Plastic Surgeons, Dermatologists Face Off Over Cosmetic Procedures

Andrew Kitchenman | May 14, 2013 | Health Care
Bill would prevent liposuction, other procedures from being performed in dermatologists' offices

A contentious argument is brewing between the state’s plastic surgeons and dermatologists, over who can perform certain procedures — and where they can be performed.

Arguing that patient safety is at issue, the surgeons are backing a bill (A-1824) and S-2079, that would require some operations — like liposuction, breast implants, and tummy tucks — to be carried out in accredited ambulatory surgery centers (ASCs) and hospitals.

Dermatologists, who generally work out of their offices, insist that current regulations ensure patient safety.

Over the past few years, dermatologists have started performing some laser liposuction in their offices, raising concerns from those operating the ASCs, specialized outpatient facilities.

While the bill focuses on a limited number of procedures, the plastic surgeons maintain that a larger variety of surgeries could be affected as new technology lets doctors perform an increasingly broad range of operations in their offices.

A chief difference between an ASC and a doctor’s office is that the former is equipped to handle surgeries that require general anesthesia, while only local anesthesia can used in a medical office.

In addition, only surgeons are usually certified to operate in ASCs.

Plastic surgeons also contend that the accreditation process for ASCs requires trained staff and specialized equipment that ensure that the facilities are safer for patients than doctors’ offices.

“The only reason that local anesthesia is being used is that these practitioners are not qualified to deliver these procedures” in ASCs, said Dr. Gary Smotrich, a Lawrence-based plastic surgeon with Robert Wood Johnson University Hospital Hamilton.

Smotrich said dermatologists are trained for two days on how to use laser liposuction machinery, while plastic surgeons are prepared for liposuctions through seven years of residency.

Dermatologists counter that general anesthesia poses the primary danger in cosmetic surgery. They also noted that operations completed in doctors’ offices are less expensive, a key consideration for voluntary cosmetic procedures.

“You’re going to deny care for people who can’t now afford to have procedures done in a much more expensive situation,” said Dr. Robert Paul, legislative chair of the Dermatological Society of New Jersey.

Paul expressed concern that the bill would block medical procedures that are currently being done safely, adding that that his specialty has been involved in liposuctions throughout the history of the procedure.

“We don’t want to have things legislated away from us,” Paul said.

Lisa Percy Albany, assistant director of state policy for the American Academy of Dermatology, said that state regulations are sufficient to ensure patient safety.

“We believe that this bill is the wrong vehicle to improve patient safety,” Albany continued.

Sen. Robert W. Singer (R-Monmouth and Ocean) questioned whether the legislation would truly increase patient safety, considering that it doesn’t require that the procedures be carried out in hospitals.

“If we were talking about doing that, I could really be supportive of this,” Singer said, adding that ASCs must call 9-1-1 to have patients transferred to hospitals if emergencies arise during surgeries.

Dr. David Abramson, president-elect of the New Jersey Society of Plastic Surgeons and chief of plastic surgery at Englewood Hospital, said patients at ASCs benefit from up-to-date equipment and a greater focus on sterilization that is required under accreditation. He added that patient safety should outweigh the savings from having the procedure at doctors’ offices. “If someone couldn’t have liposuction [due to cost], this is not a crisis,” Abramson said.

The Senate Health, Human Services and Senior Citizens Committee released the Senate version of the bill on May 9 on a 6-1 vote with two abstentions. Singer was the only senator who opposed the measure. The Assembly version was released by the Assembly Health and Senior Services Committee in December.