Miami, March 6 (KHN via EFE News). – In hindsight, she should have recognized the red flags, said Nikki Ruston, who underwent cosmetic surgery in Florida.
The Miami practice where he scheduled what is called a Brazilian butt lift had closed and moved its records to another center, he explained. The price he was offered, and which he prepaid, increased on the day of the operation, and he did not meet his surgeon until shortly before being given a general anesthetic.
“I was ready to go,” said Ruston, 44, of Lake Alfred, central Florida. “But I had already paid for everything.”
A few days after the operation, Ruston was hospitalized with an infection, blood loss and nausea, according to her medical records.
“I went for the cheapest, which is what I did,” Ruston recalled recently. “I looked for the lowest price and found it on Instagram.”
People like Ruston are encouraged to go to South Florida office surgery centers. This is happening thanks to social media marketing that paints the Brazilian buttock lift and other cosmetic surgeries as deceptively painless, safe and affordable, according to researchers, patient advocates and surgeon associations.
Unlike outpatient surgery centers and hospitals, where a patient may stay overnight for observation after treatment, in-office surgery centers offer procedures that generally do not require hospitalization, and are regulated as an extension of private practice. of doctor.
But these centers are often owned by companies that offer discounted prices by contracting with surgeons who are incentivized to see as many patients as possible per day, in the shortest possible time, according to state regulators and doctors who criticize these centers.
Ruston said he now lives in constant pain. After a spate of deaths and in the absence of nationwide rules, Florida regulators were the first to enact rules in 2019 aimed at making procedures safer. More than three years later, the data shows that deaths are still occurring.
Patient advocates and some surgeons predict the problem will get worse. Emergency restrictions imposed by the state medical board expired last September, and the business model popularized in Miami has spread to other cities.
“We are seeing entities with a strong footprint in high-volume, low-cost cosmetic surgery based in South Florida that have popped up in other parts of the country,” said Bob Basu, vice president of the American Society of Plastic and Plastic Surgeons, physician in Houston, Texas.
During a Brazilian butt lift, fat is removed by liposuction from other areas of the body, such as the torso, back, or thighs, and injected into the buttocks.
The Miami-Dade County Coroner has documented nearly three dozen cosmetic surgery patient deaths since 2009, 26 of which were the result of Brazilian buttock lifts. In each case, the patient died of a pulmonary fat embolism, which is the blockage of blood vessels by fat that entered the veins of the gluteal muscles and impeded blood flow to the lungs.
Globally, about 3% of surgeons have had a patient die as a result of the procedure, according to a 2017 report by a Foundation for Cosmetic Surgery Education and Research task force.
Medical experts said the problem stems, in part, from medical assistants and nurses performing key parts of the buttock lift instead of doctors.
It is also the consequence of an economic model driven by profit and not by safety, which encourages surgeons to exceed the number of operations stipulated in their contracts.
In May, after the fifth patient in as many months died of complications in Miami-Dade County, Dr. Kevin Cairns proposed a state emergency rule to limit the number of facelift surgeries buttocks that a surgeon could perform per day. .
“I was tired of reading stories of women dying and seeing cases come to the board,” said Cairns, a former member of the Florida Board of Medicine.
Some doctors performed as many as seven surgeries, according to disciplinary cases against surgeons opened by the Florida Department of Health. The emergency rule limited them to a maximum of three and required the use of ultrasound to help surgeons reduce the risk of lung fat clots.
But a group of doctors performing Brazilian butt lift surgeries in South Florida responded by creating the organization Surgeons for Safety. They argued that the new requirements would make the situation worse and lead patients to consult dangerous health professionals who do not follow the rules.
Surgeons for Safety declined repeated interview requests from KHN. Although the group’s president, Dr Constantino Mendieta, wrote in an editorial in August that he agreed that not everyone followed the standards of care, he called the limits placed on surgeons “arbitrary”. . The rule sets “a historic precedent for vetting surgeons,” he said during a meeting with the Florida Medical Board.
In January, Florida Republican Senator Ileana Garcia introduced a bill to the state legislature that proposes there be no limit to the number of Brazilian butt lifts a surgeon can perform in one day. daytime. Instead, it requires in-office surgery centers, where procedures are performed, to have one doctor per patient and prohibits surgeons from working on more than one person at a time.
The bill would also allow surgeons to delegate certain parts of the procedure to other doctors under their direct supervision, and the surgeon must use an ultrasound.
The Florida Legislature meets again on March 7.
Like Ruston, many people base their expectations on before and after photos and marketing videos posted on social media platforms like Facebook, Snapchat and Instagram.
“It’s very dangerous,” said Dr. Basu, of the American Society of Plastic Surgeons.
The average price for a buttock lift in 2021 was $4,000, according to data from the Aesthetic Society. According to a recent article on the American Society of Plastic Surgeons website, a “safe” Brazilian butt lift performed in a licensed facility and with proper post-operative care costs between $12,000 and $18,000.
It’s common for mid-level healthcare professionals such as physician assistants and nurses to perform the procedure in an office, according to study co-author Dr. Mark Mofid, a 2017 study by the group Research and Education Foundation Working Paper 2017. Cosmetic Surgery.
By relying on staff who do not have the same specialized training and who are paid less, in-office surgeons can perform more buttock lifts per day and charge a lower price.
Basu said patients should ask if their doctor can perform the same procedure in a hospital or outpatient surgery center, where there are stricter rules than in offices in terms of who can perform butt lifts and how. they must be done.
Bargain-hunters are reminded that cosmetic surgery can carry other serious risks besides fatal fat clots, including infection and organ puncture, as well as kidney, heart, and lung problems.
Ruston’s surgery was performed by a board-certified plastic surgeon he said he found on Instagram. Initially, 4,995 were budgeted. But when he arrived in Miami, he said the clinic had added charges for liposuction and post-surgical clothing and appliances.
“I ended up paying about $8,000,” Ruston said. A few days after returning to Lake Alfred, Ruston began to feel dizzy and weak, and she called 911.
Paramedics took her to the emergency room, where she was diagnosed with anemia due to blood loss and blood and abdominal infections, according to her medical records.
“If I could go back in time,” he concluded, “I wouldn’t have.”
By Daniel Chang
KHN’s Chaseedaw Giles contributed to this report.
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KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of the three main programs of KFF, a non-profit organization that analyzes health and public health issues in the country.
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