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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 (www.abms.org), 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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