In South Florida’s ever-expanding field of vanity medicine, where practitioners of varying experience and credentials offer “treatments” to people who are not sick, it’s a buyer-beware market.
“South Florida is the wild west of cosmetic surgery,” said Dr. Nathan Mayl, past president of the Broward Society of Plastic Surgeons. Mayl said he has seen what can go wrong at the hands of unlicensed or under-trained practitioners, and has been asked by patients to fix their “distorted lips and distorted brows, and areas where the skin has died from something toxic.”
Unlicensed practitioners may illegally offer procedures at a cut-rate price, but if something goes wrong, they quickly disappear, leaving patients to seek help in emergency rooms or with private doctors, Mayl said.
While the majority of cosmetic procedure patients get acceptable results when they go to a licensed and properly trained physician, serious complications can still occur.
Four people who got wrinkle-relaxing injections at an Oakland Park clinic remain hospitalized, suffering the effects of botulinum toxin Type A, the origins of which remain under investigation, yet they are just the most recent patients of cosmetic procedures and surgeries to suffer unintended outcomes.
Since mid-2003, at least six people have died in Florida, including a 51-year-old Fort Lauderdale man found dead in his bed in November 2003, after a face-lift and chin implant; a 45-year-old Broward mother of three who died Jan. 10, two days after liposuction and a tummy tuck; and a 51-year-old Dania Beach woman who died Jan. 16 after the same two procedures. A 53-year-old Miami-Dade grandmother died in March 2001 after being injected with industrial-grade silicone at an illegal cosmetic-pumping party at a Miramar condo.
In October, Miami-Dade County police arrested a man pretending to be a doctor after an undercover investigation in cooperation with the Florida Department of Health. The man was charged with the unlicensed practice of medicine for allegedly offering silicone injections for $800 to an undercover Miami-Dade policewoman, along with Xanax to calm her nerves before the procedure.
“There was another patient in the chair with a needle in her forehead,” said Bob Mundy, who supervises the health department’s investigation of unlicensed practitioners in South Florida.
The South Florida Sun-Sentinel spent a year investigating the dangers of vanity medicine procedures in 1999 and found 1,700 Florida doctors were specializing in cosmetic procedures from hair transplants to face peels, and unproven anti-aging therapies — more than the total number of doctors treating heart disease and cancer.
Between January 1997 and January of this year, the newspaper has confirmed 36 deaths, most of them occurring after office surgery. According to autopsy reports and other state records, at least 14 of the deaths followed tummy tucks, often combined with liposuction.
The Florida Board of Medicine tightened up the regulations for office-surgery procedures, and imposed a moratorium on doing both a tummy tuck and liposuction on the same day.
An estimated 77,000 cosmetic procedures are done in the state each year, but precise numbers are hard to come by, and there are other procedures that fall in a regulatory gray area, such as mesotherapy, the injection of vitamins, amino acids and other materials under the skin to destroy fat cells.
What makes people put their health at risk for a chance at improving their appearance?
The smarmy cosmetic surgeons on FX’s Nip/Tuck TV series pose this question to their new patients: “What is it you don’t like about yourself?”
Apparently millions of Americans don’t like the frown lines in their foreheads, the crow’s feet around the eyes, or the extra fat around their tummy or thighs. Nearly 2.3 million Botox procedures were performed in 2003 to remove wrinkles, according to statistics gathered by the American Society for Aesthetic Plastic Surgery, making it the nation’s most popular non-surgical procedure. Liposuction to vacuum away layers of fat was the most-often performed cosmetic surgery — 384,686 procedures.
According to the society, the number of surgical and non-surgical procedures has grown steadily from just over 2 million in 1997 to more than 8.2 million in 2003.
The rapid growth of such practices may be attributed to a convergence of forces — medical economics, the Baby Boom generation turning 50 at a rate of about 4 million each year, and television “reality” programs that show people being transformed by such procedures.
In the second decade of managed care, many doctors and other practitioners such as chiropractors, find their incomes have decreased, and they don’t like the hassle factor involved in fighting with HMOs or insurance companies. By specializing in techniques that are not covered by insurance, they can collect their fees directly from patients willing to pay to look younger or feel better.
“Medical economics is pulling physicians in directions they historically would not have gone,” Mayl said. “You have internal medicine doctors injecting Botox, general practitioners doing medical aesthetics, whatever that is, and ob-gyns doing liposuction, getting their training in a weekend course. It’s all revenue driven. They’re trying to make a living under very adverse circumstances.”
Dr. John C. Nelson, president of the American Medical Association, said some physicians have had to look for additional ways to maintain their incomes because of external forces such as high medical malpractice insurance and low reimbursements from government programs such as Medicare and Medicaid.
“The cost of everything else has gone up, but payment to doctors has gone down,” Nelson said. “Some doctors may in fact say, ‘I’m not making what I need to make to keep my office open,’ and I imagine some doctors have taken courses to make themselves skilled in other areas. We have no argument with that as long as the training is done in an appropriate way.”
But not every practitioner gets the appropriate training, said Dr. Peter Fodor, president of the American Society for Aesthetic Plastic Surgery.
“Unfortunately, patients sometimes are lured by promises of less-expensive treatments, or they simply fail to check the qualifications of the person administering the treatments,” Fodor said.
Fodor, who practices in Los Angeles, blamed television reality shows featuring surgical makeovers for giving viewers an unrealistic picture of the seriousness of such procedures.
“These TV shows make light of it,” Fodor said. “They trivialize the importance of taking these operations seriously. Patients need to do due-diligence research to find the right surgeon, and to make sure they have adequate post-operative care.”
Gabriel Imperato, a managing partner in the Broad and Cassel law firm in Fort Lauderdale, specializing in health care and medical law, said he has seen cases in which doctors who have lost their license to practice “end up in some gray-market area as a way to make a living,” and patients need to be cautious.
“I’m only a third-hand observer of this, but the cosmetic alteration area is very popular in South America and very popular in South Florida. The patients are as interested in those practices as the purveyors are in selling them,” Imperato said, “but if they’re showing up at somebody’s house to meet some charming charlatan who’s going to mess around with their body, what are they doing there? On a very basic level I just don’t get it.”
Nancy McVicar can be reached at or 954-356-4593.
ANSWERS ARE A CLICK OR CALL AWAY
To find out whether the practitioner offering a service is licensed to practice and is in good standing, the Florida Department of Health has a Web site,
At the top of the page is a window labeled Subject list. Scroll down and you will find Licensure, Health Professionals. That will give you some information. The listing right under it, Licensure, Medical Professionals Look-up, will tell you whether the doctor has been disciplined. There is also Practitioner/Physician Profiling. Fill in the blanks with as much information as you know, for example, the doctor or nurse’s last name and the county where they are practicing.
Another site at the Florida Department of Financial Services gives information on closed malpractice cases. Go to
Scroll down and click “Search Now.”
If you don’t have access to a computer, the toll-free phone number to obtain information on a medical professional is 888-419-3456.
If you find the practitioner is unlicensed in Florida, complaints may be filed anonymously by completing and mailing a complaint form found on another Department of Health Web site: another site to search for your doctor’s license, or by calling 877-HALT-ULA (877-425-8852)
