The Emergence of Cosmetic Plastic Surgery Clinics Run by Non-Plastic Surgeons and The Wound Complications That Can Arise

Introduction: The American Board of Plastic Surgery (ABPS) is the legitimate certifying board for plastic surgeons for legitimate plastic surgery training. This training includes the full spectrum of cosmetic surgery. ABPS certified plastic surgeons that choose to operate in outpatient facilities are required, to have admitting privileges at a hospital within 30 minutes to care for any patient, should complications arise. New corporate cosmetic clinics have emerged recently where non-plastic surgeons are performing invasive cosmetic surgeries in the outpatient setting. There is not full transparency to the patients that these surgeons have not completed plastic surgery training. As such, what is marketed as a relatively non-invasive procedure to the patients can have disastrous complications. We present two such cases of patients presenting with serious wound complications from cosmetic surgeries performed by non-plastic surgeons.Methods: Two patients underwent thermal liposuction, in one case over 6 liters were removed, over the safe limit of 5 liters for the outpatient setting. The aggressive liposuction caused third degree burns of the fat and skin. This was combined with a skin-only abdominoplasty, causing further skin devascularization. Both patients received limited post-op care, and both required emergency medical care at which time the board-certified plastic surgeon at the hospital was consulted. Both required reoperation with significant resection of necrotic tissue and flap advancement closure with wicked drainage and negative pressure wound therapy (NPWT) and IV antibiotics directed by infectious diseases physicians. Results:Both patients healed well after revision surgical management and coordinated inpatient and outpatient wound team care. Minor wound healing complications arose which resolved with outpatient wound care.Discussion: These patients experienced unnecessary pain and suffering with necrotic infected wounds, and incurred significant financial detriment as complications of cosmetic surgery are not covered under medical insurance policies. A close integration of the plastic surgeon and the wound care team is essential for managing these critical wound complications. Both patients were unaware that their surgeons were not board-certified plastic surgeons. Education of the public about board certification and legitimacy of practice is essential moving forward to protect patient safety.References:1. Chin MG, McIntire DRT, Wang MR, Liu PY, Breuing KH. Domestic and International Cosmetic Tourism Complications Presenting to a U.S. Tertiary Hospital. Aesthet Surg J. 2024 May 15:sjae112. doi: 10.1093/asj/sjae112. Epub ahead of print. PMID: 38748533. 2. McAuliffe PB, Muss TEL, Desai AA, Talwar AA, Broach RB, Fischer JP. Complications of Aesthetic Surgical Tourism Treated in the USA: A Systematic Review. Aesthetic Plast Surg. 2023 Feb;47(1):455-464. doi: 10.1007/s00266-022-03041-z. Epub 2022 Oct 31. PMID: 36315261; PMCID: PMC9619012. 3. Qureshi AA, Gould DJ, Stevens WG, Fernau J. Report on Current Experience of ASAPS Membership and Management of Cosmetic Tourism Complications. Aesthet Surg J Open Forum. 2019 Apr 9;1(2):ojz009. doi: 10.1093/asjof/ojz009. PMID: 33791605; PMCID: PMC7671244.