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.

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.

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

Safe, Experienced Injectables (Juvaderm,Restylane,Botox,etc.)

We want patients to have a great experience, whether they need standard facial rejuvenation surgery, some type of mini-lift, or enhancement with injectables such as Juvaderm, Restylane or Botox.

We recommend you do your homework. Ask about certification by the American Board of Plastic Surgery or the American Board of Otolaryngology (with Certificate of Added Qualifications in Facial Cosmetic Surgery) for surgical procedures. Ophthalmologists should also be experienced around the eye area.

Recently, doctors from all unrelated specialties have been attracted to cosmetic surgery (ie. Emergency Medicine, Obstetrics and Gynecology, Internal Medicine, General Surgery, etc.). When you find a "Medical Spa" or "Cosmetic Medicine" practice, inquire about the board certification and experience of the physician. If other personnel will be performing your injections (nurse[RN], nurse practitioner [NP-C], esthetician [non-medical] or technician [un-licensed]) you need to know even more.

Dr. Graham and Janice Sarrer NP-C have excellent background and specific additional injectable training.

The Physicians Coalition for Injectable Safety was set up by reputable organizations to promote public safety. See their site at http://www.injectablesafety.org/. They have videos and quality information. There is additional info on our site http://www.expertplasticsurgeon.com/html/injectables.html

Office Plastic Surgery & Anesthesia Safety

The safety of both anesthesia care and surgical procedures has improved greatly in the past 25 years. The number and complexity of out-patient surgery across all surgical specialties has increased several fold. All surgery involves risks, but risk reduction is accomplished in many ways.

In 2007, according to the American Society of Aesthetic Plastic Surgeons, 54% of all cosmetic procedures were performed in office surgical centers, and another 28% in out-patient surgical centers. That leaves only 17% having been done in hospitals. Surgical procedure statistics showed 8% increase from the prior year. (http://www.surgery.org/)

National accreditation is one important assessment of the dedication and quality of a office surgical facility. The American Association for Accreditation of Ambulatory Surgical Facilities evaluates our facility(http://www.aaasf.org/). We undergo annual assessment requiring 100% compliance, including periodic inspection. The criteria are numerous, but include preoperative medical screening, availability of emergency equipment and medications, and advanced life support certification. These address some of the questions raised by recent media & public concern over safety issues in Florida, California, and NYC.

We offer full-time board-certified physician anesthesiologist care, in addition to our board-certified plastic surgeon. All our anesthesia is personally done by the anesthesia doctor. Dr. Graham concentrates on your surgery and is not responsible for also supervising a nurse anesthetist. Safety is an attribute of our practice. For other ways in which our practice is different, read our new website.

Update July 16, 2008. See the link http://www.plasticsurgery.org/media/press_releases/July08-PRS-PatientSafety.cfm

Botox - Patient Awareness

The TV news and popular magazines have mentioned an intrest group's request that the FDA increase scrutiny of botulinum toxin use. The FDA records show several deaths from non-cosmetic uses of Botox. The examples mentioned include reducing muscle spasticity caused by cerebral palsy. There were no initial reports of deaths from cosmetic use.

Safety is very important. Importantly, the public needs to be reminded that they should seek qualified, experienced physicians for their treatments. They should expect adequate review of their medical history, discussion of risks, and a properly equiped medical office setting (no "Botox parties"). Board certification in Plastic Surgery, Dermatology or Ophthalmology are good starting points. Ask more questions.

O.K. to Question Your Surgeon

Since the unfortunate death of Kanye West's mother, the media is catching on. We have advised patients to ask about cosmetic surgeon credentials and experience for a long time. The Wall Street Journal (Jan 9, 2008) ran an article "Learning to Ask Tough Questions Of Your Surgeon," emphasizing the American College of Surgeon's new patient's guidebook. (http://www.facs.org/)

In plastic surgery you can confirm board certification through http://www.abms.org/ (the American Board of Medical Specialties). We are happy to discuss our experience with patients. Just ask.