As if you needed any more reasons to choose a surgeon who is certified by the American Board of Plastic Surgery for your plastic surgery procedures, along comes this story:
I want to emphasize that I reviewed the medical records in this case, and my opinion in this video is not one given lightly.
Every physician has had complications and unfortunate outcomes, even in situations when everything was seemingly done right. So I'm not quick to "point fingers". But this was not a case when things were done right from the start.
I still don't understand why anyone would ever choose a non-plastic surgeon to do their plastic surgery. These "cosmetic surgeons" are NOT plastic surgeons! They are doctors in other specialties (family practice, internal medicine, anesthesiology, OB/GYN, etc) who have decided to take some weekend courses so they can start doing cosmetic procedures in their offices. Would you think it was okay if I started doing PAP smears or delivering babies (I mean, I did both of those things in med school, and I'm a doctor, so surely I'm qualified, right)? The medical board ALLOWS any physician to do anything they want--buyer beware.
A female plastic surgeon's perspective on the world of cosmetic procedures
Hello Dr. Kavali,
ReplyDeleteMy name is Dr. Julio C. Novoa, M.D. I am an OBGYN and cosmetic surgeon practicing in El Paso Texas.
I, as other members of the American Academy of Cosmetic Gynecologists and the American Academy of Cosmetic Surgery, are very concerned about a documented fatality regarding the use of tumescent anesthesia based on the Klein technique.
Could you comment on whether Dr. Johnson exceed the recommended upper limit of tumescent anethesia of 50mg/kg body weight of lidocaine during this liposuction case.
Although I appreciate your disagreement on who should be allowed to perform cosmetic procedures, the Klein technique has been proven to be safe and effective in over 500,000 cases when properly followed during AWAKE procedures.
I have personally performed over 400 cases without a complication.
Could you please comment on the overdose level that was found by the coroner.
Also, we have often recommended that African American patients be managed using dosages below 40mg/kg body weight because it appears that this ethnicity seems to be more sensitive to the toxicity of lidocaine.
Again, could you please comment. I would be glad to share any comments, both positive and negative and any criticisms with my colleagues.
Thank you.
Dr. Novoa
Dr. Novoa,
ReplyDeleteI appreciate your comments. I also often perform awake liposuction using only tumescent anesthesia and typically keep my lidocaine dosages within 35-45 mg/kg.
The woman who died was given at least 7200 mg of lidocaine, around 105 mg/kg. Her plasma level of lidocaine was 21 mg/l.
I appreciate your concern for safety. Thank you.
Thank you for your response. I am shocked to have read 105mg/kg. In Klein original work, he did document some information about using lidocaine levels between 60-100mg/kg. However, I am unaware of anyone who is using greater than 55mg/kg. As a cosmetic surgeon having performed over 800 awake breast, lipo and lipoabdominoplasty cases without a complication, safety protocols regarding the tumescent technique appear to have been blatantly ignored in this case. These actions exceeded all parameters of patient safety, especially considering that maximal lidocaine levels who have been reached at home and expected to be at toxic levels. Based on the amount of lidocaine administered, the doctor had to have been aware of not just the risk but of the high probability of cardiac arrest at home. This is unbelievably sad and tragic. Sincerely Dr. Novoa.
DeleteUPDATE: The Georgia Medical Board has summarily suspended the medical license of Dr. Nathaniel Johnson.
ReplyDeleteIt happens. That's the reason why it is important to seek the expert doctors not the one who offers you a cheap liposuction surgery.
ReplyDelete