their face, eyes and nose done, that's O.K. But if they want that as well as breast reduction and a large amount of liposuction, I'd prefer to divide it into two procedures."

In one of the Florida cases under investigation, a combination of surgeries may have proved fatal. James McCormick had decided to go to the Florida Center for Cosmetic Surgery in Fort Lauderdale to nip and tuck his crow's feet. His doctor recommended a brow job as well and offered to throw in a chin implant at a discount. McCormick agreed to all the procedures and was at the facility less than four hours. By the next day, he was dead. Citing patient confidentiality, Dr. Jeffrey Hamm, medical director of the facility, declined to discuss the case.

Bernard reports that he has received more requests for combination surgeries since the premiere of Extreme Makeover, a phenomenally popular reality show on ABC in which subjects undergo as many as six surgeries at a time to remove any perceived flaws on their bodies. He says the show has generated good p.r. for the field, but he is worried that it raises unrealistic expectations. "People don't realize that subjects on the show are preselected," he says. "They're in excellent health, screened by psychologists and analyzed by the best plastic surgeons in the country to ensure that their transformation has the potential to look like a home run." Bernard points out that the subjects also work with dermatologists, cosmetic dentists and hair stylists.

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