Can Physician Assistants Do Smart Lipo?

Question

I know that a board-certified doc is the best choice but I have heard of PAs doing the procedure. Is this legal?

Larry S. Nichter, MD, MS, FACS · Answer

A Physician Assistant's Acting as an Independent Surgeon without Supervision and training - Scary at best
	Let's start with training - it takes a PA approximately 2 years of training to become a PA and includes all areas of medicine and often little or no plastic surgery training. Compare this to a Plastic Surgeon which requires a minimum of 10 years (4 years medical school plus 6 years of residency - with a minimum of 3 years only spent in plastic surgical training).
	A Physician Assistant's Acting as an Independent Surgeon without supervision when a patient is under general anesthesia or IV sedation is Illegal and that goes for Liposuction. There is a loop hole apparently in the scope of practice rules which hopefully will be closed soon. Basically it states that for procedures usually performed under local anesthesia a PA can perform surgery without supervision. Obviously, the intent was to allow PA's to do minor procedures such as removing moles,  superficial cysts,  open boils, or skin biopsies rather than liposuction.  Except or this loop hole, as most liposuction in this country is performed under sedation - usually IV or general anesthesia - in those situations, it  is illegal for a non-physician to practice medicine without supervision in general. The PA must therefore be using local anesthesia only or would be guilty of practicing medicine without a licence at least in the state of California (and I suspect just about all the other states). You need a MD or DO licence to do this type of surgery and to perform direct supervision if sedative anesthesia is used. 
	??Why would you want a non-surgeon perform surgery on you???
	It is bad enough that  many doctors performing cosmetic surgery in the USA are not actually plastic surgeons or even cosmetic surgeons which is  a claim made by a growing number of board certified cosmetic surgeons around the country allege. That is, these doctors specialize in other fields and have little to no experience in plastic surgery. Examples include: gynecologists,dermatologists, pediatricians, family physicians, dentists, radiologists and others who were never trained during their residency in the cosmetic procedures they are performing..
	Now imagine if these same doctors "trained" a physician assistant to do cosmetic procedures like liposuction on their own without supervision. Scary at best !!! Loop hole (local anesthesia only) or no loop hole in the current law, I could not imagine anyone in their right mind choosing this option. Whether or not they have done thousands or for how long, doesn't make up for their lack of proper training.
	
	Board certified cosmetic surgeons have started campaigning in order to make patients aware that their cosmetic surgery doctor may not be a board certified cosmetic surgeon. I would recommend that readers of this answer contact their local medical board and request stricter guidelines to protect the public.
	The bottom line is that  In-depth training in addition to  experience is required to perform plastic, cosmetic, and reconstructive surgery with high degree successful outcomes and minimal complications.
	If a physician or PA from another specialty does a weekend course on cosmetic surgery, this in no way qualifies them as a board certified cosmetic surgeon. According to Dr. Malcolm Z. Roth, president of the American Society of Plastic Surgeons (see below link) , said in September 2011 " that one of the major problems in cosmetic surgery is the lack of proper training and practical skills which causes rookie surgeons to leave patients with some serious problems, including excessive scarring, the removal of too much fat, infections, and even gangrene." "Sometimes, lengthy procedures will be done on people who are not medically suitable for them ..... If you have somebody who's not surgically trained, they [don't know] how to decide who's a good or bad candidate for surgery. We've had people go to the ER with deep vein thrombosis, heart attacks, and unfortunately, not infrequently now, we're hearing about death."
	As the safest places for surgical procedures are:
	accredited hospitals and nationally certified out-patient facilities physicians and by extension PA's who are not board certified in plastic surgery lack privileges to perform plastic surgery  and are only able to do them in their office setting. This may put you at risk.
	
	My advice:  Stay away from PA's as the primary surgeon - as their title implies they are supposed to be a "Physician Assistant" not the main surgeon. Secondly verify  your surgeon's qualifications before allowing them to perform a plastic surgery procedure. (see below link on finding a board certified plastic surgeon and how to choose the best one). Every patient should ask before selecting a surgeon:
	Are you board certified in plastic and reconstructive surgery?
	Did you complete a residency in plastic surgery and are you board certified (or board eligible in plastic surgery?
	Does your malpractice insurance cover this surgical procedure?
	Do you have privileges to perform the plastic surgery procedures in hospitals? Which hospitals?
	Be Safe and select the best for the best result.

J. Vicente P. Poblete, MD · Answer

This is done by licensed physicians, hopefully, properly trained and certified physicians. The more important question is - IF COMPLICATIONS HAPPEN, will the doctor or the PA be able to take care of those complications?

Carmen Kavali, MD · Answer

A Physician Assistant is a great asset to a plastic surgery practice.  A PA works under the supervision of a physician, and their specific partnership is authorized by the state Medical Board.  While working under the supervision of the physician, a PA can do any procedure the physician allows them to do, including Botox, fillers, and even some types of liposuction.  Keep in mind, though, that your surgeon is ultimately responsible for your results and your outcome and should be directly involved in your care.  Some surgeons allow their PAs to do more than others--it really depends on the relationship and trust the PA and surgeon have built during the time they've worked together.  You should always feel free to ask that only the surgeon see you, if that's what you prefer, of course.  And you should ask what parts of your procedure the surgeon will do and what parts (if any) the PA will do--you can state your preferences after asking, if you like.

Peter A. Aldea, MD · Answer

Regarding: "Can Physician Assistants Do Smart Lipo?
	I know that a board-certified doc is the best choice but I have heard of PAs doing the procedure. Is this legal?"

	Poor Smart Lipo. As if it did not have enough complications at the hands of doctors. Now it seems non-doctors are clamoring to practice it on uneducated , price fixated consumers.

	Liposuction, of which laser liposuction (such as Smart Lipo) is a subset, is defined by State Medical Boards as a medical procedure. I am not familiar with a single state which LEGALLY allows anyone but licensed physicians to perform such procedures. It would not surprise me to hear that this is happening but it is illegal.

	Dr. Peter Aldea

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Can Physician Assistants Do Smart Lipo?

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Answer: Can NON-MD's perform Smart Lipo?

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Everything you need to know about Smart Lipo

Our mission is to create a world where every investment in modern beauty is Worth It.