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Paulette Hacker couldn’t stop screaming. Lying on her side on a gurney, wearing only a bra and panties, she felt as if she were being stabbed again and again. In a way, she was. Through incisions in her upper back, a stainless steel tube called a cannula was suctioning out her excess fat.
“Please stop! You’re hurting me!” she cried to her doctor. Because although Hacker’s body was limp and her mind bleary from an unknown combination of drugs she’d been given through pills and a gas mask, the 38-year-old was awake partway through the second day of liposuction on her back, underarms, abdomen, hips and neck. That was the whole point: She was undergoing the new and aggressively marketed Awake cosmetic surgery, which is performed under local anesthesia.
Marketed as cheaper, more medically advanced Hacker had been excited to fly down two days earlier from Sacramento, California. The stay-at-home mom weighed 233 pounds and was trying to slim down; she’d lost 22 pounds on her own through diet and exercise—mostly jogging—and now felt she could use some help. But she’d never had elective surgery before and feared having general anesthesia.
Best of all to Hacker, Awake ads promised that patients would remain lucid throughout the operation and even be able to interact with their doctor. “I liked the idea that I’d be awake and in control,” Hacker remembers. “The surgery really looked like it was for me.”
Unfortunately, the procedure may not have been designed to meet her needs, but rather the doctors’. “The reason for the ‘awake’ portion of it has nothing to do with improving patient comfort,” says Joseph M. Gryskiewicz, M.D., of Minneapolis, chair of the emerging-trends committee of the American Society for Aesthetic Plastic Surgery (ASAPS). “It has to do with doctors not needing to involve an anesthesiologist.” General anesthesia is expensive, and the specialists who provide it prefer to work in hospitals or clinics that have met high safety standards. Awake surgery has become a way for doctors who lack hospital privileges—but who want to cash in on the plastic surgery market—to exploit a loophole by performing the operations in the privacy of their offices. “This is just a gimmick by people who can’t operate their way out of a wet paper bag,” Dr. Gryskiewicz argues.
Hacker had chosen Dr. Bittner’s medi-spa after studying his website, which showcased his Johns Hopkins education, testimonials and pictures of smiling patients beside the tall, tan doctor. Hacker checked to make sure Dr. Bittner was qualified, and there it was: “board-certified.” She didn’t realize that he was a board-certified radiologist. A non-plastic-surgery background is the norm for Awake practitioners, who tend to be family physicians, OBs, ophthalmologists, pathologists—any doctor willing to shell out up to $7,000 for two-day training courses held around 30 times a year by a group of recently formed professional associations.
A patient’s autonomy—her ability to exert control over her own body—is a huge selling point, emphasized again and again on the websites of Awake practitioners. But the idea of asserting your rights on the operating room table is misguided at best, says Diana Zuckerman, Ph.D., president of the National Research Center for Women & Families. “A woman lying there is not in any position to be giving advice to the surgeon,” she exclaims. “To make it sound like empowerment? The mind reels.”
The threat to patients is not theoretical: After a 37-year-old Florida woman went into shock and died after undergoing lipo with a doctor trained only by short courses designed for gynecologists, the state board of medicine found that “these courses do not provide adequate training to develop the proper surgical judgment” on who is a good candidate, what form of anesthesia is safest for her and how to avoid and react to complications.