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.

More News About Questionable Procedures or Practitioners

Now both National Public Radio (NPR) and the web company WebMD are alerting the public to concerns about a group of procedures called "injection lipolysis." Other names used in marketing are; lipodissolve, lipozap, mesotherapy, lipotherapy or fat melting. They use a variety of chemicals, but these lack FDA approval for that usage. Quality scientific studies have not been done to prove safety and effectiveness. Proponents have claimed liposuction-like results without surgery.

The FDA contacted several US companies promoting these treatments and warned them to cease. It also notified a Brazilian company about their web marketing.

You can get more information at:

http://www.npr.org/blogs/health/2010/04/lipodissolve_gets_fda_warning.html

http://www.webmd.com/skin-beauty/news/20100407/fda-cracks-down-lipodissolve-hype

Increasing Interest in Breast Augmentation

Breast Augmentation in one of the most commonly requested plastic surgery procedures, nationally and in our experience at the Aesthetic Center for Breast & Cosmetic Surgery. (We are also known for facial & body cosmetic surgery)

We are noticing an increased level of interest among our new and established patients. More phone calls. More e-mails. More questions in person. We are happy to answer the full variety of questions; from price to discomfort, from size to recovery.

Almost everybody has something planned this Spring. Something they're looking forward to. To looking their best in Spring & Summer attire. We find these patients enjoyable, positive & very happy with their breast enhancement results. Call or e-mail us if we can help.

info@expertplasticsurgeon.com
864-676-1707

Dr. Graham is one of the areas most experienced breast enhancement surgeons. He has a strong reputation for his interested & caring manner, his emphasis on safety & comfort, and finally beautiful & natural-looking results for his patients.

Plastic Surgery Top Ten: 2000 decade's biggest trends

2010's start gives us the perspective to look back over the decade of 2000 and decide what the most important trends were in plastic surgery. The publication Plastic Surgery News did this in their Jan/Feb issue and here is their list:

10) MEDICAL TOURISM increases and raises the concern about sacrificing quality for cost.
9) Increased OFFICE-BASED COSMETIC SURGERY -- now chosen by the majority of patients over a hospital or out-patient multi-use facility.
8) Increase in MAJOR WEIGHT LOSS patients, following gastric bypass or other bariatric surgery.
7) POLITICAL ADVOCACY for plastic surgery, including stopping the national cosmetic procedure 5% tax from Washington and various state bills.
6) Stressing HIGH STANDARDS. After high profile deaths including Kanye West's mother Donda, and the author of First Wives Club Olivia Goldsmith, the media and the public became more interested in the message of quality & safety repeated by the American Society of Plastic Surgery.
5) Hyaluronic acid SOFT TISSUE FILLERS (Restylane, Juvederm, etc.) and others became available, offering patients new options for facial aesthetic enhancement. The injectable products influenced many non-plastic surgeons to become cosmetic physicians (outside their primary specialty).
4) BOTOX became FDA approved for cosmetic use in 2002 and launched a major trend in non-surgical cosmetic medicine. Dysport continued the trend and PurTox and Xeomin await FDA approval in 2010.
3) "REALITY TV" found millions of viewers eager for plastic surgery entertainment, and spawned several copycat series. Plastic surgeons saw a new openness and interest among patients.
2) SILICONE GEL implants were allowed back by an FDA decision in 2006. Long-term studies of newer models are underway.
AND FINALLY...
1) FACE TRANSPLANTATION becomes a reality. Two such procedures have been performed in the US, and several others overseas. Victims of our recent wars may be the next major area for this marvelous reconstructive work.

We can only hope that the next decade will bring as many wonderful and exciting advances to plastic surgery, so that we have even more to offer our patients.

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

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

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.

In The News: MedSpa Regulations

Here at the Aesthetic Center we maintain high standards and limit the use of lasers to our experienced, licensed medically trained physician and nurse practitioner. Here is what's happening elsewhere in the country:

New Standards Urged For Treatment at Spas Use of Chemicals, Lasers Proliferates Boston Globe (2009-02-24) P. A1; Kowalczyk, Liz

A task force of lawmakers and physicians are fighting to create tougher regulations regarding medical spas in Massachusetts. The medical spa industry is growing; the number of spas has grown to 2,500 in the United States over the past few years. The group argues that consumers are at risk of injury because they are being treated by untrained and unlicensed workers. Jeffrey Dover, a dermatologist, says that the most common injury is caused by workers using the wrong laser or setting to get rid of body hair, which causes the removal of skin pigment as well. The proposal states that medical spas would be required to have a license from the Department of Health, and laser skin treatments would have to be done by a specially trained doctor or nurse. Medical spas are difficult to create legislation for because there are so many specialties, such as cosmetologists, electrologists, aestheticians, nurses, and physicians, within one business. Each specialty has its own rules and standards, so there are no laws about which professional can do which procedure. Owners of medical spas are split over whether they want their businesses to be regulated.

http://www.boston.com/news/local/massachusetts/articles/2009/02/24/new_standards_urged_for_treatment_at_spas/
http://www.expertplasticsurgeon.com/html/laser.html

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.