Beware of budget tightening, regulators warn amid social media-inspired boom

(CNN) — Looking back, Nikki Ruston said she should have recognized the red flags.

The Miami office where she scheduled the operation, known as the Brazilian butt lift, has closed and her records have been transferred to another facility, she said. The price she was told—and paid upfront—extended the day of the procedure, and she said she didn’t see her surgeon until she was put under general anesthesia.

“I was ready to leave,” Ruston, 44, from Alfred Lake in Central Florida, said. But I paid everything.

According to her medical records, a few days after her July procedure, Ruston was admitted to the hospital due to infection, blood loss, and nausea.

“I went cheap. That’s exactly what I did,” Ruston recently recalled. “I was looking for the lowest price and found it on Instagram.”

People like Ruston are routinely lured into office surgical centers in South Florida with social media marketing that makes Brazilian butt lifts and other cosmetic surgeries look deceptively painless, safe and affordable, say researchers, patient advocates and surgeon groups.

Unlike outpatient surgical centers and hospitals, where the patient may stay overnight for follow-up after treatment, office-based surgical centers offer procedures that typically do not require an inpatient stay and are managed as an extension of the doctor’s private practice.

But such surgeries are often owned by corporations, which can offer discounts by contracting to surgeons who are incentivized to handle as many patients per day as possible in as little time as possible, according to government regulators and physicians critical of the institutions.

Ruston said she now lives with constant pain, but for other patients, the Brazilian butt lift has cost them their lives. After a string of deaths and a lack of national standards, Florida regulators were the first in the country to introduce rules in 2019 designed to make procedures safer. More than three years later, data shows that deaths are still occurring.

Patient advocates and some surgeons, including those who perform the procedure themselves, expect the problem to only get worse. The emergency restrictions imposed by the state medical board in June expired in September, and the corporate business model popularized in Miami is expanding to other cities.

“We’re seeing organizations that are highly experienced in low-cost, large-scale cosmetic surgery based in South Florida showing up in other parts of the country,” said Dr. Bob Basu, vice president of the American Society of Surgery. Plastic Surgeons and Medical Practitioner in Houston.

During a Brazilian butt lift, fat is taken by liposuction from other parts of the body such as the torso, back or thighs and injected into the buttocks. According to the Aesthetic Society, a trade group of plastic surgeons, more than 61,000 buttock augmentations, both buttock lifts and implants, were performed nationwide in 2021, up 37% from the previous year.

As with any surgical procedure, complications can occur. The Miami-Dade County Medical Examiner has documented almost three dozen deaths of patients after plastic surgery since 2009, 26 of which were the result of a Brazilian butt lift. In each case, the person died from a pulmonary fat embolism, when fat entered the bloodstream through veins in the gluteal muscles and stopped blood from flowing to the lungs.

Neither the national reporting system nor the insurance code track outcomes and patient demographics for a Brazilian butt lift. According to a 2017 report by the Aesthetic Surgery Education and Research Foundation Task Force, about 3% of surgeons worldwide die as a result of surgery.

Medical experts say the problem is partly caused by medical professionals such as physician assistants and nurse practitioners performing key parts of a buttock lift instead of doctors. It is also driven by a business model that is motivated by profit rather than safety and encourages surgeons to perform more surgeries than their contracts allow.

In May, after the fifth patient in as many months died of complications in Miami-Dade County, Dr. Kevin Cairns proposed a state of emergency to limit the number of butt lifts a surgeon can perform each day.

“I’m tired of reading about women dying and seeing cases being brought before the board,” said Cairns, a physician and former member of the Florida Medical Board.

According to disciplinary cases against surgeons filed by the Florida Department of Health, some doctors performed up to seven surgeries. The emergency rule limited them to no more than three and required the use of ultrasound to help surgeons reduce the risk of pulmonary fat clot formation.

But a group of doctors performing a Brazilian butt lift in South Florida clapped their hands and formed Surgeons for Safety. They argued that the new requirements would exacerbate the situation. Qualified doctors will have to perform fewer procedures, they say, leading patients to dangerous medical professionals who don’t follow the rules.

Since then, the group has donated more than $350,000 to the state Republican Party, Republican candidates, and Republican political action committees, according to Florida State Department campaign contributions data.

Surgeons for Safety turned down KHN’s repeated requests for an interview. Although the group’s president, Dr. Constantino Mendieta, wrote in an August editorial that he agreed that not all surgeons follow the standard of care, he called the restrictions placed on surgeons “arbitrary.” The rule sets a “historic precedent for the control of surgeons,” he said during a meeting with the Florida Medical Board.

In January, Florida Senator Ileana Garcia, a Republican, filed a bill in the state legislature proposing no cap on the number of Brazilian butt lifts a surgeon can perform per day. Instead, it requires office-based surgery centers where procedures are performed to have one physician per patient, and prohibits surgeons from working on more than one person at a time.

The bill would also allow surgeons to delegate some parts of the procedure to other doctors under their direct supervision, and the surgeon must use ultrasound.

The Florida legislature meets on March 7.

Consumers considering beauty treatments are being urged to exercise caution. Like Ruston, many people base their expectations on before and after photos and marketing videos posted on social media like Facebook, Snapchat and Instagram.

“It’s very dangerous,” said Basu of the American Society of Plastic Surgeons. “They get excited about the low price and forget about the homework,” he said.

According to the Aesthetic Society, the average cost of a buttock augmentation in 2021 was $4,000. But this is only for the doctor’s fee and does not cover the cost of anesthesia, operating room, prescriptions or other expenses. According to a recent article on the American Society of Plastic Surgeons website, a “safe” Brazilian butt lift performed in an accredited facility and with proper care costs between $12,000 and $18,000.

While Florida requires a physician’s license to perform liposuction on patients under general anesthesia, according to Dr. Mark Mofid, in the medical field, mid-career practitioners such as physician assistants and nurse practitioners typically perform the procedure in an office setting. , co-author of the 2017 Aesthetic Surgery Education and Research Foundation Task Force study.

By relying on employees who don’t have the same specialized training and are paid less, office surgeons can perform more buttock lifts per day and charge a lower price.

“They do it all at the same time in three or four different offices, and it has one surgeon,” said Mofid, a San Diego-based plastic surgeon, adding that he does not perform more than one Brazilian butt lift at a time. day. “The surgeon is not dealing with a real case. These are helpers.

Basu said patients should ask if their doctor is authorized to perform the same procedure in a hospital or outpatient surgery center, which has stricter rules than office surgery centers on who can perform a buttock lift and how it should be done. .

Discount seekers are reminded that cosmetic surgery can carry other serious risks besides fatal fat clots such as infection and organ puncture, as well as kidney, heart and lung problems.

Ruston’s surgery was performed by a certified plastic surgeon she found on Instagram. She was initially given $4,995, which she said she paid in full prior to the operation. But when she arrived in Miami, she said, the clinic increased fees for liposuction, as well as postoperative clothing and appliances.

“I ended up paying about $8,000,” Ruston said. She said that a few days after Ruston returned home to Alfred Lake, she became dizzy and weak and called 911.

Paramedics took her to the emergency room, where doctors diagnosed her as anemic due to blood loss, as well as blood and abdominal infections, her medical records show.

“If I could go back in time,” she said, “I wouldn’t.”

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