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SINGAPORE: For flab-conscious consumers wanting a shortcut to weight loss, it could provide some assurance of safety, without coming at too steep a price.
But among industry practitioners, the proposed guidelines on liposuction procedures are raising quite a storm of reactions.
The Ministry of Health (MOH) released its promised draft regulations on Sunday, spurred by the risk of botched liposuction procedures in the hands of inadequately qualified practitioners.
Contrary to what some had expected or called for, general practitioners and aesthetic doctors without a plastic surgery degree are not banned from practicing liposuction, provided they meet certain qualifications. This means patients could continue to enjoy their lower rates.
Unexpected, though, is that some plastic surgeons may feel the regulatory pinch as well.
With liposuction regulated as under the Private Hospitals and Medical Clinics Act, any clinic that offers the procedure would have to get ministry approval and comply with specific licensing conditions.
For instance, the guidelines suggest, the removal of less than one litre of fat in healthy patients under local anaesthesia can be done in properly-equipped surgical facilities in the approved medical clinics.
But when more than one litre of fat or general anaesthesia is involved, or the patient has a medical condition, the surgery can only be performed in a day surgery centre or hospital.
Practitioners who do not comply could have their clinic licenses revoked.
On Sunday, Health Minister Khaw Boon Wan said exactly when the guidelines come into force would depend on the feedback received — and already, just days after the draft was sent out, some have called for tighter rules while others urged for more lenient ones, he said.
Dr Roy Chio, a GP with aesthetics training, described the one-litre rule as "reasonable" though "conservative". "A large survey in America had also come to the consensus that removing one litre in a non-surgical setting is acceptable," he said, adding he hoped the MOH would be flexible.
Plastic surgeon Dr Ivor Lim, however, was not happy. "It's about the technique, not the volume," he said, citing an instance of a patient whose arm was scarred after a botched liposuction involving the removal of less than a litre of fat.
Also, plastic surgeon Dr Martin Huang contended, "some plastic surgeons' clinics have very well-equipped operating facilities, as good as those of a day surgery centre". So to be fair, the ruling should include clinics with "operating facilities equivalent to a day surgery centre".
Some patients could see their costs go up, said Dr Chio, as a room at a day surgery centre can cost "a couple of hundreds to over a thousand".
And a GP trained in aesthetic medicine felt the fat-removal limit was "hard to enforce" as, ultimately, "it's really up to the integrity of doctors".
Still, the regulations are "a good start", he said, and "the public can see that doctors are as competent as plastic surgeons. So, they can go for procedures at a more affordable rate".
While doctors generally agreed the proposed schemes for accreditation and quality assurance were beneficial, Dr Lim wanted to know how the MOH would police or audit doctors.
For instance, a doctor who wants to practice liposuction "must have undergone at least one year of surgical training following housemanship" and observed and performed a "minimum number of liposuction procedures under preceptorship".
This is "grossly inadequate," said Dr Huang. "Many GPs would have gone through one year or more of rotating through surgical departments … What is the minimum number and who is the preceptor? Another non-plastic surgeon who has done more liposuctions than you?"
Speaking for the Singapore Association of Plastic Surgeons, president Dr Walter Tan said regulations that allow practitioners "to be certified in a piecemeal fashion" for "just one technical procedure in the entire spectrum" was "suboptimal".
"It also makes a mockery of the comprehensive way that bonafide Plastic Surgeons are trained, a process that takes at least four to five years to complete," he said. The guidelines also do not address the ability "to manage the outcome of unsatisfactory results of liposuction".
On the other hand, Dr Chio, who is president-elect of the Anti-Ageing and Aesthetic Medicine Society of Singapore, said non-plastic surgeons have done many cases of liposuction well. "They can't say that those cases done previously count for nothing."
He added: "We can always refine the guidelines for better patient protection, but it's good in the general direction of focusing on training."
Secretary Jenny Kong, 45, who has done liposuction on her stomach, said the regulations were a "bonus" but thought the compulsory 15-day waiting period — for patients to think over the risk before a procedure — "a waste of time".
Banker Mariena Khoo, 35, argued that the wait would only be a delay for doctors and patients. No surgery is risk-proof, said the three-time liposuction patient, and it's up to patrons to be discerning: "I don't see how this is going to allay my fears at all." - TODAY/sh
WHAT MOH PROPOSES
The draft licensing conditions for liposuction state that doctors must have one year of surgical training after housemanship and relevant liposuction-specific education, training and experience. Doctors must also be certified and up-to-date in basic resuscitation.
These “broad training requirements” may vary depending on the practitioner’s total experience and type of procedure he does.
Patients must also be properly evaluated and counselled on costs, risks and outcomes. They must have at least 15 days to consider these before the procedure is done. The patient must submit a written informed consent, which includes acknowledgment of alternative treatments to liposuction.
Feedback on the proposed regulatory regime can be emailed to moh_info@moh.gov.sg.
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