As celebrities drive up demand for plastic surgery and other cosmetic procedures, more doctors, dentists and even businesspeople who aren't plastic surgeons are getting in the game.

That's raising questions about whether the procedures are properly supervised and complaints from plastic surgeons that they're increasingly being called on to fix others' shoddy work.

The "increasing democratization of cosmetic surgery" is causing problems in plastic surgeons' business models and bad medical outcomes for some patients, said Vikram Reddy, M.D., a plastic surgeon and chief of clinical integration at Henry Ford Macomb Hospital.
In the 1980s and 1990s, plastic surgeons conducted the vast majority of all cosmetic surgery — reaching a record high 17 million procedures in 2016, up 3 percent from 2015.
But the past decade has seen an increase in gynecologists performing vaginal rejuvenation, general surgeons conducting body contouring procedures after bariatric surgery, emergency physicians doing breast reconstruction, and ear, nose and throat doctors performing facelifts, Reddy said.

"There is nothing inherently wrong with this, but, while there are strict standards for surgeons performing something like joint replacements, the oversight on cosmetic surgery is minimal to none," Reddy said. "Infections or emergencies happen quite often. If a doctor doesn't have hospital privileges, for a tummy tuck or rhinoplasty, patients can get infections, and go to a hospital or ER for care."

Reddy regularly sees patients in the St. John Macomb emergency room for botched plastic surgeries. Some are performed by physicians in their offices and some by nurses or technicians working for nonphysician owners of medical spas.
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