Face it.
Millions of people have gotten plastic surgery in recent years, from cheek or pectoral implants to eye or arm-skin lifts.
Industry Web sites and ads feature testimonials of many satisfied customers. But stories of abuse and tragedy are prompting calls for the plastic-surgery business to undergo some regulatory nips and tucks of its own.
Enter California's new "Donda West Law," which goes into effect next Friday.
Named after rapper Kanye West's mother, who died a day after plastic surgery in 2007, the law prohibits doctors from performing elective cosmetic surgery unless a patient has "an appropriate physical examination within 30 days of a procedure, and "written clearance" by a physician, nurse practitioner or physician's assistant.
A Los Angeles County coroner's report said it is unknown whether West, 58, a former college professor, had any exams before she underwent three surgical procedures at once.
A relative told the coroner that West went to four doctors before Jan Adams, a Brentwood celebrity surgeon, agreed to operate.
Representatives of plastic surgery groups call the new law, which was carried by Assemblywomen Wilmer Amina Carter, D-Rialto, well-meaning and a tribute to West.
But they say it doesn't require anything of plastic surgeons that reputable physicians don't already do under existing law.
Dr. Terry Zimmerman, president of the Greater Sacramento Plastic Surgical Society, said doctors using hospitals, surgical suites and anesthesia to perform cosmetic surgery are already required to obtain a patient's medical history and be sure the patient has had physical exams before going under the scalpel.
"The Donda West law does not state anything new," Zimmerman said, "which is why there was no opposition."
If tests indicate surgery might jeopardize health, Zimmerman said, reputable doctors refuse to go ahead with a procedure.
Mylie Bell, an El Dorado Hills resident, underwent surgery with Zimmerman. She said she would never have gone forward if she hadn't had pre-operation lab tests and cardiology clearance.
"Maybe there are some people so bent on surgery, though, they will go ahead," she said.
A medical examiner found that West died of pre-existing coronary artery disease and "multiple post-operative factors" on Nov. 10, 2007, a day after Adams performed an abdominal tuck, breast surgery and liposuction on West.
Carter pursued her bill at the urging of a constituent who is the niece of Donda West. It first passed the Legislature last year, but Gov. Arnold Schwarzenegger placed it among a pile of bills he refused to sign because of disputes over the budget.
Carter agreed that her law doesn't create new regulations or penalties.
"This is not for those who already follow guidelines," Carter said. "Over 50 percent of the reason for this bill is for consumers. They may or may not be looking into the seriousness of plastic surgery."
Carter said she was shocked to discover that some very young people pursue plastic surgery. "It's like going out to buy makeup," she said.
Carter favors more penalties for violating cosmetic-surgery laws, but she said that such an attempt would have encountered stiff opposition.
A system of penalties to punish malpractice already exist, doctors contend.
Adams was dogged for months by suspicions about his handling of West's surgery. He gave up his physician's license in April of this year for other reasons, however.
A former host of a plastic-surgery TV reality show, Adams faced various complaints before the Medical Board of California, including a record of drunk driving citations dating back to 2003.
This year he was sentenced to a year in the Solano County jail for driving drunk without a license in 2008.
State records also show two malpractice judgments against Adams in 2001 and two in 2007.
Between 2007 and 2008, plastic surgery increased for all ethnic groups except whites, according to the American Society of Plastic Surgeons.
Nationally, the society estimates, about 12.1 million cosmetic procedures were performed in 2008, an annual increase of 3 percent in everything from invasive surgery to minimally invasive microdermabrasion of skin.
The number of invasive surgical procedures only, though, dropped 9 percent in a year, to nearly 1.7 million in 2008.
The recession, according to the society, put a damper on liposuction, which was down 19 percent in 2008. But it didn't slow requests for buttock lifts, up 8 percent.
The society estimated the entire U.S. cosmetic procedure business at $10.3 billion in sales in 2008.
Dr. Jack Bruner, a Sacramento plastic surgeon, said if the Donda West Law "does a little bit of good, then it's OK."
Surgery always carries some risk, he said, and shouldn't be undertaken lightly.
Bruner said he is working on the draft of another law he would like to see approved that is aimed at increasing consumer awareness of the qualifications of doctors advertising plastic surgery services.
Bruner's suggested law would require physicians to display prominently in their offices what their "board-certified" medical specialty is.
Any licensed physician can perform plastic surgery, even after only a weekend training session, Bruner said.
But consumers should know, Bruner said, if a doctor has that extra stamp of approval in plastic surgery by the American Board of Medical Specialties.
"People have been hurt by health care providers presenting themselves as 'board-certified' in plastic surgery when they were certified in something else," Bruner said.
Donda West Plastic Surgery Law To Take Effect In California
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