Medical students are taught the principle primum non nocere, which means “above all, do no harm.” A physician must place the patient’s best interests first and administer treatment only when the benefits far out-weigh the side effects. Although this seems obvious, this principle is not always followed. Most patients receive excellent care from their physicians; others do not. This is especially true when patients are undergoing surgery.
    Cosmetic plastic surgery is unique since healthy individuals undergo surgery that is not medically necessary. In this situation, the patient determines the risk-benefit ratio in deciding whether to undergo an operation. Assuming that the operating plastic surgeon is fully qualified, has an excellent reputation and is board certified by the American Society of Plastic Surgeons, a standard of competence should be assured. A concerned patient should inquire where the proposed surgery will take place.
    Cosmetic procedures that are invasive are almost always performed as an outpatient in either ambulatory surgery centers (ASC) or outpatient hospital facilities. Until recently, many of the local hospitals allowed plastic surgery patients to pay less for operating room time since health insurance does not pay for these procedures. Unfortunately, the State of Maryland laws changed requiring all patients to be charged the same rates for operating rooms.
    This change resulted in a marked increase in cosmetic surgery OR charges for surgery performed in a hospital. This law does not apply to ambulatory surgery centers (ASC).
    Cosmetic surgery patients who are healthy and have no serious medical problems have their procedures done in an ASC. All ASC’s that treat Medicare patients must be certified. Medicare certification assures the patient that the ASC maintains a very high standard of care. Each facility is inspected at intervals to assure quality patient care. Should an ASC fail inspection, it must correct the deficiency to continue operation.
    The last facility in which cosmetic surgery is ‘performed, is the physician office-operating room. Since cosmetic procedures are performed under general anesthesia or deep intravenous sedation, the patient should ask the physician a number of questions:
    1. Is your operating facility certified? 2. Who will be providing the
anesthesia for the surgery? 3. Is
the individual a board certified anesthesiologist or a nurse anesthetist?
4. Have you had any deaths in your office operating room? 5. How many patients have you had to transfer
to a hospital following surgery
for care? 6. Do you have a recovery room Registered Nurse to monitor the patient’s progress? 7. What provisions do you have in place to address an emergency situation? 8. Is a physician always present until the patient is discharged from the office operating facility?
    Cosmetic surgery patients
are wonderfully happy patients. Reducing the risks of surgery can be assured by having it performed in a clean, well-equipped, state-of-the-art, certified facility, by a competent board certified plastic surgeon and with the aid of a team led by a board certified anesthesiologist.