Accreditation, Board Certification, State Regulation: Elements in Safe Office Based Surgery

Patient safety in surgery has long been important in the lengthy education and training of surgeons. Plastic surgeons typically have 4 years of medical school, 5 years of general surgical residency and additional years of plastic surgical residency or fellowship. The American Society of Plastic Surgeons is a national organization that emphasizes patient safety in many ways. One of them is the requirement for ongoing specific patient-safety education, another is the requirement that member surgeons only operate in accredited surgical facilities.

ACCREDITATION is the process which recognizes that the facility meets detailed standards. The process is similar to that for hospitals and out-patient surgical centers, but tailored to the size and scope of the office facilities. The process includes complying with standards (architectural, equipment, staffing training, reporting, etc.). Our center is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF.org). JCAHO, AOA and AAAHC are other similar organizations. As of 2007 South Carolina state law requires accreditation by one of these national organizations.

BOARD CERTIFICATION is a voluntary process of evaluating a physician's education and training. Members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery are required to maintain board certification. Dr. Graham achieved board certification in plastic surgery in 1992. He exceeds continuing medical education standards in his specialty. Patients treated in our office surgical facility have the additional benefit of a board certified MD anesthesiologist for their procedures.

STATE REGULATION has been encouraged by the American Society of Plastic Surgeons, as they believe patient safety will be enhanced. The South Carolina State Board of Medical Examiners put in place state regulations several years ago, but these were strengthened when full accreditation was required for all medical offices providing general anesthesia or deep sedation (level II & III facilities). Regulations are contained in statue Chapter 81-96. Additional regulations are produced by DHEC.

Breast Lift Quality in South Carolina; With or Without Implants

Sutton Graham, MD, FACS has an excellent reputation in our region for quality breast lift (mastopexy) surgery.

We have the pleasure of treating a variety of women seeking breast lift. For example, many women are healthy and active following child-bearing and breast-feeding. They look good in many of their clothes, but need effective bra support to maintain attractive breast shape. They have trouble wearing bathing suits, sundresses, plain tee-shirts, gowns and evening wear; all because they feel they need good support.

Breast lift can change that. You can look better when your outfit is braless, or look even better wearing a bra. Firm support will be unnecessary. Finally, after a breast lift, you will find that sports bras give you more effective support and comfort when jogging, playing tennis, or other vigorous sports.

Another common breast lift patient is a woman who has succeeded in loosing considerable excess weight. She may have done this by diet & exercise, or weight-loss (bariatric) surgery. While she may be pleased with her slimmer physique, she may report dramatic loss of breast shape. Mastopexy breast lift is capable of removing large amounts of loose skin, while preserving all natural breast glandular tissue.


Many breast lift patients want a lift and a larger breast size. Mastopexy is often combined with augmentation (implants). This can give an excellent youthful look to your breasts. It can restore pre-pregnancy breast size and shape. Or it may improve on what you already have.

Breast lift operations are designed to preserve your nipple and areola sensation. There may be temporary decreases, but normal sensation usually returns, with most procedures. Similarly, women usually maintain the ability to breast-feed, although breast lift is not commonly indicated before having children. We will recommend the procedure that gives you the least scar, most effective improvement, and maintains safety. We usually recommend 5-7 days off work, and 3 weeks before resuming exercise work-outs. We'll advise you about shopping for new bras, etc. Breast lift plus tummy tuck or liposuction may be referred to as a "mommy make-over."

Our procedures are performed in our nationally accredited office surgical facility, with a board-certified physician (MD) anesthesiologist. Our nurses and staff are very experienced in caring for and advising breast lift patients, and they'll make your recovery smooth. We think you'll say we provide the best surgery experience you'll ever have.

For more information, check our website http://www.expertplasticsurgeon.com/html/breast-lift-reduction.html#breast-lift. There you'll find an extensive before & after photo gallery. You'll also find a link to our E-mail (info@expertplasticsurgeon.com). We would love to hear from you!

Sutton Graham, MD, FACS is an experienced board-certified plastic surgeon specializing in breast and cosmetic surgery. The Aesthetic Center serves patients throughout South Carolina, North Carolina and Georgia.

Cosmetic Surgery Safety: California requires pre-op medical clearance ("Donda West Law")

Dr. Graham has emphasized safety and patient comfort for almost 20 years performing cosmetic surgery. Our patients receive thorough medical history evaluation and perioperative teaching, appropriate physical examination, and evaluation of our physician anesthesiologist prior to surgery. We contact our patient's primary care doctors, and occasionally cardiologists, to request relevant health information prior to surgery. This is nothing new.

Following an unfortunate well publicized tragedy in California, a local legislator held a public contest to request suggestions for laws. As a result her law requires a preoperative medical evaluation by a physician before cosmetic surgery.

Excerpt: "Governor Arnold Schwarzenegger signed into law on Oct. 11 legislation authored by District 62 Assemblymember Wilmer Amina Carter that would requires a health check and a written clearance before being allowed to undergo plastic surgery. Assembly Bill 1116, named the Donda West Law, was inspired by the death of Kanye West's mother. The bill came as a result of her 62nd Districtwide contest, "It Ought to Be a Law." "This law will potentially saved lives," Assemblymember Carter said. "There is a growing trend of people opting to have elected cosmetic surgery, and they are not aware of the risks involved." Specially, the law requires physicians and surgeons, including people licensed by the state holding permits to perform elective facial cosmetic surgery to complete a physical examination including a complete medical history on their patients, prior to performing elective cosmetic surgery"

For the complete article see: http://democrats.assembly.ca.gov/members/a62/newsroom/20091014AD62PR02.htm

The text of Assembly Bill 1116 follows:

http://info.sen.ca.gov/pub/09-10/bill/asm/ab_1101-1150/ab_1116_cfa_20090504_131942_asm_comm.html

Accreditation standards for Office Surgical Facilities and hospitals routinely require pre-operative medical history taking and physical examination. All surgeons that are members of the American Society of Plastic Surgeons (http://www.plasticsurgery.org/) are required to only operate in accredited facilities. For more information on our quality and safety see our website, http://www.expertplasticsurgeon.com/html/about.html#nationally-accredited-facilities

Q: What are you board certified in? A: Plastic Surgery

Patients seeking cosmetic surgery from a plastic surgeon should realize that many other types of licensed physicians perform cosmetic procedures, even surgical procedures. In addition to reputation and recommendations from your trusted physicians, you may want to confirm that the doctor you plan to see is board certified in plastic surgery.

The American Board of Medical Specialties (http://www.abms.org/) is our nation's most respected and established organization that oversees board certification. It only approves 24 medical specialty boards. There are hundreds of additional organizations that issue "board certifications" without meeting to high standards of the ABMS. Patients can check their prospective doctor on the ABMS website.

“Any doctor who has graduated from medical school, fulfilled residency requirements, and has been licensed by the state in which he or she practices, can set up an office and practice medicine, even in a specialty for which he or she has not trained,” Dr. Weiss said. “An ABMS Member Board certified doctor ––has participated in a voluntary training and assessment process that demonstrates knowledge and skill in their chosen specialty/subspecialty beyond the basic licensing requirements.” To read the full article, check

http://www.abms.org/News_and_Events/Media_Newsroom/Releases/release_HowToSelectADoctor_07022009.aspx

Sutton Graham, MD, FACS in certified by the American Board of Plastic Surgery, the only board granting unrestricted certification for cosmetic surgery (face, breast & body). He is a member of the American Society of Plastic Surgeons (http://www.plasticsurgery.org/), the American Society for Aesthetic Plastic Surgery (http://www.surgery.org/) , and he earned a Certificate in Advanced Education in Cosmetic Surgery. He is a Fellow of the American College of Surgeons (http://www.facs.org/).

Dr. Graham has over 19 years of experience in plastic surgery, practicing in Greenville, SC. He serves patients from throughout Upstate and central South Carolina, Western North Carolina, and NE Georgia. Occasionally, patients come from a distance. We specialize in aesthetic / cosmetic surgery of the face, breast & body.

Nationally Accredited Office Cosmetic Surgical Suite

One of the benefits of our location on Halton Road, Greenville, SC is a clean, modern, spacious, and specially equipped Cosmetic Surgical Facility. It operates under the name Plastic Surgery Specialty Center, PA, and is overseen by Dr. Sutton Graham. The head nurse is Cathy Cole, RN, CPSN (registered nurse, certified plastic surgery nurse).

Our facility anesthesia is only delivered by Dr. Merritt Tolan, board-certified anesthesiologist with years of experience, and a wonderful caring manner. Tina Kraus, RN is our recovery nurse, and brings years of hospital recovery experience. Dr. Graham's surgical assistant is Terri Scott, CST (certified surgical technologist).

Our location features a specialized office surgical facility, with over 2,000 square feet that are designed and engineered to national accreditation standards. Our facility offers outstanding patient safety as well as comfort and privacy, and includes the following features:
Convenient and private entrance/exit
Sterility and infection control
Patient and blanket warming equipment
High-temperature in-house laundry facilities
Dedicated OR Nursing Director
Certified medical gas system
Experienced Anesthesiologist (physician)
Electronic patient monitoring equipment
Back-up power generator
High-efficiency OR air filtration system
Instrument processing and sterilization rooms
Monitored recovery spaces
Our Patients Experience the Difference
Unlike a typical hospital or multi-specialty surgery center, our facilities are used only for cosmetic surgery procedures. We do not have many different surgeons treating all types of unrelated procedures and diseases. Our accredited, on-site facilities are used only by cosmetic surgeon Sutton Graham, M.D., and each member of our staff really understands the unique needs and concerns of cosmetic surgery patients. Our specialized facilities and expertise helps ensure the quality and safety of each surgical procedure. In addition, we have carefully designed a number of protocols to optimize the postoperative recovery of each patient. Every patient is educated and given detailed information in advance.
To learn more about what sets our practice apart from others in Greenville, including our cosmetic plastic surgeon and nationally accredited facilities, please contact the Aesthetic Center for Breast and Cosmetic Surgery today.

Procedures performed include: Breast augmentation, breast reduction, breast lift, nipple & areola corrections, replacement of breast implants, correction of implant problems, facelift, cheeklift, necklift, browlift, eyelid lift (blepharoplasty), chin implant, fat grafts for lips / cheels / nasolabial grooves, tummy tuck abdominoplasty, liposuction, thigh lifts, arm tucks (brachioplasty), and others.

Patients come to us from throughout our region and beyond. (North Georgia, South Carolina, North Carolina). For example: Greenville, Spartanburg, Anderson, Easley, Pickens, Seneca, Clemson, Pendleton, Piedmont, Tryon, Landrum, Greenwood, Hartwell, Newberry, Clinton, Asheville, Hendersonville, Flat Rock, Brevard, Highlands, Cashiers

Safe Surgery in the News

Recently the Wall Street Journal ran an article stressing the importance of safety and accreditation in office-based surgery (including cosmetic surgery). (July 21, 2009) We couldn't agree more.

The article highlights that many facilities lack oversight, regulation, etc. Potential patients should be aware that the American Society of Plastic Surgeons saw the importance of facility accreditation several years ago. The ASPS requires that all of its members only operate in accredited facilities. Members are also board-certified in plastic surgery.

Our office surgical facility was carefully designed from the outset with safety in mind. It has been nationally accredited from the beginning by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). This includes annual review, on-site visits, staff training and certification, back-up equipment and safety systems. Our facility meets or exceeds state laws and regulations. All anesthesia is performed by our board-certified MD anesthesiologist. All OR nursing and physician personnel are Advanced Cardiac Life Support certified (ACLS). http://www.expertplasticsurgeon.com/html/about.html#nationally-accredited-facilities

http://online.wsj.com/article/SB10001424052970203946904574300971306299860.html

Finding A Good Plastic Surgeon: Article in LA Times

See a recent article in the Los Angeles Times http://www.latimes.com/features/lifestyle/la-ig-plasticsurgerybox19-2009jul19,0,1952565.story

Teaching nurses about safe out-patient surgery

On Monday April 27th Dr. Graham and his staff are hosting an educational seminar for the Association of Operating Room Nurses (AORN) Piedmont Chapter. This is a nursing professional organization specific to OR nurses, most of them hospital-based.

We will provide education about office based surgery including national accreditation, safety standards, back-up systems, peer review, advanced cardiac life support training, and finally specific facial, breast & body cosmetic procedures.

This seminar is an element in required continuing nursing education.