Stringent regulations in place for liposuction

07 Jun 2011, The Straits Times

Leave cosmetic surgery in capable hands

We currently have a situation where some general practitioners (GPs) with a certificate of competence (COC) are allowed to perform certain cosmetic surgical operations, such as liposuction.

This is a dangerous trend. The only surgical speciality which has cosmetic surgery as part of its core curriculum and training is plastic surgery.

Liposuction is invasive and can be a major surgical procedure. The current practice of allowing GPs to observe and then be mentored through a few cases, as advocated by the Ministry of Health (MOH), cannot be considered sufficient training to equip such GPs with the ability to confidently manage any problems that may ensue.

The first entry of the liposuction cannula into the body can be potentially fatal if it penetrates the wrong organs such as the liver, spleen, gut or lung. The new guidelines implemented last year - restricting these GPs to performing liposuction of under a litre at a time - are flawed and do not address the core issues. A patient could die before that one-litre limit is reached.

Furthermore, there are several doctors without the COC who clandestinely perform other cosmetic operations, such as blepharoplasties (double eyelid and eyebag surgery), facelifts, breast augmentations and even tummy tucks.
Singapore has developed a sophisticated structure of specialisation training that has earned it an enviable reputation as the region's premier medical hub of excellence offering world-class specialist care.

However, there has been much talk of the inadequate number of primary health-care physicians both in public and private practice. It is not difficult to understand why - many have given up and moved into providing more lucrative aesthetic services. Do we want GPs to be doing surgical cosmetic procedures when they should really be concentrating on providing much- needed primary health care?

Doctors who are surgical specialists should be the only ones allowed to perform operations. Those who are not, should not. If a GP wants to perform cosmetic surgery, he or she should enter a proper training programme and get a surgical degree first.
MOH should put a stop to non-qualified practitioners performing any cosmetic surgical operation. At the end of the day, patient safety must be paramount and members of the public should not be put at risk of complications or even death in the hands of unqualified practitioners.

Dr Woffles Wu

FORUM NOTE: The writer is a plastic surgeon

Reply From  MOH

We refer to the letter “Leave cosmetic surgery in capable hands” (ST, 30 May). Dr Woffles Wu, a plastic surgeon, has raised concerns that some general practitioners are allowed to perform cosmetic surgical procedures like liposuction.

The Ministry of Health (MOH) has put in place stringent licensing terms and conditions to regulate the practice of liposuction.  All doctors who wish to perform liposuction have to be accredited by the Accreditation Committee on Liposuction (ACL) and their medical clinics have to comply with specific licensing conditions. For other aesthetic procedures, doctors also have to abide by the guidelines on aesthetics practices of the Aesthetic Practice Oversight Committee (APOC). These committees with membership including plastic surgeons and dermatologists, set guidelines to assess the competency of doctors who wish to perform aesthetic procedures.

The tumescent technique of liposuction, which is the commonly used liposuction method, was originally invented and popularised by two dermatologists. Therefore, it is more important to assess a doctor’s competency in performing this procedure based on the adequacy and currency of training instead of field of practice. As with any surgical procedure, liposuction carries some risk, even in the best of hands. Therefore, we have advised that doctors who perform liposuction must have properly evaluated and counselled the patient on the procedure. MOH will continue to monitor the situation to ensure that patient safety is not compromised. Doctors who are found to practise outside their scope of competency will be referred to the Singapore Medical Council.

A small number of GPs have been accredited to perform liposuction but this should not distract us from the bigger picture of addressing the health needs of Singaporeans. The Ministry is in the process of strengthening our primary care sector by enhancing the training of GPs so that more of them could function as Family Physicians. This will eventually help to improve our primary care capability, especially in managing chronic diseases in our ageing population.

Dr Arthur Chern
Group Director, Health Regulation Group
Ministry of Health