Fatal Beauty: Before Cosmetic Surgery, Patients Should Do Their Homework by Gina Shaw It was a classic New York ironyóof the deadly kind. Author Olivia Goldsmithómost famous for her ìdonít get mad, get everythingî novel ìThe First Wives Club,î in which scorned wives of a ìcertain ageî wreak revenge on the men who left them for younger womenódied in January after complications from anesthesia during cosmetic surgery to remove loose skin under her chin. More than 870,000 people underwent cosmetic surgery procedures in 2003, a 6.7 percent increase from 2002, according to the American Academy of Cosmetic Surgery. Breast augmentation was up 8.5 percent, and liposuction, the most popular surgical procedure, was up 6.3 percent. Noninvasive cosmetic procedures, such as Botox and microdermabrasion, jumped by 11 percent. ìRealityî shows such as ìExtreme Makeover,î ìI Want a Famous Faceî and FOXís ìThe Swan,î in which surgeons transform women who then compete in a beauty contest, make cosmetic surgery seem like just a really expensive day at the spaóthe next step in making yourself the most beautiful that you can be. But as more and more of us decide to take the ìmakeoverî concept to the next level, itís important to r emember that, as in Goldsmithís case, getting liposuction, a chin lift or even a simple Botox injection doesnít come without risks. Shortly after Goldsmithís death, a Tampa-area ABC affiliate reported that five people had died at Florida plastic surgery centers within the past seven months. Complication rates for cosmetic procedures vary by the type and complexity of the surgery, and whether or not general anesthesia is involved. (Anesthesia always adds its own risks to any surgery.) The risks are generally considered to be quite low when proper precautions are taken: A national survey done at Wake Forest University Baptist Medical Center published last year in Dermatologic Surgery found only 13 adverse outcomes (patient injuries or deaths) in office-based cosmetic surgery centers between 1999 and 2001. But as Goldsmithís case makes clear, the worst does sometimes happen. One way to ensure that your cosmetic procedure as safe as it can be is to make sure itís done in a facility that has been accredited by organizations such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). A 1997 study found that in these facilities, the rate of serious complications from cosmetic surgery was less than half of one percent, and the mortality rate was only one in 57,000 cases. The American Academy of Plastic Surgery recommends that you also ask any cosmetic surgeon the following safety-related questions: Are you certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada? Do you have hospital privileges to perform this surgery, and if so, at which hospitals? How many procedures of this type have you performed? Where and how will you perform my surgery? What are the risks involved with my procedure? How long of a recovery period can I expect, and what kind of help will I need during my recovery? When physicians take your medical history, be sure to tell them everythingóany serious medical problems you have had, previous adverse reactions or allergies to any type of medications, what medications youíre currently taking (including things you may not think of, like birth control pills, which can affect clotting, as well as herbal remedies and supplements), whether you smoke cigarettes, and whether you drink regularly or use illegal drugs. All of these factors can affect your risks during surgery, especially if youíre undergoing anesthesia. Donít be less vigilant about a practitionerís qualifications just because youíre undergoing a simpler procedure, such as Botox or Restylane. Injectables like these are still medical procedures and should be administered by a qualified physicianóso, yes, this means rethinking that Botox party. ìA casual social activity for the purpose of administering botulinum toxin is an inappropriate and a potentially dangerous setting for performing medical procedures of any kind,î said Dr. Fred F. Castrow II, president of the American Academy of Dermatology. ìAdding alcohol to the mix is a bad idea for a number of reasons, especially since bruising can be intensified. As with any medical procedure, the possibility of adverse effects occurring from a botulinum toxin injection is always a possibility. Patient safety comes first and should not be taken lightly under any circumstance.î All of these precautions, although essential, donít absolutely guarantee a safe outcome. Goldsmithís surgery, for example, took place at the Manhattan Eye, Ear, and Throat Hospitalóconsidered one of the best hospitals in the city. (Her death and another less than a month later at the same hospital are still under investigation.) ìIf you look at the data from Florida, the one state where they do collect fairly comprehensive data on adverse events, most of the adverse events occur in the offices of physicians who are board certified; most of the adverse events occur in the offices of physicians who do have hospital credentials,î said Dr. Steven R. Feldman, a dermatologist and co-author of the Wake Forest study. ìRequiring physicians to get those credentials doesnít seem to answer the real question.î So are the risks of a tummy tuck or an eyelift or chin implants worth the reward? Only you can make that decision. But donít ìSwanî-dive into plastic surgery without doing your homework. Gina Shaw is the medical writer for The Washington Diplomat.