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In Depth

Health

Cosmetic surgery

Balancing risk

Last Updated April 10, 2008

It's pretty tough to get an accurate read on how many Canadians are getting their tummies tucked, breasts augmented or faces lifted. Neither Health Canada nor Statistics Canada keeps track of what's happening on the cosmetic surgery front.

It's no easy task.

In Canada, you can get cosmetic surgery in one of two places: a hospital or a private clinic. Hospitals are required by law to follow certain standards and safety protocols. Private clinics are unregulated, so they aren't covered by the same rules.

However, the owners of private clinics can join the Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF). The organization was formed in 1990 to help ensure that surgical procedures done outside a hospital are performed safely and carefully.

Procedures done in a CAAASF-approved facility must be done by a surgeon who is certified by the Royal College of Surgeons of Canada. That surgeon must be cleared to perform the same procedures in a hospital operating room.

The thing is, with most types of cosmetic surgery, you don't have to be an accredited surgeon to start nipping and tucking.

Who can perform cosmetic surgery?

In Canada, almost any medical doctor can perform cosmetic surgery — even if he or she has had little or no training in surgery. The Royal College of Physicians and Surgeons of Canada does not recognize "cosmetic surgery" as a specialty designation. So doctors who call themselves "cosmetic surgeon" or "cosmetic plastic surgeon" are doing it without the backing of the body that certifies physicians and surgeons.

However, there are two specialties in cosmetic surgery that receive formal training certification from the college:

  • Plastic surgeons for cosmetic surgery of the face and body.
  • Otolaryngologists (ear, nose and throat surgeons) for cosmetic surgery of the face and neck.

There is also specialty training available for doctors who wish to perform procedures commonly called cosmetic surgery. The training ranges from weekend workshops to in-depth courses.

What are the most common types of cosmetic surgery?

According to Medicard Finance, a company that collects data on cosmetic procedures in Canada, there were more than 302,000 surgical and non-surgical cosmetic procedures performed in Canada in 2003, the latest year for which it has statistics. The total market was worth more than half a billion dollars in 2003.

The most common procedures by dollar value were:

  • Liposuction, with 24,337 procedures performed at a cost of $146 million.
  • Breast augmentation, with 16,937 procedures at a cost of $101.8 million.
  • Injectables, including Botox and collagen, with 184,000 procedures performed at a cost of $92 million.
  • Non-surgical facelift, with 17,628 procedures performed at a cost of $70.5 million.

What are the risks of cosmetic surgery?

There are risks with any kind of surgery. If you have a history of cardiovascular disease, lung disease or obesity, you will face a higher risk than healthier people of developing complications such as pneumonia, stroke, heart attack and blood clots in the legs or lungs.

Other surgical complications can include:

  • Nausea, dizziness and pain.
  • Numbness and tingling, which could become permanent.
  • A collection of blood beneath the incision, which may have to be removed.
  • Fluid beneath the wound, which may have to be drained.
  • Excessive bleeding that could require a transfusion.

In addition, when you undergo procedures like liposuction, you may be at risk for severe skin infections, which could lead to significant scarring, punctures to internal organs or numbness. In rare cases, death is also a risk because of shifts in the body's fluid levels as fluids are being injected and sucked out. The fluid shifts can cause kidney and heart problems. Severe reaction to the anesthesia could also lead to death.

How do I know whether a doctor is qualified to perform cosmetic surgery?

Ask a lot of questions.

The Ontario College of Physicians and Surgeons provides a cosmetic surgery checklist on its website. In addition, most of the bodies that certify physicians and surgeons across the country allow you to check a doctor's credentials online or over the phone.

Are there any regulations in the works governing cosmetic procedures?

Ontario is in the process of tightening guidelines covering cosmetic procedures. In September 2007, 32-year-old Krista Stryland died after undergoing liposuction at a Toronto clinic. Two months later, the Council of the College of Physicians and Surgeons of Ontario introduced a series of measures aimed at improving patient safety.

They include:

  • Barring doctors from using the word "surgeon" to describe themselves, unless they are certified by the Royal College of Physicians and Surgeons of Canada.
  • Forbidding doctors from advertising medical specializations, unless they are formally accredited in that field.
  • Inspecting private clinics that perform cosmetic procedures.

On April 10, 2008, the council met in Toronto to further discuss the introduction of new guidelines governing cosmetic surgery.

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