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Tuesday, January 17, 2006

Byline: Julie Deardorff

As a special holiday-season promotion, the first 200 people who lined up outside the trendy Chicago nightclub Reserve on a recent frigid weeknight received $500 off liposuction or breast-augmentation surgeries from a local cosmetic-surgery practice.

In some ways, the pretentious dance club was the perfect place to randomly peddle surgeries that aren't medically necessary. The use of cosmetic surgery, which has become more affordable for the masses in recent years, is skewing toward a younger demographic. And inside crowded, deafening hot spots like Reserve, visible first impressions are really all that matters.

But in the wake of increasing demand for cosmetic surgery by both men and women, physicians have started offering discounts or trying other aggressive marketing incentives. Cut rates, early-bird specials, gift certificates and contests now make a serious medical procedure such as liposuction look like the sale of a handbag.

This raises ethical and safety concerns, ones that reality television shows such as "Extreme Makeover" have been able to gloss over, because the donated services aren't technically considered a prize. But the two major groups in the United States _ the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) _ have policies to protect people with unrealistic hopes from being preyed upon. Both groups expect members to refrain from offering surgeries as prizes at charity raffles or fundraisers or in other ways that bypass an initial evaluation by a doctor.

Last spring the Condell Medical Center in Libertyville, Ill., found this out the hard way. They offered their own version of an Extreme Makeover, which included free services from nine specialists, including a cosmetic surgeon. Candidates only had to be a U.S. citizen, a Lake County, Ill., resident, at least 25, have six weeks available for treatment and have a home support system.

Shortly after the newsletter advertising the contest was mailed, Condell officials discovered their embarrassing mistake; the cosmetic surgeon quickly pulled out and the promotion fizzled. "Without a plastic surgeon, it wasn't much of a makeover," said Donna Zradicka, Condell's marketing manager. "We'd hoped to make a difference for someone whether they were in an accident or living in a woman's shelter, but we couldn't find a way to deliver it (without violating the ethics code)."

The main problem with offering surgery as a door prize, a gift certificate or at a discount to partygoers is that it could compel someone who wasn't considering it to embark on an unnecessary procedure. It ignores the important first step in patient safety. That step involves an interview, physical exam and discussion of the benefits and risks to see if the patient is a good candidate. In some cases, a client might need to lose weight before surgery, or psychiatric care might be a better option than cosmetic surgery.

If every plastic surgeon were qualified, these marketing incentives might not be so problematic. But anyone with a medical degree can call himself a plastic surgeon. Academies provide weekend courses where dermatologists, gynecologists and even oral surgeons can get official-looking wall certificates. And they're not necessarily bound by the same rules and code of ethics as board-certified plastic surgeons.

To protect yourself, ask your doctor three questions: Are you board-certified? By which certifying body? And what is your specialty? (When asking your doctor about his area of expertise, a good answer is "." A not-so-great answer is "gynecology.") You can check their honesty with the American Board of Medical Specialty (, an entity comprising 24 medical specialty boards; the ABMS oversees physician certification in the U.S.

Though it's the season for gift giving, the ASAPS warns that surgeries should be self-motivated. Don't do it because you received a discount coupon or because someone else thinks your breasts should be perkier. If you must give someone a gift certificate, make it for one of the top five non-surgical procedures: Botox injections ($399 national average cost), a deep facial cleaning ($220), collagen injection ($399), laser hair removal ($382) or a chemical peel ($825).

Whether you want a straighter nose or a tummy tuck, the second word in cosmetic surgery is "surgery." If you're not satisfied, there is no 30-day return policy.


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The Atlanta Journal and Constitution


New face, new future Ga. surgeons offer hope to Zambian girl


Edition: Home

Section: Atlanta & The World

Beatrice hid her face behind her fingers. The slight child slowly peeled back her fingers, revealing her eyes, mouth and nose. Her doctors smiled at the startling transformation.

The 8-year-old orphan from Zambia wasn't so sure. She had dreamed about having a nose, like other children, since she came to Atlanta for reconstructive surgery. As her team of doctors surrounded her for a final consultation Aug. 17, she wasn't comfortable with the new look.

She had lived without a nose since surgery for a tumor on her face as an infant left her with a hole where her nose and upper lip had been. Her appearance has always been more startling to others than the little girl with the upbeat personality.

Beatrice looked around the room at speech pathologist Kara Kenkle and Doctors Jack Thomas and Joseph Williams. She had known Williams the longest and gave him an approving glance and hug.

Williams, a pediatric craniofacial surgeon, praised the group responsible for the child's new face. The 9-member team, at Children's Healthcare of Atlanta at Scottish Rite, included two pediatric plastic surgeons and speech pathologists, a pediatrician, dentist, orthodontist, prosthodontist and audiologist. All donated their time.

"Our goal has always been to get Beatrice to a point where she is comfortable enough to enjoy being a child," said Williams.

Childspring International, an Atlanta-based organization that finds medical treatment for children, mostly from Third World countries, brought Beatrice to Atlanta 15 months ago. Helen Shepard, Childspring development director, said that in a few months, Beatrice will return to live at Emma's Kids, a Church of God ministry and school that helps street children in Zambia.

Her doctors say Beatrice will come back to Atlanta for future surgeries. Williams is happy with changes in his young patient but won't be totally satisfied until he can do another operation in about a year to bring her jaw forward. That will increase space in her head, improving her speech and appearance. When she is a teenager, she will have more work to build an upper lip and a permanent nose.

During the first procedure a year ago, Williams and Dr. Mark Deutsch took a flap of skin and vein from the child's right forearm and created a palate and platform for an upper lip by pulling the skin around a titanium plate.

In January, Williams took bone from her hip and transplanted it into her jaw. He also worked on bringing in the corners of her mouth.

In early August, Beatrice received a prosthetic nose, an acrylic appliance to cover the roof of her mouth, and a partial denture attaching new teeth to existing teeth in the back of her mouth.

Thomas, a pediatric dentist, said the piece allows Beatrice to speak easier and normalizes the mouth and nose by separating them.

"She has a normal-looking smile now. She looks tremendous," he said. "This has made her more social and confident."

After her second surgery, Beatrice moved from a home in Smyrna to live with a family in Alpharetta. Her temporary guardian, who doesn't want to be named, said the little girl has adapted well to her two children, a houseful of animals and a busy life in suburban Atlanta.

When Beatrice started kindergarten a few weeks ago, she decided to leave her new nose at home. Her caregivers think having a nose was a more dramatic change than the little girl anticipated, and it will take awhile for her to adjust.

"We aren't through yet, but we are close," said Williams. "What we wanted was to give her a chance for a normal life. In a lot of ways, we've done just that."

CAPTION: ANDY SHARP / Staff 8-year-old Zambian orphan Beatrice shyly covers her face with both her hands.

CAPTION: ANDY SHARP / Staff 8-year-old Zambian orphan Beatrice covers half her reconstructed face with one hand.

CAPTION: ANDY SHARP / Staff 8-year-old Zambian orphan Beatrice reveals her reconstructed face to the camera.

CAPTION: ANDY SHARP / Staff "We wanted . . . to give her a chance for a normal life," said Atlanta craniofacial surgeon Dr. Joseph Williams of his huggable little patient, 8-year-old Zambian orphan Beatrice.

(Copyright, The Atlanta Journal and Constitution - 2005)