Sound understanding of surgical procedure a must for clients :

Well equipped hospitals, key to safe cosmetic surgery

By Carol Aloysius

Cosmetic or aesthetic surgery has become a hot topic of discussions following the recent death of a female doctor within minutes of being administered an antibiotic injection. She is said to have visited the centre for removal of skin from the abdomen and grafting it around her eyes. Police and Health officials who raided the plastic surgery clinic housed in a private residence, found it lacked basic facilities, had outdated drugs, and untrained staff, while the MBBS qualified doctor was listed as a 'physician' which did not permit him to carry out plastic surgery.

The incident has raised several important questions: How safe are the country's growing number of clinics and beauty parlours currently performing face lifts and other beauty treatments involving surgical procedures? Who monitors them? What are the legal and ethical issues involved? How many qualified plastic surgeons work in the country? How can the public access them? Is there a National Registry of Specialists? Consultant Plastic Surgeon, Colombo North Teaching Hospital, Ragama, Dr KOLITHA KARUNADASA answers these questions in this interview with the Sunday Observer.

Q. Cosmetic surgery which is now rapidly gaining a strong market, is a relatively new field in Sri Lanka. Briefly tell us about its history. When was it introduced here? And where was it first practised?

A. Plastic surgery was first introduced to the country in 1962 and has a long course of 52 years.

Initially the surgeons were appointed and a plastic surgery unit was developed in The General Hospital Colombo( Currently the National Hospital of Sri Lanka).

Over the years the field has expanded and currently plastic surgeons are working in National Hospital, Lady Ridgeway Hospital for Children, Colombo North Teaching Hospital Ragama, Colombo South Teaching Hospital Kalubowila, Teaching Hospital Kandy, Teaching Hospital Karapitiya, and other teaching hospitals in Kurunegala, Anuradhapura, Jaffna and Batticaloa.

Q. How would you define 1) Plastic surgery 2) Cosmetic surgery?

A. The speciality of plastic surgery is that branch of surgery concerned with restoration of normal form and function. Cosmetic or aesthetic surgery is also a component of plastic surgery where body parts are surgically altered to bring about an improvement in the appearance.

In addition to cosmetic surgery plastic surgery consist of Reconstructive Surgery, Hand and peripheral nerve Surgery, Burns Surgery, Cleft and Craniofacial surgery, and Microsurgery. Cosmetic surgery and aesthetic surgery is synonymous.

Q. What is the main difference between the two disciplines?

A. Plastic surgery is the main speciality and cosmetic surgery is just a component within the main field.

All plastic surgeons are trained in cosmetic surgical procedures as well. But the terms 'Cosmetic surgery' and 'Aesthetic Surgery' are used with a sense of marketing and advertising.

Q. Are the techniques used similar?

A. Yes, it is the same speciality.

Q. Cosmetic surgery is rapidly gaining ground in Sri Lanka. Your comments?

A. The common and self perception of beauty has undergone a dramatic change in the past 40 years, culminating in a preoccupation not only with body weight, but also with the body shape. The emphasis is placed on a lean and youthful appearance by the modern society. This is largely responsible for the increased demand for the procedures designed to produce an aesthetically pleasing appearance.

Q. From your experience, are more women apt to undergo cosmetic surgery than males?

A. Yes, it is the female in any culture to seek procedures to improve their appearance. Today more males are opting for cosmetic surgery.

Q. Today, people opt for cosmetic surgery to remove age marks from their neck, lift a double chin, remove dark patches around the eyes, or a mole on their skin, or for some skin blemish. Your comments?

A. There is no harm in removing moles and birth marks and also undergoing procedures to regain shape or the contour and to be youthful. But it is essential get these procedures from the correct place and a qualified professional.

Current medical practice is guided by the evidence gained by scientific research and audit. Any medical or surgical procedure can be associated with potential problems or adverse effects, but with the advancements in the technology these are rare, and even serious complications such as severe allergy (anaphylaxis) infections (sepsis) can successfully managed now.

Q. If they repeatedly resort to cosmetic surgery just to firm their skin, or improve their looks what adverse effects will it have on their health in the a) short term b) long term?

A. Cosmetic surgery can be performed in multiple body sites simultaneously and also repeat surgery is possible. But a repeat surgery can be more complex than the initial. There is no special adverse effect on the general health. But the procedure is associated potential adverse effects and complications are there.

Q. Are cosmetic surgery procedures complicated? Can they be done outside a hospital facility e.g. in a dispensary or private clinic?

A. Cosmetic surgical procedures can range from a minor to major operations involving several hours. These procedures should be performed in safe environment ideally a hospital.

The reasons are the qualified and trained professionals are in a hospital, and most of these procedures are invasive which need strict aseptic (sterile or germ free) technique inside a theatre suite. It's expensive to maintain sterility and extremely difficult in a dispensary or a private place.

These infections not only mean common bacterial but also serious ones such as HIV/ AIDS and Hepatitis B and C which are not uncommon in current society among healthy looking individuals. If an instrument used on such infected individuals is used on a another person without being sterilised properly, there can be serious problems subsequently.

Furthermore, life saving and resuscitation facilities should be available when undergoing any invasive procedure and these costly gear is not commonly available in a dispensary or a private room. Hence if you are undergoing cosmetic surgical procedure it should be in a well manned and equipped facility.

Q. What about plastic surgery? Do patients have to enter a medical facility for this procedure? Or can it be done in any government OPD?

A. Ideally these procedures should be performed in a well equipped hospital. As plastic surgeons in the government hospitals the priority is to carry out reconstructive procedures due to the limitations of available facilities in a free health system. OPD is not the place to perform cosmetic procedures. It is a facility for patient assessment and treatment for minor ailments.

Q. What is Liposuction in relation to aesthetic surgery? Is it to remove fat deposits from the body?

A. Liposuction is a surgical procedure to remove fat in selected areas of the body to contour or to regain the shape.

It is not a weight reducing operation. If performed correctly liposuction is a very effective procedure.

Q. Who are the ideal candidates for this type of surgery? Young or middle aged persons?

A. Except in extremes of age liposuction can be useful to reshape the body. This is not the ideal operation for extreme obesity also.

Q. Are many women and even men resorting to this kind of surgery to lose fat around certain parts of the body?

A. Yes, it is to remove fat from selected areas depending on the patient's body habits and also on what they want. These areas have to be selected after careful analysis of the client.

Q. Can you lose weight by liposuction? Or only the fat deposits of a specific area of the body e.g. hips, breasts? Tummy? Thighs?

A. Liposuction is not primarily a weight reduction procedure but a re-contouring procedure. Commonly liposuction is used to remove fat from abdomen, flanks, chin, arms, thigh and hip and also breast especially in males with gynaecomastia.

Q. Today, due to cosmetic surgery becoming so popular, some beauticians have also started doing minor operations in their salons, assuring their clients that it is a safe procedure. Your comments?

A. These cosmetic surgical procedures should be carried out in a safe environment with facilities for maintenance of aseptic technique and to rescue and resuscitate a patient in an emergency situation.

We see patients coming with infections and various undesirable results following cosmetic procedures done at various odd places. It is the responsibility of the clients to inquire about the professional qualifications and the safety of the environment of these places.

Q. In addition to beauticians, there is an increasing number of doctors who are doing the same thing inside their clinics, and some even inside their homes. Are there special regulations with regard to this practice laid down by the Health Ministry in the Cosmetics Act of 2009?

A. There are grey areas in the existing law and medical ordinance with regards to the description and boundaries of the practice that a registered health professional can perform.

Non existence of a proper job description and absence of a list of lawfully qualified specialists is a major problem. Hence the public is unable to identify a properly qualified professional.

Even though advertising is unethical and unlawful, some of these so called beauty surgeons use printed and electronic media for publicity.

The intelligent public should be more vigilant about such unethical publicity and false information. There are laws to register and regulate drugs and cosmetics but the rules and regulations to monitor the practices and actual usage of these drugs and cosmetics have to be strengthened promptly to avoid a catastrophe.

Q. Is it possible for cosmetic doctors to ensure their clinics are environmentally clean and germ free, to prevent infection? What could happen to patients if they are not?

A.Maintaining a germ free (sterile) operation suite is not easy and cheap, and I don't think these private clinics, salons or beauty parlour can have such germ free environments.

Infections can be minor to major resulting in grave consequences.

More importantly infections transmitted from blood or body fluid, such as HIV/AIDS and Hepatitis is not rare in the society. Hence the public has to be cautious even when they are going for a hair cut that requires sharp razor blades.

Q. What are the basic qualifications for a person to practice plastic surgery or cosmetic surgery?

A. It is long process to become a qualified plastic surgeon in Sri Lanka as in other medical specialities.

After qualifying as a MBBS doctor, further postgraduate training of over five years in Sri Lanka and two years of overseas training in a reputed plastic surgery unit has to be completed.

In Sri Lanka they can get a postgraduate degree MS or MD from the postgraduate institute of medicine of the University Of Colombo.

At the completion of training these doctors will be certified as specialist plastic surgeons on recommendation of the Board of Studies for Surgery.

A qualified plastic surgeon is appointed to the government hospitals by the Public Service Commission. Currently there are thirteen board certified specialist plastic surgeons working in the government hospitals.

Q. Once a person gets a face lift or some other cosmetic surgery, will it last a life time?

A. Depending on the procedure the duration of the effects vary. Many procedures will not provide results lasting a life time simply because the process of ageing can not be stopped by a plastic surgery. Even body contouring effects will last longer especially when the individual is keen on maintaining their body shape.

Q. As a plastic surgeon what is your honest opinion about cosmetic surgery? Who do you recommend it for?

A. Cosmetic surgery can be recommended to those who wish to improve their appearance, but they should have a sound insight and understanding as to what they want and what actually could be done.

Q. Your advice to the public?

A. It is important to note that people think that being 'fair' is beautiful and spend a lot of time and resources in achieving fairness.

But this is not correct. Beauty lies in individuals' features and proportions. There is no medicine to make you 'lean and fair'.

Q. Any golden rules on how to look young and beautiful and have a glowing skin without cosmetic surgery?

A. Living a healthy lifestyle is the key to maintain the beauty. Healthy dietary habits with regular exercise, stress management, avoidance of smoking are important aspects to consider.

Q. Any other comments?

A. I think it is high time to regulate the quality of cosmetic and health related advertising.

In addition there are a multitude of electronic and printed media discussing health related matters every day. It is essential to assess the quality of these items, to get the proper message across to the society.

Ban e-cigarettes in restaurants and workplaces, says WHO

Electronic cigarettes should be banned inside cafes, restaurants and workplaces, and should not be advertised to children and non-smokers, the World Health Organisation (WHO) has said.

In a long-awaited report, the United Nations' health agency resisted calls from many experts to soften their approach to e-cigarettes, recommending a raft of measures to curb their use, while also warning over the growing influence of the tobacco industry in the "e-cig" market. The report also said that e-cigarettes which are flavoured to taste like fruit, sweets and alcoholic drinks should be banned, amid fears they encourage children to use the products.

Millions of people now use e-cigarettes worldwide, but public health experts remain divided over their potential harms and benefits. Studies have suggested that they help people to quit smoking, but the WHO said that there was currently "insufficient evidence" to prove their benefit.

The recommendations on indoor use in public places go further than existing regulations in most countries.

The vapour produced by e-cigarettes is known to be considerably less harmful than tobacco smoke, but the WHO said there were still concerns over the nicotine and other toxicants produced.

The Department of Health said that no such ban was planned in England, but measures to curb e-cigarette use in public places are already under consideration in Wales, which has taken a harder line against the products.

The UK Government already plans to ban e-cigarette sales to under 18s. From 2016, changes to the way e-cigarettes are regulated will see some authorised as medicines if manufacturers can prove their therapeutic benefits.

Some experts have called for them to made available free on the NHS as quit-smoking aids.

Tobacco companies which manufacture e-cigarettes, including British America Tobacco, are understood to be among the companies seeking medicines licencing from the UK's Medicines and Healthcare Products Regulatory Agency (MHRA) - raising the possibility that NHS money could end up going to tobacco manufacturers.

In their report, the WHO issued a strong warning over the tobacco industry's involvement in the e-cigarette market.

"No matter what role the tobacco industry plays in the production, distribution and sale of electronic nicotine delivery systems, this industry, its allies and front-groups can never be considered to be a legitimate public health partner or stakeholder while it continues to profit from tobacco and its products or represents the interests of the industry," the report said.

While acknowledging that e-cigarettes carried "promise" in terms of controlling tobacco use, the WHO said that manufacturers should be banned from making health claims for their products until they had provided scientific evidence which had been approved by regulators.

In the UK, more than two million people are believed to be using e-cigarettes.

A recent study by one of the UK's leading smoking cessation experts suggested the products are more effective than nicotine patches and gum at helping people to quit smoking. Prof Robert West of University College London, said that the evidence did not support the WHO's claims that e-cigarettes posed a significant risk to bystanders.

"These devices are not just a bit safer than smoking; there is good reason to believe they are much safer - and that is what smokers need to know," he said.

- The Independent