Over the last month, a dermatologist practicing in Georgia known as the “dancing doctor” was suspended by the Georgia Medical Board, which said she posed a “threat to public health, safety, and welfare.” At least ten patients have sued this physician with complications including disfigurement and brain damage, and reportedly there are another 100 former patients who may pursue litigation as well. According to her social media account, this physician was performing cosmetic surgery procedures including abdominoplasty, fat grafting to the buttocks, and others that were far beyond her scope of training and in general have no reason to be performed outside the plastic surgery specialty. In one instance, a patient suffered brain damage after an 8-hour abdominoplasty. The longest abdominoplasty procedure I have performed in my career lasted approximately 3 hours and 15 minutes. In addition, while I am only able to judge via public content, the “dancing doctor” seems to have been performing surgery incorrectly and in more than one instance created superfluous, arguably incorrect, surgical incisions. Dancing in the operating room during surgery is highly disrespectful, but it is equally alarming that a physician without the necessary training was able to perform these aesthetic surgery procedures legally at all. How did this happen? The chair of the Georgia Medical Board told WSB-TV in Atlanta that “… when you are licensed to practice medicine in Georgia, you’re licensed to practice medicine and surgery. It says so right on your license.” The same is true in the state of New York where I practice. Unfortunately, this latitude is probably overly generous and led to the “dancing doctor” situation at hand: a practitioner in a non-surgical specialty, one not eligible for admission to the American College of Surgeons, was legally able to perform significant, multi-hour surgery. (Note that this physician does not seem to be a member of the American College of Moh’s Surgery, a procedural specialty within dermatology which involves excision of skin cancers, though she advertises expertise in “skin surgery” on her website. Moreover, even having such membership would not allow her entry into the American College of Surgeons or entitle her to perform abdominoplasty.) In my view, scope of practice regulations have become a necessity. While the overwhelming majority of physicians have no interest in practicing outside the scope of their training, there are some bad actors in the cosmetic surgery ecosystem. Non-American Board of Medical Specialties (ABMS) “board certifications” are marketed to patients by non-plastic surgeons seeking to perform cosmetic surgery, and the difference between a so-called “cosmetic surgeon” and a board-certified plastic surgeon is not well understood by patients. While there may be justifiable overlap with other specialties on certain cosmetic procedures, many cosmetic surgery procedures, especially those of the breast and body, should only be performed by a trained plastic surgeon. For example, a hospital would likely credential a physician in obstetrics and gynecology to perform labiaplasty but not to perform breast augmentation; and head and neck cosmetic surgery overlap with several specialties outside of plastic surgery, including otolaryngology, oromaxillofacial surgery, and oculoplastic surgery. Social media and digital marketing are part of the problem Both Instagram and Google Adwords advertising have become popular with patients seeking aesthetic treatment and those providing it. These marketing channels are part of the problem in that they fail to self-police. For example, even though the “dancing doctor” has a suspended medical license, she continues to post to social media with before and afters and other content implying she is still practicing. Instagram has no option for which to report these photos under its guidelines. The closest category is “violence or threat of violence” or “unlawful activity,” and Instagram informed me that such posts do not qualify under this provision. Moreover, I have witnessed fraudulent images of “before and after” treatment results posted on Instagram, which were actually commercial stock images, and I have seen my own surgical content stolen by other practitioners without consequence. Google Adwords fails to police bad actors as well. I advertise on Google Adwords as part of my marketing strategy, and in the past, my advertisements were temporarily disapproved by Google due to “nudity” on the linked page in my before and afters, then due to modification of the original photo with pixelation to cover that nudity, and finally due to the presence of Botox and other “pharmaceuticals” on my page. It is difficult to demonstrate breast augmentation treatment results without “nudity.” To reconcile the last issue with Botox, I was required to obtain a “pharma certificate” from Google before my advertisements would continue to run. However, there seems to be little control over who may advertise these cosmetic surgery procedures on Google. I recently tabulated the first page of search results of “best tummy tuck” in the New York City area, and three of four advertisements were from unqualified, non-plastic surgeon practitioners. This result is similar to that for liposuction Google searches and several other cosmetic surgery procedures. I believe that scope of practice laws are needed to improve patient safety in cosmetic surgery, and social media and digital advertising must self-police in the absence of meaningful regulatory reform. It would be preferable if scope of practice and advertising were limited to those who are credentialed at a hospital to perform cosmetic surgery procedures. In addition, where medical devices have no use other than aesthetic surgery, companies should limit their sales to plastic surgeons. A few companies such as Sientra, the makers of breast implants, already do so, but many do not. Unfortunately, as of now there are likely other “dancing doctors” waiting in the wings. Joshua D. Zuckerman is a plastic surgeon and can be reached at Zuckerman Plastic Surgery. Source
