Cosmetic Surgery Desperation and Depression

Korean case shocked the globe, but U.S. doctors report horrors in bad economy.

November 13, 2008, 5:29 PM

Nov. 14, 2008— -- Hang Mioku's last act in her 20-year addiction to plastic surgery made her infamous: She picked up a syringe, filled it with cooking oil and injected into her own face.

Mioku's extreme act and the resulting disfigurement made international headlines. She told the Korean media that she turned to cooking oil because she had run out of the silicone a doctor had given her to perform injections at home.

Doctors already frown upon silicone injections as a hazardous, ineffective practice; when the story first broke in the West, the U.K. Telegraph marveled: "Amazingly, she found a doctor who was willing to give her silicone injects and, what's more, he then gave her a syringe and silicone of her own so she could self-inject."

Cosmetic and plastic surgeons in the United States aren't all that amazed that Mioku went to the lengths she did. While most in search of an improved look aren't as desperate as Mioku, plastic surgeons report fixing more mistakes as people turn to similar do-it-yourself procedures and get cut-rate jobs by unqualified physicians.

Some doctors make a good living fixing botched surgeries, calling the repair work "revisions." Other doctors only take on revisions when the mistake is extreme and the patient needs expert help.

"I once revised somebody who wanted an enhancement and had the breast injected with liquid silicone, not even by a physician," said Dr. Malcolm Z Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y.

Roth said the silicone in this case was different from the silicone used in legitimate breast implants and had resulted in "hard, lumpy, painful, irregularly shaped breasts."

"It can migrate, or go to other parts of the body. It can cause noncancerous growths," he said. To lessen the woman's chronic pain, Roth said he essentially performed a mastectomy and started from scratch.

Dr. Craig A. Vander Kolk, a professor of plastic surgery at Johns Hopkins University and director of cosmetic surgery at Mercy Medical Center in Baltimore, has had his fair share of botched injections and face-lifts to treat.

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"I saw one patient --she got an infection, ended up with a scarring and a facial nerve damaged," said Kolk. "Her face was lopsided, she couldn't move the corner of her mouth and she had terrible scars."

More Surgery Equals More Risk

"We can usually make something much better, but can we take it back to what it was before? Probably not," he said. "Once you've done two or three operations, you significantly increase the risk of problems and making things look more natural."

Kolk, Roth and other plastic surgeons note that a bad economy fuels these problems: Doctors in other specialties may dabble in cosmetic work to make extra money, and patients are more motivated to shop around for bargain basement prices.

"Especially with this market, it's become a bigger issue with the economy in the last year," said Dr. Vincent Marin, a surgeon certified with the American Board of Plastic Surgery.

"The cheaper price sometimes brings with it lesser quality," said Marin, who practices at the La Jolla Cosmetic Surgery Centre in La Jolla, Calif. Marin said he's noticed that many of his patients shop for price first, but only start researching to find a quality surgeon after they've had a botched surgery.

Angel D., who asked that not use her full last name, said her first "bargain" breast enhancement eventually cost her eight years of painful revision surgeries, multiple cross-country trips and a total of $45,000 instead of $2,000.

"It was just like flaps of skin," said Angel. "I had indents around my right breast, all around my areola. If you put your finger in it was as like Play-Doh."

That was her description after doctors corrected her first botched breast enhancement. Angel said it all started in 2000, with a Christmas gift from her ex-fiance.

"I didn't have bad breasts to start with, I was 90 pounds and I was a small 32B," she said. "But I was dating somebody who wanted big boobs." A size D to be exact.

Angel said everything went well until three months after her surgery.

"My right breast became hard to the touch and I couldn't lie on my side because it was so painful. Instead of being round, it started looking square in areas," Angel said. "It just looked deformed."

Angel later found out she had a capsule contracture, or shrinking scar tissue around the breast.

Suspicious Cosmetic Offices Can Harm

When Angel returned to the 20-physician plastic surgeon office near Boca Raton, Fla., the physician who had done her work was gone. Angel said she later found out that all the doctors in the practice were nonstaff contractors and that the only recourse at the office was to pay full price for another fix.

She had a capsule contracture three months after her second surgery, along new deep scars and an infection. Finally, Angel went to an expert surgeon in Manhattan to get the implants out.

"He had shown me after the fact, there was green inside there and it was infected," said Angel. "I went on eight consultations after that and nobody wanted to touch me. They like primary consultations. They don't like to be responsible for fixing other people's mistakes."

For years Angel lived with virtually no breasts because each surgery had to remove scar tissue from her original form.

Eventually Angel found help with Dr. Jason Pozner of Boca Raton, Fla. Several surgeries later, including complete reconstruction of her right breast, Angel said she's happy.

"My breasts now are normal," said Angel. "I really had thought it was hopeless, so I'm very lucky."

Angel said that her first doctor was offering a suspiciously low price, but at least he was a certified plastic surgeon. Others may not be so lucky on the first try, as the economy tempts nonspecialists into trying cosmetic procedures.

"In this economy, with plastic surgery going down, you're going to have nonspecialists who are looking for a buck," said Alex Kuczynski, a New York Times contributor and author of the book "Beauty Junkies: In Search of the Thinnest Thighs, Perkiest Breasts, Smoothest Faces, Whitest Teeth, and Skinniest, Most Perfect Toes in America?"

To be called a full-fledge plastic surgeon takes work. Doctors must complete five to seven years of plastic surgery residency training after medical school and pass the certification requirements for plastic surgery from the Accreditation Council for Graduate Medical Education.

A Mix of Turf Wars, and Some Real Quacks

Cosmetic doctors can run the gamut of well-trained surgeons from other specialty fields, to family doctors or dentists who took a weekend course in face-lifts or liposuctions.

"It's shocking to me, I have friends who say 'oh he's a member of the American Board of Cosmetic Surgeons' -- it doesn't mean anything," said Kuczynski. "The industry is so slick, it's so well-packaged and it's marketed to people who have a bit of insecurity."

Dr. G, an obstetrician and now a cosmetic surgeon, disagrees to some degree. Dr. G. wanted to remain anonymous for fear of trouble professionally, but said he has seen botched surgeries from plastic surgeons as well.

"I've seen half-a-dozen patients in the past couple of years who've come from prominent plastic surgeons with distended stomachs after liposuction," said Dr. G.

According to Dr. G, what the women thought was fat turned out to be uterine fibroids. "I suspect the plastic surgeon didn't perform a pelvic exam," he said. "Maybe there are some poor, inexperienced cosmetic surgeons just as there are poor inexperienced plastic surgeons."

Whatever procedure a patient chooses, Dr. John Canady, president of the American Society of Plastic Surgeons, urges people to reflect on the price.

"As a patient, you owe it to yourself and your kids and your family that you really need to do that with a fair amount of planning and forethought," said Canady. "If you're talking about surgery on yourself, that's not the time you want to be out getting the lowest possible bargain rate."

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