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Health, Beauty & Fashion

Revamp rules for cosmetic surgery?

Plastic surgeons speak out against 'easy' rules for aesthetic medicine
The Straits Times - June 13, 2011
By: Poon Chian Hui & Melissa Pang
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Revamp rules for cosmetic surgery?

PLASTIC surgeons are questioning whether the rules surrounding cosmetic procedures such as liposuction are tight enough, given the high number of general practitioners offering them.

More than half of GPs engage in some kind of aesthetic practice, from chemical peels to fat grafting, according to the Ministry of Health (MOH).

But there are no figures to show how many have the necessary certificate of competence.

The issue was thrown into the spotlight yesterday when it was reported that the family of property firm chief Franklin Heng, who died after having liposuction, is suing the two GPs involved for at least $1 million.

The 44-year-old died in Tan Tock Seng Hospital in 2009 after undergoing the procedure at Reves Clinic in Orchard Road.

Two weeks ago, prominent plastic surgeon Woffles Wu wrote to The Straits TimesForum Page saying GPs should stop engaging in cosmetic surgery.

In the letter, he deemed this 'a dangerous trend', saying that the current practice of allowing GPs to obtain liposuction certification after observing and being mentored through a few cases 'cannot be considered sufficient training'.

In a reply to Dr Wu last Tuesday, the ministry said stringent licensing is in place for liposuction - in which patients' fat is sucked out.

Dr Arthur Chern, group director of the ministry's Health Regulation Group, said in the reply that doctors from any field should be able to carry out aesthetic procedures, as long as they are trained.

He pointed out that the most common liposuction method today, tumescent liposuction, was invented and popularised by two dermatologists.

It is estimated that more than 5,000 liposuction procedures are carried out in Singapore every year. In general, GPs tend to charge lower fees than plastic surgeons.

The MOH told The Straits Times last week that 38 GPs are licensed to perform liposuction.

There are 1,363 family clinics registered here. But the doctors who work in them spend an average of only 6 per cent of their time on aesthetic work, said the MOH, adding: 'Very few GPs engage exclusively in aesthetic practice.'

Liposuction accreditation is carried out by MOH. Licensing guidelines, which first emerged in 2008, dictate that doctors of other disciplines have to fulfil a list of criteria before they can offer liposuction.

For example, they must observe 10 procedures and perform five under a mentor appointed by the Accreditation Committee on Liposuction under MOH.

The rules were tightened last November. Changes include a seven-day 'cooling-off' period for patients to mull over their decision to go for surgery.

All other aesthetic procedures are governed by guidelines set up in 2008 by the Singapore Medical Council (SMC), Singapore Medical Association and College of Family Physicians.

The SMC, for instance, has an Aesthetic Practice Oversight Committee.

Under the guidelines, any doctor can offer aesthetic procedures if he gets a certificate of competence by submitting qualifications, such as those obtained overseas, to the SMC for verification; or by attending workshops it approves of.

About 16 workshops are currently available, focusing on techniques such as botox injections, dermal fillers and lasers.

The half-day workshops, run by dermatologists, consist of lectures and demonstrations. It is estimated that more than 400 doctors, mostly GPs, have taken these courses in the last two years.

Dr David Loh, honorary secretary of the Society of Aesthetic Medicine, of which 80 per cent of 150 members are GPs, said extra measures are also in place to improve standards and safety.

For example, it runs a Liposuction Peer Review Committee that meets regularly to discuss problems encountered and to learn the best practices, said Dr Loh, a GP who does liposuction.

Referring to the letter, he added: 'Dr Woffles Wu is concerned for patient safety, and from the society's point of view, we are also all about safety.'

The plastic surgeon fraternity, however, feels that the current guidelines should be relooked.

Dr Vincent Yeow, president of the Singapore Association of Plastic Surgeons, said the relatively quick certification process is inadequate, given that plastic surgeons train for seven years and have to pass formal examinations to be fully accredited as specialists.

Singapore has about 40 registered plastic surgeons.

'The association feels that in this era, a conscious effort must be made to be more mindful of training requirements.'

Dr Yeow, who is from KK Women's and Children's Hospital, said current requirements lack hands-on practice, and called for 'greater awareness of both the restrictions as well as the limitations behind the aesthetic treatment guidelines'.

Dr Wu, speaking to The Straits Times, went further to brand the certificate of competence and licensing rules 'a joke'.

Despite these guidelines, he said, he gets patients seeking help as often as every week, for complications from procedures botched by GPs. He emphasised that this is not a 'turf issue', but of patient safety. 'The enormity of the problem is escalating.'

Dr Leslie Kuek, a past president of the Singapore Association of Plastic Surgeons who practises at Gleneagles Medical Centre, has also had more of these patients turning up.

Last year alone, he knew of four liposuction complications that left the person's skin looking like 'a piece of cloth that hasn't been ironed'. While he is not against GPs offering non-surgical aesthetic services, Dr Kuek maintains that the current rules allowing procedure-specific certification is flawed as doctors should be trained to treat patients as a whole, not 'offer piecemeal therapies'.

The surgeons pointed to the recent death of Mr Heng as a wake-up call for the authorities. A coroner's inquiry is yet to be carried out. The liposuction accreditation of the doctors involved and the clinic's licence to offer the service have been suspended until further review, said MOH.

A one-time liposuction patient who wanted to be known only as Jack, said his decision to trust a doctor stemmed from his interaction with him during the consultation process. For example, he would note if the doctor adequately explained the risks, as well as how the post-operation care would be carried out.

The 35-year-old underwent the procedure with a GP last year on his abdomen and was pleased with the results and care given.

The Society of Aesthetic Medicine has in the meantime proposed that doctors 'work closely in a collegial manner'.

Its executive committee said in a statement published in The Straits Times Forum Page about 10 days ago that there are psychiatrists, paediatricians, obstetricians and gynaecologists, as well as ear, nose and throat surgeons among its ranks.

'The reputation and sophistication of Singapore as a medical hub lies not in the skill of one speciality alone. It is built upon collegiality, among other things,' it said. 'Collegiality means that doctors, whether they are in the public or private sectors, or whether they are GPs or specialists, all work together as colleagues rather than as competitors.'

Dr Kevin Chua, a GP at Drs Chua & Partners, acknowledged that cosmetic surgery can be risky. Some safety requirements GPs have to consider include easy access to ambulance services and hiring qualified staff, such as nurses and anaesthetists, to handle post-operation care.

Similarly, MOH said 'all surgical procedures carry some form of risks'.

'While there are the necessary regulatory framework in place to safeguard the interest of patients, we urge patients to always carefully consider the risks involved by discussing with the doctors before deciding whether to undergo any optional procedures,' said its spokesman.

The ministry will continue to conduct regular reviews on aesthetic practices and make revisions where appropriate, he added.



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