WASHINGTON (Reuters) – While cosmetic surgery to get a cuter nose, flatter tummy or bigger breasts may seem like no big deal to some people, patients face medical risks as they do in any surgical procedure, experts in the field said.

But another growing risk to people desiring these cosmetic operations, according to these experts, is the influx in recent years of opportunistic doctors not certified as plastic surgeons aiming to get a slice of this lucrative business.

The perils of plastic surgery were illustrated by the November 10 death of Donda West, mother of rapper Kanye West, at a Los Angeles-area hospital after she underwent cosmetic surgery.

"There’s no such thing as surgery without risk," said Dr. Foad Nahai, president of the American Society for Aesthetic Plastic Surgery, whose members include 2,400 doctors specializing in cosmetic plastic surgery.

"And I always tell my patients, ‘Please forget the word cosmetic. Remember the word surgery.’ And what I do is surgery. And surgery is serious," added Nahai, who performs face-lifts, nose surgery and other procedures in his Atlanta practice.

Cosmetic surgery is basically a cash business — health insurance companies typically do not cover elective beauty makeovers. And demand has never been higher, with U.S. television shows like "Dr. 90210" and "Extreme Makeover" helping to publicize and glamorize the business.

More than 1.8 million surgical cosmetic procedures were performed in the United States in 2006, led by breast augmentation (329,000), nose reshaping (307,000), liposuction (303,000), eyelid surgery (233,000) and tummy tuck (146,000), according to the American Society of Plastic Surgeons.

Including things like wrinkle-fighting Botox injections and laser hair removal, the 6,800-member society counted nearly 11 million cosmetic procedures in 2006.


Leaders in the field expressed alarm over a crossover of doctors into cosmetic surgery who are not certified by the American Board of Plastic Surgery but are attracted by the allure of money and freedom from insurance companies.

Thus, gynecologists, family doctors, oral surgeons and others are entering the field with scant expertise in plastic surgery, sometimes with weekend training courses.

"They worry me tremendously," said Dr. Richard D’Amico, president of the American Society of Plastic Surgeons.

A study by Los Angeles plastic surgeon Dr. Geoffrey Keyes presented at a conference last month tracked about 1.1 million U.S. outpatient procedures at accredited facilities from 2001 to 2006 and found 22 deaths, 12 caused by blood clots.

D’Amico said he did not know of statistics on uncertified plastic surgeons working at unaccredited facilities.

"If somebody is practicing within the scope of their specialty, they’re board certified and they’re providing services within an accredited or licensed facility, the safety issue becomes tremendously good," Keyes said.

"But when you have people who are not trained — for example, non-surgeons — doing extensive procedures, sending patients home without any monitoring or oversight, that’s when you can have problems," Keyes added.

D’Amico offered three rules to minimize risk:

— pick a surgeon certified by the American Board of Plastic Surgery, which requires a doctor to graduate from an accredited medical school, have certain plastic surgery training and pass comprehensive exams;

— if the surgery takes place outside a hospital, pick a properly accredited or licensed facility;

— and patients must be thoroughly evaluated to ensure they are healthy enough to get through an operation, with checks for heart issues, diabetes or a history of blood clots.

Montclair, New Jersey plastic surgeon Dr. Valerie Ablaza said it may be unwise for doctors to perform multiple cosmetic procedures all at once in order to minimize a patient’s risk.

"Let’s remember we have to be safe here. We’re not buying a car. This is about your health and about your body," said Ablaza, co-author of the book, "Beauty in Balance: A Common Sense Approach to Plastic Surgery and Treatments."