Lifting the lid on cosmetic surgery
After a decade of repairing botched plastic surgery procedures, our specialists are urging the Government to speed up regulation, writes Celine Naughton
Stories of Irish cosmetic treatments that go wrong are frightening. But they have to be believed -- because they come from top doctors whose job is to try to repair the damage.
They tell of facial palsy, over-filled skin that results in hideous bumps and lumps, an eyebrow that droops alarmingly.
Then there is the equipment. One specialist said that a child's teddy bear would be tested more stringently than some machines used in some of our clinics.
Our leading consultants have now issued a warning to women of the dangers of botched cosmetic surgeries and non-invasive cosmetic treatments.
Thanks to a shocking lack of regulation of the industry, the risks of being left disfigured and in pain are high, they say.
And after a decade of repairing jobs that have gone wrong at the hands of practitioners they consider unqualified and untrained, the country's specialist doctors are urging the Government to speed up the regulation process before things get out of hand.
For some, it is already too late. Last month the family of Limerick woman, Kay Cregan, who died after a plastic surgery operation in New York in 2005, filed a multi-million lawsuit against the doctor whom they believe is responsible for her death.
The 42-year-old mother of two underwent a facelift operation performed by Dr Michael Sachs at his Manhattan clinic and died three days later on St Patrick's Day.
And last year, Bernadette Reid from Wicklow died following surgery for a gastric band operation at a south Dublin clinic, against the advice of her GP who had considered her unsuitable for the procedure because she was too overweight and had chronic asthma.
Even though coroner Dr Kieran Geraghty recorded a verdict of death by natural causes, her case highlighted the dangers of this highly lucrative but unregulated industry and the clinic has since closed down.
All 26 members of the Irish Association of Plastic Surgeons (IAPS) have had to repair botched surgeries. Dermatologists too are being called on to correct problems caused by non-invasive cosmetic treatments gone wrong.
"People without the necessary expertise are putting the lives of patients at risk," says Dr Rosemary Coleman, Consultant Dermatologist with the Blackrock Clinic.
"One of my patients had atypical moles lasered off her back by a doctor with a basic medical degree and no training or qualification in dermatology. Those moles could have been cancerous or pre-cancerous, yet they were never tested.
"They were simply lasered off, leaving scars on the patient's back and I don't know whether she may present in years to come with metastatic disease. It's appalling.
"I see plenty of other side effects of treatments that have gone wrong -- dropped eyebrows, facial palsy, over-filled skin that results in lumps and bumps . . . In this case, I may be able to dissolve the filler and start again, but sometimes the damage is permanent.
"Even some machines used for certain procedures are not considered medical devices. There is less safety testing carried out on these machines than on a teddy bear with a CE safety standard label."
The ethics of aesthetics may leave much to be desired, yet consultants' hands are tied because there is no regulatory body and no legislation in place to prevent unsafe practices.
"This needs to be addressed urgently, because the medical side of cosmetic treatment is being ignored," says Dr Coleman.
"The Department of Health and Children is failing to protect the public by not having regulations in place."
In August of this year, the Government-appointed Commission on Patient Safety and Quality Assurance issued its report, "Building a Culture of Patient Safety," containing 134 recommendations.
"The most significant recommendation is the introduction of a licensing system for all health services whether they are delivered publicly or privately," according to the Department of Health and Children.
"Such a system would, of course, require legislation which will be extremely complex and take some time to develop," says a spokesperson.
The Irish Association of Plastic Surgeons has long been lobbying for regulation.
"We understand how complex it is, but we urge the Department to put in place legislation as soon as possible to protect those who unwittingly put themselves in harm's way.
"We need to protect innocent people who think they have somebody well trained and they don't," says Mr David O'Donovan, Secretary of the IAPS.
When he appeared on The Late, Late Show last year Mr O'Donovan showed images of two harrowing cases of plastic surgery gone wrong. One was that of a woman whose tummy tuck scar broke open and resulted in months of gruelling procedures to repair the damage. The other was that of a breast implant which caused such an infection that the woman ended up at the level of a mastectomy patient, requiring painful reconstructive surgery.
"The psychological damage to that patient was excessive," he says. They were just two examples of the kind of damage that Mr O'Donovan and his colleagues continue to deal with. And while the country may be in the throes of a worldwide economic meltdown, the Irish taxpayer is footing the bill for all those cases who end up in public hospitals for repair operations.
"The problem was that during a period of economic growth, the cosmetic surgery business expanded exponentially and when these new problems arose, we didn't have the necessary regulations in place to deal with them," says Mr O'Donovan. "We missed the boat."
The IAPS proposed a set of guidelines which have been endorsed by the Medical Council and the College of Surgeons, "but we still don't have the legislation or the regulatory body, and neither are there resources to police private clinics," says Mr O'Donovan.
"Once you have a basic medical degree you need no specialist qualification in order to perform plastic surgery. A GP could do a breast augmentation in the morning, even though he had never seen it done or performed one -- and that is perfectly legal. IAPS members are trained in plastic, reconstructive and aesthetic surgery. Other people carry out procedures despite having no formal qualifications." One major concern of the IAPS is that of surgeons being flown in from abroad by private clinics and simply flying home after performing a procedure. "You would expect any other surgeon to be resident in the country in which he is practising," says Mr O'Donovan.
"Yet private clinics are shipping in surgeons who are not around when the patient needs aftercare, or complications arise. Some say their doctors are specialists, but they don't say what they're specialists in. For instance, a doctor performing breast surgery could, in fact, be a bowel specialist."
Conversely, while doctors fly into Ireland to perform procedures, cosmetic tourists continue to travel abroad for plastic surgery that costs a fraction of the price here, but this can be a risky business as was highlighted last month when a French doctor accused of mutilating 96 women in botched procedures was sentenced to four years in jail and fined €75,000.
Michel Maure, who called himself "the greatest plastic surgeon in the world," was qualified as a medical doctor, but had no training as a plastic surgeon, yet he carried out a number of procedures at cut-price rates from a derelict building.
Investigators found that he had treated his patients with expired drugs and illegal animal-based sutures. Many of his patients were left in agony or disfigured. "All I can say is that cosmetic surgery is not something to get because it's cheap," says Mr O'Donovan.
For the ordinary lay person, choosing a doctor for any cosmetic work is a minefield. A consultation with a 'cosmetic doctor' may sound reassuring, but "a cosmetic doctor is not a dermatologist," warns Dr Coleman who studied seven years in dermatology after eight years studying and practising general medicine.
"The cosmetic doctor may be just out of medical college and has done a Botox course for an afternoon." The Irish Association of Cosmetic Doctors, a body representing 22 practitioners, begs to differ, however.
According to its spokesperson, Dr Patrick Treacy, "A dermatologist tends to deal with skin disease whereas a cosmetic doctor usually deals with skin aesthetics. There is often a crossover and a cosmetic doctor usually has higher dermatology qualifications."
'Doctors differ and patients die' goes the old saying, but in the world of cosmetic surgery, it's more likely they will end up trying to find reason in a baffling quagmire of confusion.
If you are thinking of these or any other treatment to enhance the way you look, the expert advice is clear -- be careful.
For non-invasive treatments, Dr Coleman recommends you ask your GP to refer you to a good dermatologist. The IACD also recommend a GP referral. For surgical options, the IAPS lists its members on its website: www.plasticsurgery.ie