It is a reality that in the 21st century one of the main concerns of Western society is the physical appearance that manifests itself through the constant search for dietary advice, gyms, extreme diets to maintain the perfect body, beauty clinics that claim to deal with all kinds of procedures promising to achieve standards of beauty that do nothing other than put at risk the lives of patients. This situation has made plastic surgery an attractive business for non-certified health professionals with poor and untrained knowledge in this field. For these reasons it is important to carry out a conscious and meticulous search when deciding to perform an aesthetic procedure.
In 2009, The international Society of Aesthetic Plastic Surgeons (ISAPS) reported the performance of 8.5 million procedures of plastic surgery in the world, which escalated to to 11.5 million in 2017.
Statistics done by the ISAPS estimate there are 40,000 plastic surgeons in the world and that 50% of them are distributed around the United States, Brazil, Mexico, Germany, Spain, Colombia, Italy, Venezuela, Argentina, and Iran. Putting Latin America at the top of the list when it comes to performing plastic surgeries.
12,000,000 procedures are currently performed by surgeons certified by ISAPS. It is estimated that for each certified plastic surgeon there are 2-3 doctors who, without certification, perform aesthetic surgeries. Which is extremely alarming since it is not only impossible to make statistics of the procedures performed but also reduces the regulation of these and the implementation of security measures.
Despite these limitations it is known that the most performed plastic surgery is the liposuction followed by breast augmentation, blepharoplasty, abdominoplasty, and rhinoplasty. The first three represent 50% of the total of all plastic surgeries reported. Liposuction, despite representing only 20% of all surgeries performed in the world, accounts for 90% of all complications and mortality in patients undergoing the procedure. This surgery is also the most performed by aesthetic doctors, not plastic surgeons, who don’t know much on how to handle and correct these complications thus raising the mortality rate.
The main cause of death is a poor management of anesthesia, this is not equivalent to having a bad anesthesiologist, but to the fact of omitting the participation of one during the procedure, a situation that is more common when performed in clinics where the patient is cared for. Adequate anesthesia, often applied by the same aesthetic doctor, which limits further the management of complications. The second cause is pulmonary thromboembolism, which is caused by a pulmonary artery obstruction due to a thrombus linked to risk factors specific to each patient and the prolongation of surgery. The third cause of death is due to perforation of a hollow viscera and to secondary peritonitis.
In 2010, Dr. Foad Nahai, former President of ISAPS, developed the Diamond Patient Safety Project, which describes 4 essential requirements that must be required in a safe plastic surgery for the patient:
By ensuring that these 4 requirements are met, you will optimize your safety and the success of your surgery.
Today it is known that 70% of plastic surgeries are performed in the surgeon’s office, which has opened a debate in the medical community since one of the reasons is the decrease in cost. Between 2000 and 2004, 18 deaths from plastic surgery were reported in clinics, of which 11 were after the patients’ departure and the main cause was pulmonary thromboembolism in 70% of the 7 remaining patients, and the ones left died in the surgical act died due to poor handling of the airway and without having the minimum control required.
Although it is true that plastic surgery is in an exponential growth in procedures performed, it is also a reality that it is a disorder in terms of regulation of procedures and certification of surgeons. It is unheard of to find surgeons performing liposuctions or gynecologists performing breast augmentations so it is the responsibility of the authorities to carry out a strict monitoring and regulation of human talent and not only the surgical facilities and surgeons who are already certified.
