Debate ensues over uncertified doctors’ role in growing field

By Elizabeth Owens-Schiele, Special to the Tribune

December 28, 2011
Lucia Williams decided as she approached her 40th birthday that it was time for a tummy tuck and breast enhancement.

The northwest Indiana resident chose a doctor who came highly recommended by a co-worker. But after the surgery, performed at a outpatient clinic in Chicago, Williams passed out in the shower at home. Her husband rushed her to the emergency room, where she was diagnosed with septic shock and airlifted to the intensive care unit at the University of Chicago Medical Center. Later, doctors removed her breast implants and skin flaps left over from her tummy tuck.

Williams recovered but was left with scars and recurring skin rashes. Dr. David H. Song, who was among those who treated Williams at the University of Chicago, stressed that the complications she suffered from the earlier procedure are extremely rare.

Still, Song points to Williams’ case as an cautionary tale because the doctor who performed her initial procedure was not a board-certified plastic surgeon. Williams, too, said she regrets not doing more research before choosing a doctor. (A lawsuit she filed against the physician was later dismissed by a judge.)

Though Williams’ procedure was several years ago, more doctors who are not plastic surgeons are offering cosmetic procedures. From dentists and obstetricians administering Botox to general surgeons offering breast implants, many doctors say it provides a steady cash income without the bureaucratic hassles and often-delayed reimbursements from insurers or the government.

Song, chief of the plastic surgery section at the U. of C. Pritzker School of Medicine, said he believes nonspecialists shouldn’t perform any cosmetic procedures.

“You wouldn’t go to your plastic surgeon to get your baby delivered or screened for cervical cancer or to get a Pap smear,” Song said. “It takes six years to be a board-certified plastic surgeon, and we learn the intricate anatomy of the face and the nerves. … We have more training and are in the best position to do these types of procedures.”

Yet other doctors say there’s a safe middle ground. They make a distinction between relatively minor procedures like wrinkle-smoothing injections and riskier and more invasive procedures like weight-loss surgeries.

Progressive Care for Women is an obstetrics and gynecology clinic in downtown Chicago that also offers cosmetic procedures like laser hair removal and spider vein treatments.

“So many of our patients ask about (Botox) and it’s very easy and low-risk,” said Dr. Michele Hakimian, one of the clinic physicians. “I even know an internist, an ER doctor and (others) doing Botox as well. A lot of it came about because of health care changes, and a lot of doctors seek cash services so they don’t have to deal with managed care.”

Several Chicago-area OB-GYN doctors said some cosmetic offerings are a natural outgrowth of their primary work, since, after a pregnancy, women sometimes complain about spider veins, cesarean section scars and the unwanted hair growth from menopause-related hormone treatment.

“There’s a huge demand for services for anti-aging and beauty treatments,” Hakimian said. “(Our patients) trust us because we’ve been with them for so many years of their life.”

Two of the clinic’s patients, Pam Farley, 45, and Kiran Ionita, 33, separately said they prefer to have cosmetic procedures done in a doctor’s office rather than at a hair salon or spa.

“A lot of places in the city, the spas, will give you raspberries and champagne and music. I don’t want all the fluff,” said Ionita, a schoolteacher who said she spends about $300 a month on services like laser acne treatment and facials.

Dr. Joel Polin, who wrote a position paper for the American College of Obstetricians and Gynecologists on OB-GYN doctors performing cosmetic procedures, said he believes only a small fraction of the professional association’s 35,000 members perform such procedures.

“I think if they are trained to do them and they want to do them and their patients want to do them, they should do them,” Polin said.

Still, the position paper also addresses ethical concerns and standards. Polin, a professor of obstetrics at Temple University School of Medicine in Philadelphia, said gynecologists should not suggest cosmetic procedures to patients but merely provide information when requested. Such procedures shouldn’t be aggressively marketed beyond small signs or pamphlets in a doctor’s office that patients can “look at … or reject,” he said.

Many such signs and brochures come directly from drug manufacturers. A representative of Allergan, the manufacturer of such beauty products as Latisse for eyelash enhancement, Botox and Juvederm facial fillers, said while any licensed doctor can order or prescribe its products, the company hasn’t seen a significant increase in OB-GYN offices offering such treatments.

Allergan “is committed to providing physician education and training on our facial aesthetics product portfolio and to advocating that consumers go and seek consultation from a trained and qualified doctor to ensure optimal patient outcomes,” spokeswoman Heather Katt said in a statement.