Cover Story - January 27, 2006
Nip and tuck
New book warns: Be careful when choosing a plastic surgeon
by Julie Nostrand
In a crowded restaurant, a woman hikes up her skirt to show a plastic surgeon her thigh. At a private party, another corners a plastic surgeon to discuss a "private matter" regarding her nose. "Can you help?" they ask desperately. "Of course," the doctor answers with a disarming smile, "please call." A card is discreetly passed to the potential patient. It happened so many times Troi Martin lost count. But in the buyer-beware world of plastic and cosmetic surgery, these women are potentially risking more than their vanity. After working 20 years as a surgical technician and consultant to front offices in the plastic surgery field, Martin has seen it all. She readily acknowledges the fact that plastic surgery helps many women and men every year. In fact, she heartily supports pursuing plastic surgery if it means gaining self-confidence and improving self-esteem. It's the potential victimization of patients when they enter the largely unregulated world of plastic surgery that disturbs her. In the world of cosmetic surgery, beauty and youth are promised in exchange for cash with little recourse if something goes wrong. Martin, a Blackhawk resident, recently published a book, "Behind the Cosmetic and Plastic Surgeon's Mask," recounting her experiences working with local plastic surgeons. She wrote the book to focus attention on some of the questionable practices in the industry of cosmetic and plastic surgery and to warn those interested in surgical procedures of the potential dangers. Some interviewers are calling the slim hardback a "tell-all," but to Martin, it's just the facts. And while Martin encourages people to have plastic surgery, her book is loaded with cautionary tales, out-of-control egos and anecdotes that, while humorous, might make a person interested in pursuing plastic surgery think twice. The book itself doesn't talk about procedures specifically; rather it focuses on the characteristics of the professionals who work in the field. Written from notes she took while working, the book upset at least one local surgeon and he tried to stop its publication. But since Martin doesn't name names in the book or in the media, she moved forward with her message. Martin's message is simple: "I want people to keep their eyes and ears wide open while they are in the office." She said the problems in the system are endemic. Plastic surgery differs from other surgeries because it is largely elective and patients pay cash. Without insurance companies looking over their shoulders, doctors can charge any price and offer any service to clients. "That (lack of regulation from insurers) is why they are so free to do what they are going to do," said Martin. It's easy to understand how plastic surgeons fall prey to greed, she said. In this day and age where movie-star good looks and youth are glorified, people line up for a nip and a tuck. The ever-increasing demand for their services allows successful surgeons to make enormous amounts of money, and there is a temptation to sacrifice a patient's well-being in pursuit of the almighty dollar. Martin said it is common for surgeons to perform up to eight procedures in a day, with patients toward the end of the day unaware of the doctors' caseload. As a result, doctors may be hurried and tired. This over-scheduling can contribute to a doctor being rougher with patients or even more prone to make mistakes as he tires. And what if something goes wrong? "There is no bigger piranha than an attorney and a plastic surgeon together," said Martin. "They are vicious." Because cosmetic surgery is elective, the courts are unsympathetic to victims of botched procedures. If a case does go to court, it is rare for juries to find in favor of the patient. "While a jury might concede that the doctor botched the procedure," writes Martin in her book, "it will likely maintain that because the patient voluntarily chose elective surgery, she must accept all the consequences." This reality hasn't daunted Vanessa (not her real name). She is currently pursuing legal action in Contra Costa County against a local plastic surgeon. "I used this (the surgery) as something to look forward to," said Vanessa, a former model, who sought surgery on her eyes, brows and nose. She was not a novice to the medical field or plastic surgery. She is a registered nurse and had had some minor work done in the past. She thought she knew how to pick a plastic surgeon. She diligently read the doctor's Web site, studied before and after pictures, and had a recommendation from someone she knew. She even interviewed another doctor before choosing the surgeon who performed her operation. From the beginning, she knew something was wrong. While she was coming out of the surgery and still groggy from the anesthetic, she asked the doctor if he completed the work on her nose as agreed and he indicated the surgery had gone well. But during her recovery, the swelling was far worse than she expected. She had watched lots of "Extreme Makeover" shows prior to having the surgery, but was unprepared for such swelling. When the stitches came out a week later, she was mortified. The incisions were jagged, the tissues beneath the skin were not properly aligned, the implant in her nose was off center, and one scar was visible. She tried to follow up with the doctor. At first, he told her to give it more time. After she gave it more time, he offered to touch up the work. But given that she was unhappy with his technique, she was frightened to go under his scalpel again. She asked him to refund her surgical expenses and he flatly refused. When she threatened to sue, he was disinterested. In court, he sent his attorneys to represent him and they refused to negotiate. The lawsuit is still pending, but she feels she learned a valuable lesson in the process. "I have a nursing background, and I still didn't pick the right person," said Vanessa. "I just hope others read my story and don't make the same mistake I did." Martin agrees the public needs to know that bad things can happen during and after plastic surgery. She also stresses that many risks can be avoided by conducting a thorough physician search before committing to a procedure. For instance, Martin advises prospective patients to interview at least six plastic surgeons before deciding who will perform the surgery. She also advises patients to be vigilant during conversations with doctors. Many of the surgeons are slick salesmen, accustomed to up-selling patients additional procedures. If anything seems amiss or if there is a communication problem with the physician, follow your instincts and head for the door. Martin cautions patients to be realistic regarding the outcome of their surgery. While "plastic surgeons can work magic, they can't work miracles. "At least 15 percent of all patients have unrealistic expectations about the recovery and the outcome," said Martin. Many patients do not consider the post-surgical pain they will experience prior to surgery. And this can vary, depending on the surgeon. "Some surgeons are more gentle than others," said Martin. Bruising and lengthy recoveries can depend on the surgeon's techniques; so don't be shy about asking years of experience and the number of procedures performed similar to the one sought. It is also important to understand a physician's educational qualifications before signing on the dotted line. Martin said "plastic surgeons" are some of the most highly skilled professionals practicing medicine. "Cosmetic surgeons" are doctors who may have a specialty in ears, nose and throat, and later switched fields to cosmetic surgery. Fewer years of training can make a big difference in the outcome of the procedure. Finally, Martin recommends checking a surgeon's background for common offenses like drunken driving, drug offenses and pending lawsuits. While it may be a time-consuming process for patients, a trip to the courthouse could save someone a second trip to the operating table. "It says something about your surgeon if you find something," says Martin. "It happens often enough that people should check." It may be too late for Vanessa. As her lawsuit winds its way through the legal process, she is scheduling follow-up surgery with another doctor. But this time it will be different. For this surgical treatment, she thoroughly researched her doctor and found one who is very experienced, has a long history of good surgical outcomes and a clean record. She is hopeful her homework will pay off. Despite her experiences, Vanessa does think plastic surgery is a good option. "If it's going to make you feel better, lift your spirits, and it's not excessive, then I think you should do it." Tips for navigating the world of plastic surgery * Plan to interview at least six doctors before making a decision. * Write down the name of the staff member who will be making appointment for the consultation with the doctor. This will ensure questions are answered quickly and accurately. * Note if the office is operating smoothly. Try to get a sense of how the office staff treats patients after surgery. * Look for bloodstains on the doctor's clothes or shoes. While this might not disqualify a good surgeon, it may demonstrate a lack of respect for patients. * Find out who the anesthesiologist will be. If a nurse is sedating patients, scratch the doctor from your list. * Ask about the number of times the doctor has performed the surgery and ask about lawsuits filed against the doctor for the procedure sought. --From "Behind the Cosmetic and Plastic Surgeon's Mask" by Troi Martin Interview with Troi Martin Q: Is this book negative or positive toward the idea of cosmetic and plastic surgery? A: Neither, I'm very much for improving one's self, emotionally and physically. Q: What do you want your readers to know about this book? A: This book is not about different types of procedures, it is about the moral and ethical sides of many plastic and cosmetic surgeons of today. Q: Where did you obtain your information? A: I have worked with cosmetic and plastic surgeons for over 20 years, as a surgical technologist, assisting them in the operating room. A patient care coordinator working with pre- and post-op patients. And a customer service trainer for office staff. Q: Are most plastic surgeons guilty of poor moral and ethical values? A: No, the ethical surgeons do not have a problem with my book. However I had a California surgeon threatening to seek an injunction to stop the publication of the book. Q: How does your second book, "A Guide for Customer Service in the Beauty Industry," fit in with your first book? A: It helps cosmetic and plastic surgeons and their staff on ways to best service their patients. This guide was written for beauty college students, day spa staff and plastic surgery staff. Q: How many cosmetic surgery office staff have you trained? A: I have worked with over 200 doctors offices.