Rarely “Botched”

On my desk is a “news-papery” looking journal called the “Plastic Surgery News.” It comes out monthly and it’s articles are of general interest to plastic surgeons, but are not “scientific” in nature. In this issue, there are some fluff pieces on particular surgeons telling about their lives, a job board, a slate of delegates to vote for – that sort of thing.

The lead article this month is entitled “Plastic surgeons share the good, the bad and the ugly impact of reality TV.”

It’s a fairly long piece that describes reality TV shows about plastic surgery told from the plastic surgeon’s perspective who “star” in them.

Richard Ellenbogen, an LA cosmetic surgery pioneer who I remember hearing on the radio in the ‘90’s while I was doing my general surgery training, features prominently. He’s long retired, but remembers how the TV show about him and his practice was a double edged sword. It publicized his practice and from that he got a lot of patients, but what the show really wanted was ratings. To get them, they were willing to distort his life both inside and outside his office, and almost put him out of business when they said he retired at the show’s close. He hadn’t!

They talk to one of the Atlanta Plastic surgeons (another TV show) – Marcus Crawford, and to a young LA surgeon named Sheila Nazarian who’s about to star in a show that isn’t named. According to the article, Sheila’s excited to “have a platform” to talk about plastic surgery and promote its merits. Sheila’s also been in practice for a little over two years.

Now, training to be a plastic surgeon ranges from rigorous to very, very rigorous (mine took 9 years after medical school!).

During that time, you learn how to think - first like a doctor, then like a plastic surgeon. At the end of that training, you are allowed to take a test to become board certified in plastic surgery and, if you pass, you attach those credentials to your name.

But the application to sit for that test takes a couple of years to come to fruition, and during that time, the newly minted surgeon is out practicing. I was fortunate enough to join two surgeons who had “been around” a while, and their real world experience was invaluable. They kept me out of trouble.

They say that good judgement comes from wisdom, wisdom from experience, and experience from weathering poor judgement. During your training as a plastic surgeon you get some of that, but you get far more from being in practice.

You see, during your training, the “poor judgement” wasn’t yours – usually it was your attending surgeon’s, and while weathering his poor judgement has an impact, it has a far greater impact when you are the one making the decisions.

Back to Sheila and her two years of practice experience. She’s in trouble and she doesn’t even know it. Unless she’s extraordinarily cautious and does only small surgeries, she’s going to have a problem and the unblinking eye of the TV camera is going to be there to capture it. The TV executive’s must be salivating!

I feel sorry for her and for her patients, but I feel worse for our specialty because it’s going to exaggerate the problems that we have and everyone will suffer. There’s another TV show that focuses solely on these problems called “Botched” - two Newport, CA surgeon’s fix problems created by other surgeons. When I first saw it, I was of two minds. First I was really happy for Terry Dubrow. He’s a good friend of mine (we trained together in LA in general surgery) and we’ve kept in touch over the years. He’s making a fortune and he deserves it – he’s a good surgeon and his personality is fun to watch on TV.

But as I thought about it, I came to realize that the whole notion of promoting “botched” surgery really does the specialty a disservice. You see, competent surgeons rarely make unfixable problems.

Sure, bad results can happen – we can’t always completely control the healing process. But after a time in practice, you learn what works in your hands. More importantly, you learn how to “get out of trouble.”

After two years in practice, Dr. Nazarian is unlikely to have that good judgement and is likely to contribute to the distortion of our wonderful specialty by displaying her problems to a national audience. That she’s chosen to go on television suggests that her judgement is already suspect. Wouldn’t it be ironic if her problems end up on “Botched?” I’d better call Terry.

- Robert Sigal, MD