Analysis: Some cosmetic surgery unethical

By STEVE MITCHELL, UPI Medical Correspondent

Michael Jackson's damaged nose from alleged repeated plastic surgery -- the subject of several recent TV reports -- raises questions about the ethics of doing facelifts, breast augmentations and other cosmetic surgery that has no medical benefit, experts have told United Press International.

Jackson's disfigured face was revealed last year when he removed the surgical mask he routinely wears while testifying in a court case in Santa Maria, Calif. The tip of his nose was scarred and discolored and skin tissue appeared to be dangling from it. Jackson has admitted having nostril reconstruction but has denied having any other facial surgery.


"It appears to me that he's had numerous surgeries on his nose and it appears he's had something to widen his chin," perhaps a chin implant, said Thomas Loeb, a plastic surgeon in New York City who has done facial reconstructive surgery on celebrities, including Paula Jones' nose.


Loeb told UPI that Jackson also might have had a procedure done "to make a dimple in his chin," cheek implants or some other modification and surgeries on his upper and lower eyelids.

The results of the repeated operations raise questions about the ethics involved of exposing patients to the risks of medically unnecessary surgery, which can result in infection, bleeding, deformities requiring secondary surgeries -- and even death in rare cases.

"There is a sense outside of cosmetic surgery among mainstream medicine that these people are pretty much on the edge and it's not really medicine anyway -- it's more of a technical procedure under the guise of medicine and these guys are really just in it for the money," one bioethicist, who requested anonymity, told UPI.

"I think we've run into a serious problem in this area," said Steve Miles, a professor of medicine at the University of Minnesota's center for bioethics in Minneapolis.

"We've created a healthcare system that says we're going to use a market model that says whatever a consumer requests ... fits into appropriate medical practice," he added.

"The position of the medical profession has been that everything the customer agrees to ... is fair game so long as the risks have been fairly presented," Miles said.


Referring to hypothetical situations of patients requesting repeated nosejobs or a sixth facelift, Miles said, "We don't have any medical ethic where that request is extreme." He noted the phrase "do no harm" is not contained in the Hippocratic oath, as popularly attributed. (The relevant passage, as translated, binds the physician to "abstain from whatever is deleterious and mischievous.")

Jackson's amount of alleged surgery is "not that much plastic surgery," Loeb said, adding, "If Michael's nose didn't look so terrible, ... we all wouldn't be so critical."

Asked who bears responsibility for determining when to limit repeated cosmetic procedures, Loeb responded, "Everybody bears responsibility when a patient has too much surgery. The patient is partly responsible and the doctor is partly responsible."

However, he added, "The surgeon isn't making (the patient) walk through the door."

Loeb noted the surgeon should always ensure that the patient has realistic expectations. If a patient is overly concerned over a small bump on the nose, surgery is not likely to be satisfactory and the surgeon should decline to perform the requested operation, he said.

The debate "should be about where to stop, not whether to get plastic surgery," Loeb said, adding, "It's going to continue" and people are going to continue to request it.


Organizations representing plastic surgeons did not respond to inquiries from UPI. Although both the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery initially agreed to discuss the ethics of cosmetic procedures, they failed to follow through with the arranged interviews.

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