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Toronto case puts cosmetic surgeons' qualifications into international spotlight

Article-Toronto case puts cosmetic surgeons' qualifications into international spotlight

Key iconKey Points

  • A Toronto cosmetic surgeon faces multiple misconduct charges and allegations of mistreating 28 patients
  • Physician facing charges was a family practitioner before additional training as cosmetic surgeon, drawing questions of competency
  • Case highlights concerns about growing number of nonspecialists performing surgeries such as liposuction

A Canadian liposuction procedure gone tragically awry has thrown a spotlight on what some doctors view as a turf war between cosmetic and plastic surgeons — and may lead to a clarification of the unclear professional standards that now guide such operations.

At press time, a decision was still pending by the College of Physicians and Surgeons of Ontario (CPSO) following a well-publicized yearlong disciplinary hearing against Toronto cosmetic surgeon Behnaz Yazdanfar, M.D. Dr. Yazdanfar faced multiple misconduct charges and allegations of mistreating 28 patients after a 32-year-old real estate agent died in her clinic in 2007 following a tumescent liposuction procedure.

Dr. Yazdanfar was a family practitioner before taking additional training as a cosmetic surgeon — a background that, while approved in Canada, raised questions about her competence.

"The physicians who are the best qualified to perform cosmetic surgery such as liposuction are those who have training in surgery," says Achilleas Thoma, M.D., M.Sc., F.R.C.S.(C.), F.A.C.S., immediate past-president of the Canadian Society of Plastic Surgeons (CSPS). "Patient safety should be our top priority, and in this vein, physicians should practice within their own domain."

But others hold a different view, including a leading U.S. practitioner who testified in the case.

"Plastic and reconstructive surgery is not cosmetic surgery, and competence in plastic surgery does not in any way automatically lead to competence in cosmetic surgery," says Patrick McMenamin, M.D., of Sacramento, Calif., immediate past-president of the American Academy of Cosmetic Surgery (AACS), who testified as an expert witness for the defense. "Therefore, a doctor should be judged on their experience, training, education and proven competence in their field."

The circumstances of the liposuction patient's death prompted an investigation into Dr. Yazdanfar's treatment of patients. The case also raised questions about which surgical protocols should be followed and which specialty should be the sovereign voice for physicians who offer such procedures.

PROCEDURE GONE WRONG The 150-pound patient underwent liposuction under general anesthesia, receiving 6 liters of tumescent fluid, according to Dr. McMenamin. An approximately equal amount of total aspirate was removed, but containing just slightly more than 2.7 liters of supranatant fat.

The procedure was uneventful, but the patient developed complications and died shortly afterward.

The Ontario Provincial Coroner's Office ruled that the death was caused by hypovolemic shock complicating liposuction. But Dr. McMenamin, interviewed recently by Cosmetic Surgery Times, says he and other experts disagree that the patient had inadequate fluid replacement.

"In my opinion, this is a complication of general anesthesia where the patient lost vascular tone and could have been treated with pressor agents," Dr. McMenamin says.

According to the coroner's report, the patient became unresponsive about an hour after the procedure, and fluid resuscitation was started. An ambulance was called about 40 minutes later, and she was transferred to a hospital.

The patient's vital signs were absent, with a coagulopathy and bleeding from multiple puncture sites, according to the report. She received multiple transfusions, and CPR continued for about two hours before she was pronounced dead, about seven hours after the procedure.

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