STAFF REPORTERS
Ontario's self-regulating medical watchdog is cracking down on family doctors who conduct cosmetic surgical procedures, demanding they prove their skills and come clean with patients about their credentials.
The College of Physicians and Surgeons of Ontario is investigating 16 doctors performing high-risk cosmetic procedures in private clinics that could be a danger to the public because of concerns about their qualifications and training.
A second group of 20 doctors have been put on notice that, if they do not answer mandatory questions about their qualifications, their licenses will be suspended in 60 days.
For the first time in Ontario, the college is taking action against family doctors who call themselves "cosmetic surgeons" without having proper qualifications.
Under proposed new rules announced yesterday, the title "surgeon" will be reserved for physicians certified as surgical specialists by recognized medical bodies. Specialties such as plastic surgery take years of post-graduate medical training.
Currently, hundreds of family physicians in Ontario advertise themselves as cosmetic surgeons without any specialty designation or training.
"The regulation is to ensure people are appropriately using their title," said college spokesperson Kathryn Clarke. The change will be discussed by council again in February and, if passed, sent to the Ontario government for approval.
The death of 32-year-old Toronto real estate agent K*** prompted the college to move swiftly after years of poor policing in this area. On Sept. 20, K*** died after Dr. B*** performed liposuction at her O*** Clinic to remove "pregnancy fat." Y*** declined repeated requests for an interview.
The Ontario coroner's office is still investigating the S*** case. No decision has been made on whether there will be an inquiry into her death. Y*** continues to practice in her Toronto clinic.
Y***'s website pitches her as a "premier Toronto cosmetic surgeon" with an "impressive résumé" featuring "extensive" experience, medical credentials and professional affiliations. She is not a certified surgeon.
In September, a Star investigation documented years of dithering by the medical watchdog about whether to crack down on unqualified cosmetic surgeons.
College council briefing notes and discussion papers dating back to the early 1990s, obtained by the Star, revealed years of lax standards and unenforced regulations even as college officials were quietly raising concerns about family physicians conducting cosmetic procedures without oversight or training.
Three weeks after the Star story was published, the college sent mandatory surveys to 406 physicians requesting details about their cosmetic procedures practices to determine whether they should receive "a practice assessment" by the college.
College officials yesterday refused to name the 16 doctors who are the subject of "immediate" action.
"The 16 we know to be practicing in a high-risk circumstance where they are doing relatively invasive procedures out of a hospital setting by individuals who may not be adequately trained," said Dr. Jeffrey Turnbull, the college president.
The 16 will be evaluated by trained physician assessors as soon as possible, officials say. But those doctors have the right to continue practicing until that time.
"We won't release the names until we can do due diligence and ensure these people are appropriately trained. But I can reassure you we will be reassessing them properly," said Turnbull.
If patients have questions about their doctor, they should look at the college website at cpso.on.ca, said Turnbull. The college recently posted tips for the public on what questions they should ask about a physician's qualifications before they undergo a cosmetic procedure.
Beyond the doctors, when the procedures are performed outside of a hospital at "independent health facilities," the college wants to inspect the premises and equipment used.
Every physician who performs cosmetic procedures at one of these facilities must inform the college in writing of what services they intend on providing and they must submit to an inspection that could include direct observation of the performance of procedures. The inspection will take place at least once every four years.
The council is making "significant steps forward" to protect the public, Turnbull said.
"We are going to start moving quickly. You'll see in the next several months we'll be out assessing many of the different practices where there are cosmetic procedures taking place in what we consider higher risk circumstances," he said.
Turnbull said the college was not bowing to pressure from the government to better police its members. He said the college was responding to the public and other doctors who are concerned.
Toronto lawyer Alan Rachlin applauded the college's changes but also said there is nothing in place to protect the public today.
"It doesn't address what do you do in the meantime? There is no protection in place for the public right now," Rachlin said. The patient questionnaire on the college website doesn't cut it for Rachlin.
"How the hell will they get that in the hands of a consumer and ensure the consumers look at it?" he asked.
"Again, if you walk into a clinic office and see 30 diplomas on the wall, are you qualified to know if those diplomas mean anything or not?"
In 1989, T***, a 44-year-old Unionville mother and real estate agent, died after cosmetic surgery. Her death prompted a 1990 inquest that recommended the college establish standards for quality of care at private clinics and the credentials of the doctors performing surgery there. But mandatory oversight of cosmetic doctors and their facilities hasn't been pursued in Ontario until now.
In Alberta and B.C., all surgeons and their surgical facilities must be licensed for each procedure they perform. They cannot advertise themselves as cosmetic surgeons without holding a surgical specialty. Doctors who call themselves cosmetic surgeons are not required to meet any of the strict training and oversight rules that govern plastic surgeons. In addition to five years of specialized surgical training, plastic surgeons must pass a national exam and be certified as members of the Royal College.
"I was a general practitioner before I became a specialist," says Dr. Brian Peterson, a plastic surgeon in Kelowna, B.C., and president of the Canadian Society for Aesthetic Plastic Surgery, which represents plastic surgeons.
"As a GP, you have medical school and an internship. You have no experience doing surgery and no appreciation for all those things that can go wrong. Five years of surgical training teaches you how to select patients properly and what to do when things go wrong."
Peterson recently wrote all of the provincial college registrars urging more rigor when it comes to monitoring medical advertising claims.
"Advertising should not be misleading," he wrote. "Any physician stating they are a surgeon, should hold a specialist certification in surgery from the Royal College (of Physicians and Surgeons) and hold similar privileges at their regional hospital to provide comprehensive care of patients. Anything less than this is misleading to patients and allows the potential for harm."
Karyn Wagner, executive director of the Canadian Society of Plastic Surgeons, said the public "should be made aware that there is a difference between a certified plastic surgeon and a general practitioner conducting cosmetic surgery."
I would never, ever refer to my doctor as a half assed quack. Though, it does leave a bad taste in your mouth doesn’t it?
14) Can you imagine your doctor brushing off life-threatening complications and telling you "You look great!" when you ought to be heading for the emergency room? It's been known to happen in the cosmetic surgery biz…
Known to happen? I can tell you I have witnessed the complication brush off time and time again first hand. It’s as much a part of the business of cosmetic enhancement as taking the payment. Often, downplaying side effects or symptoms of a major surgery is almost necessary as it tends to be a rather neurotic time for the most stable of us as the shifts of your healing body take place. Then there are the times when people are seriously and permanently injured by the cosmetic surgery brush off. I got a call from one of my very, very best friends one random afternoon. She told me something bad had happened. When I asked her for the details she explained that she had gone for a routine lip injection appointment at a reputable clinic. Everything appeared to be going off as usual without a hitch until one of the last injections was made on her upper lip. As the nurse filled the left side of my friends upper lip her face suddenly took on an ashen, grey tone that was growing and spreading from the site of the needle pierce. The injection nurse immediately stepped back in surprise and horror as my dear friends face began to deaden and darken before her eyes. After being quickly rushed to the head physician of the establishment my bud was assured she was only experiencing some severe swelling. She was assured of this as she became more and more cataleptic and close to losing consciousness. When she called me she had just left the office and was wandering home feebly home. She was becoming a bit disoriented and her face continued to darken and throb. After gathering the details I went to meet her immediately. When I saw her I was torn between calling a cab to take us to the hospital and destroying her brain because she was exhibiting signs of turning into a fully fledged zombie. Her swollen, bruised face had taken the tones of grey and added tones of blue and tones of purple and her face looked like a network of straining veins and useless bloodlines. It didn’t take a very well trained eye to see that the injectionist had hit one of her arteries below her nose and that if she didn’t to get the blood flow moving again and soon, she would surely face dire consequences. We were heading to the hospital mere moments after I saw her mangled visage. She was told after being injected with filler dissolvent and being put in a hyperbaric chamber at the hospital that she had gotten very lucky. My darling bud suffered necrosis in a small part of her nose but had the issue not been remedied as soon as it had she may have lost portions of her face to the ravage of necrosis. The tissue death and subsequent irreversible blackness that follows blocked blood flow. My friend was a clear and terrifying example of the cosmetic surgery brush off. She should have been adequately treated and her situation should have been given the weight it deserved right from the start. But fear and blame and the looming law suit can cause a natural dismissal and brush under the rug of clients serious conditions post treatment. 9 hyperbaric oxygen tank sessions and numerous counseling sessions and my friend felt almost like her old self. But if you are choosing to put yourself in the line of risk at a cosmetic clinic, it’s best to always be aware that the clinic staff will do their best often enough to let you ride that line of risk and effect all on your own.
15) You want health insurance coverage for other breast-related illnesses? Goooooooood luck.
17) The first time I had a chance to feel a pair of tits with implants in them; they felt like two blocks of cement covered with a quarter inch of skin. I was told it was an unusually high quality job, too.
Now Paul just you wait one second there. I have fondled many a boob job and I have yet to find a pair of boobs that didn’t feel pretty damn good. I think breast implants feel super nice with a perfect amount of squish, firm and warm. Though that is before they have a contracting capsule I suppose.
18) They claim that the cement tit problem has been solved, and modern operations don't produce that kind of extreme hardening any more. Well, they still end up hardening sometimes. One doctor who trumpets the improvements over past techniques and calls saline implants "absolutely safe" (George Beraka of New York -- he gives plastic surgery advice on women.com and elsewhere) still admits that 5 to 8 percent can end up "as firm as your thigh" due to scar tissue... and that he sees "a lot of bad results" from other doctors. I think he's understating the problem rate... Mentor found that 9 percent of augmentations had serious capsular contracture (which causes hardening, and sometimes pain), sometimes bad enough to require re-operation.
Firm as your thigh eh? Well, how firm is that exactly? I mean I know how firm my thigh is. But your thigh might be totally different comparative to firmness. My mom’s thigh has a different firmness than your mom’s thigh. Matthew Mcconaughey’s thigh will feel completely different compared to Mickey Rourkes thigh. If a thigh is relaxed it’s not all at firm on anyone now is it? Face it Paul. Face it. Breast implants feel fucking great. There I said it! That felt good. That’s one thing you can’t take away from me Paul. Firm as your thigh…pffft.
19) The more we see blown-up boobs, the more we learn to recognize them instead of being fooled. The more we learn to recognize them, the less attractive they are. The more people are exposed to these bug-eye bosoms, the more often they are going to start seeing them as unattractive instead of as appealing. I've been seeing them that way for years now.
Bug eyed bosoms. I have to remember that term. I like it.
20) If I am not making myself clear, let me spell it out right now: implants are ugly! Implants only look good on the level of first impressions. Expect people in your life to react with an initial charge followed by a gradual accumulation of disgust. Anyone who likes you over the long term will do so in spite of them, not because of them -- the same as they would if you had a glass eye.
Hot damn man, that is some hard hitting stuff. When Paul says it, I can’t help but believe it. Frightening and powerful. This dude is good.
21) Lots of men have written me in response to this page and said they agree that implants are gross... but after tens of thousands of hits here, only a handful of men ever wrote to tell me they disagree and think implants are attractive... and sometimes I can't even be sure because the mail they've written is so inarticulate. (The total number of such messages written in proper English, so far, is about three.) From other mail I get, it seems to be very commonly the case that when women want implants, it's the men in their lives who are trying to talk them out of it, often without success. Our stereotypes tell us to expect the opposite -- men are supposed to be thrilled by this kind of "improvement". If our assumptions are backwards on this, how realistic is the rest of our thinking about implants? How much of what you look forward to after you have your implants is not going to work out the way you expect, because it's based on that kind of assumption?
I once asked my darling boyfriend Drew if he would be able to see anything when he looked at me but fake breast if I got implants. He was a very fantastic man and he thought it over for a good long while.
“I guess I won’t know until you get them.” He said. “So please don’t get them.”
22) If you envy women with big jugs, talk to them... a lot of them wish they could have smaller ones. (By the way, I wouldn't get breast reduction surgery either unless you're desperate. The surgery is more serious and, in the short term, probably more risky than breast enhancement is -- there are cases where the nipple, after being unplugged and stuck in a new position, dies and rots away -- but at least the risk is over once it heals.)
See risks of Breast Augmentation.
23) If you think being made fun of for being flat is bad... well, some women tell me that the amount of ridicule they experienced got worse, not better, after getting implants. Remember the old proverb about the color of the grass on the other side of the fence.
24) Any man who has a higher opinion of your body after you get implants will probably also have a lower opinion of your mind. Or do you imagine he'll never know? Fat chance. If they're saline and not overfilled to the point where they become unrealistically firm, he'll notice the sloshing.
Ahhh, the infamous saline sloshing. A friend of mine in Miami claimed she had a friend whose saline breasts sloshed so audibly she could not make love without music blasting.
25) An awful lot of implant jobs come out crooked, uneven, or weird looking. An awful lot of women think it's worth that, just to have the size. Does that make any sense to you? It doesn't to me.
A woman who danced regularly at The Cathouse had a most unfortunate boob job. One nipple pointed up and to the left. One nipple pointed down and to the left. You simply couldn’t tear your eyes away from her botched boobies.
26) If you're embarrassed because your titties are itty bitty and you want to do something about it... don't forget that the less natural breast tissue you start out with, the less convincing an implant job will look. The only ones that look halfway decent are when what's added is less than what was already there.
Remember Montana’s skittering ferret implants from Club Venus?
I wish I had forwarded Mr. Keinitz’s list to Miss Montana during her pre-op.
But then what would have kept me entertained those long hours at the club?
27) Fashions in body shape change. A lot of people nowadays are going to feel real stupid in 20 years when they look at the tattoos they've got... and you can bet the same is going to be true of a lot of cosmetic surgery. It happened with nose jobs: now there are a lot of women with nostrils aimed forward like headlights, making them look like a new species of pig. They don't do nose jobs that way any more, because it looks awful. Yet thousands paid to have it done that way, because that was the style at the time. Says one Hollywood actress: "That whole big chest thing is so eighties."
28) Speaking of fashions... some people have pointed out that strange, uncomfortable, weird-looking, fetishistic, and dangerous women's fashions tend to have an upsurge after any period where there are improvements in women's rights. We are in such a period now. I think implants have become such a fashion. In America, we've gotten accustomed to implants that, to someone from outside our culture -- even from a place as similar as England or Australia -- look bizarre and hideous.
Interesting. So you are saying there tends to be a rise in women voluntarily being uncomfortable when woman’s rights are improving? I think that says a lot about the collective female unconscious. Or the collective unconscious of the male powers that be. Either way, that is a cycle that needs to be nipped in the bud if I ever did see one. This gets my guts all stirred up it does.
29) However fashions go, when you get old, you're gonna look really weird and implausible. They call it the "double bubble" look -- each breast shaped sort of like the letter B. (That term is also used for a complication in which the underside of the breast has a second fold, like a double chin.)
There was a time, and I am speculating here, that this double bubble phenomenon appeared to have occurred to the popular country singer Jewel.
Search images of Jewel and you will see the suspicious double bumped breasts that got me wondering.
30) Then again maybe you won't (have the double bubble complication), because your implants probably won't last until then. Those who know say that anyone who gets implants should not keep them more than ten or fifteen years without either removing them or replacing them with a fresh set. This is because the container, though it's rugged when new, loses its strength and eventually becomes fragile. That means more surgery, with more expense and more risk... but not as much risk as leaving the old ones in place until they break or their contents leak out. One reason the rate of implant surgery keeps rising is because at least half of them are repeats.
31) Whether you replace your implants or take them out, it's going to be quite a challenge to find any way, as an elderly woman, to have halfway natural looking breasts. If you have any plans to ever get old, bear in mind that by getting implants now you may be throwing away any chance of not looking deformed at that age.
Yeah. But who has sex when they are old anyway, right?
32) You have to protect your implants. A simple fall that would ordinarily only give you a bruising can create a major medical crisis if an implant gives way. The longer it's been in you, the more easily it will rupture. Putting implants beneath the muscle -- something that is becoming popular because the shape comes out less obviously fake that way -- means that eventually just using your shoulder strongly will put you at risk (assuming that your shoulder still has its strength after the muscle has been distorted). The extra care you need to protect and maintain the implants makes you just a little bit crippled as long as you have them.
The nurses at the clinic gave me some disturbing information one fine summer day. Apparently. The constant light weight of the implant straining on the wall of the chest starts to weaken the chest muscles in time. Apparently. As years pass the muscles in the chest can give way all together. Apparently. Once the muscles in the chest are too weak to sustain the weight of the implant any longer the implant can easily migrate throughout the body. Apparently. Implants have traveled into their host’s stomach, into their neck, tucked into their armpit, rested on their sternum.
33) Any surgery on breasts can, and often does, damage nerves and reduce skin sensation. The amount of loss is unpredictable. The damage can't be reversed. Attempts to reduce this effect have a tradeoff: they increase the visibility of the surgical scar. Complete numbness of the nipple is not unknown. In a smaller number of cases, the side effect is the opposite: painful hypersensitivity to touch.
34) If you feel inadequate as a woman, the problem to address is in your head, not your chest. Self esteem first, cosmetics after! If you ignore that, you are doomed to disappointment. A lot of people who think a cosmetic change like this is going to fix their lives end up despondent and suicidal when they find they're still the same person with the same life. This is such a common problem that cosmetic surgeons have to pay a lot of attention to weeding out patients who might be suicide risks. Getting chest surgery to improve your self-esteem is like buying a girdle to improve your eyesight: you're addressing the wrong problem.
Paul, I wish you were my father or my brother so we could have grown up together. I wish we had time to sit together in a rocking chair by a wood burning fire where you could stroke my hair and tell me everything was going to be ok. I wish I could have run to you when I was an awkward teenager blossoming into a woman. I wish you could have told me all of these things regarding breast implants before I had even seriously entertained the notion. Not that it would have done much good most likely. My actual, fantastic, biological brood has frequently done just that. I am a pretty stubborn dame when I set my mind on something.
Regardless, Paul, you ever want to rock in a rocking chair anyway give me a call.
35) Breasts probably have a wider range of natural healthy variation than any other body part... and we seem to be trying to forget this. If we act as if only one subset of the range of variation is good -- as the entertainment and advertising industries are currently doing -- we condone and reinforce a mindset that says ordinary people are defective. We distort our sense of what is normal and end up treating healthy people (including ourselves) as if they were pitiable freaks. Every additional person who gets that surgery adds to the marginalization of those who don't.
Shut the fuck up Paul! It’s free country and I can want what I want and I am not marginalizing anyone thank you very much. Unless I am and to those I may marginalize if I undergo breast surgery, please accept my sincere apologies. I mean no harm at all. Therein lays the very, non feminist angle to implants. I know this angle is the most obvious of the angles. There are two parts of the anatomy distinctly female. The vagina and the breasts. Mutilating one of the two distinctly female body parts is a non feminist action. It is a tragedy and an outrage in many ways to witness the exploitation of femininity. To strive for the male ideal in our female parts is a crime to female history and female future. However, the world is a complex environment. What I can assuredly say is a bane to females I can also admit is a boon to the modern woman. Something so non feminist as a breast implant also has its very feminist traits, quite the pickle I find myself in.
36) Treating your own normal body as being defective is an act of self-hatred. (That doesn't mean you feel hatred for yourself... but one thing I've learned in life is that the way you feel about yourself is as much a result of such actions as a cause of them.) Acting on this in a public way and flaunting the results before everyone rubs this off on other people; it becomes not only self-hatred but an act that carries disrespect to other women. You're like Michael Jackson bleaching his skin and having his nose narrowed -- the message that sends to other African-Americans is hardly a positive one.
‘…the way you feel about yourself is as much a result of such actions as a cause of them.’
This is the subject that consumes me. When I break it down logically I can see how self hatred may play a real role in taking on elective surgery. The trouble starts when I try to find the hatred within myself and I simply cannot identify it. I look and I look and I search and I search in the dark crevices of my mind and I cannot seem to locate any self hatred. But it does not mean that it is not there or that is can’t in turn be created by acts of self hatred. And I spin onward, jousting with an invisible foe, clawing to an undetermined location.
37) What do you think you're really accomplishing by getting implants? If you examine your goals, you may find they are not very rational or realistic. Unless you're a professional model or are dedicating your whole life to the goal of marrying an elderly millionaire, the implants are probably not going to bring you much closer to what you really want. What are you really after? You'd better take a hard look at that question before you act on the assumption that implants will get it for you.
What a truly fantastic question. What are you really after when getting breast implants? I suppose that question has been the catalyst for the thousands of words I have written? I suppose that question is far to complicated to sum up? Or maybe it’s all so simple that I have been missing it? Sometimes I feel that breast implants make you more esthetically versatile. You can dress demurely and fly under the radar. Or you can reveal your cannons and be the belle of the modeling, entertainment, sexual ball. Sometimes I can truly find my way around justifying breast implants as only a turn on. A valuable tool to achieve enhanced sexual satisfaction. I sometimes think breast implants can’t be as bad as all that. I could be very wrong however.
38) If you want more male attention, implants may increase the quantity but only with a corresponding decrease in quality. You'll probably get your biggest gains in approval among guys who are most prone to objectifying you, and least prone to treating you as an equal. The guys who like implants the best are those who prefer pornography to live women, and probably find ordinary women a turn-off if they're not somehow artificial zed by things like fake hair, shaving, ridiculous shoes, and so on. Implants can be very artificial zing. And don't forget that for every woman who complains that she doesn't get the male attention she wants, there's another complaining that she wishes she didn't have the amount she does get.
The day I woke to realize my partner had artificial zed me would be a dark day indeed. A dark day when you realized all your memories and experiences had been rubbed away and replaced with a shiny, artificial, temporary veneer.
39) If you want to like your body better, the way to do it is to start liking the body you've got better. If your mindset toward your body is negative, no change of appearance will ever eliminate that! If you think it will, you end up chasing an illusion. When you are in the habit of always finding fault with your body, you will never run out of faults to find... indeed, you'll only find more and more as you get older. It's a trap, and changing your body won't get you out of it -- the one thing that will is to change the fault-finding way of treating yourself. If I treated you that way, I'd be an intolerable asshole... so why treat yourself that way? If you keep hitting your forehead with a rock, that doesn't mean you need a better stronger forehead -- it means it's time to put down the rock.
It is true. When I first started working at the cosmetic clinic I was one extremely confident chick. I’d like to think I still am but when you work somewhere that puts so much emphasis on improvement you start to look at yourself differently. It is indeed a slippery slope. When you start making tweaks to your appearance, be it fillers or Botox or fully fledged surgery something awful and