SALT LAKE CITY — Plastic surgery has been booming across the country since the pandemic — and experts say they’ve seen a corresponding influx of less-qualified providers offering these procedures without proper training or board certification.
It's an issue that's particularly important for patients in Utah, which is one of the top spots for plastic surgery in the country.
“People always think of New York, Florida, California,” noted Steven Williams, a board-certified plastic surgeon and the president of the American Society of Plastic Surgeons. “But when you look at it per capita, Utah also ranks relatively strongly.”
Cosmetic surgery procedures grew 19% nationwide from 2019 to 2022, according to data from the American Society of Plastic Surgeons. In 2022, the most popular cosmetic surgeries were liposuctions, breast augmentations, tummy tucks, breast lifts and eyelid surgeries. (The data is not broken down by state but showed the largest percentage of those procedures, at 35%, were done in the Mountain and Pacific regions.)
Less invasive procedures – like Botox and fillers – have also seen spikes, and were up 70% or more in 2022 compared to 2019.
During the pandemic, people “weren’t going on vacation, they were away from work, they had time to have a surgery performed or have some self care,” Williams said. “And so there was a real boom.”
But this rising interest means consumers need to be wary, he said – especially given that there’s nothing to stop a provider who hasn't specialized in plastic surgery from performing these procedures.
"Unfortunately, the onus is on patients,” Williams said, “because there is some irresponsibility in the medical community.”
While some people think their doctor must be board certified in plastic surgery, that isn’t the case.
In Utah, providers trained as gynecologists, general surgeons or family practitioners could perform cosmetic surgeries, so long as they had some form of general surgery or plastic surgery rotation in their training, according to the state Division of Professional Licensing (DOPL).
Mark Steinagel, the division’s director, noted that board certification is not required “to perform any medical procedure, but competency is required."
FOX 13 News identified and reviewed 27 medical malpractice complaints filed in Utah since 2020 against 18 providers who perform plastic or cosmetic surgery. Of those being sued, a third are not board certified in plastic surgery, the review found.
One of the lawsuits is against a naturopathic physician, who two patients allege misrepresented himself as a surgeon before performing their liposuctions.
Another suit was filed against a physician and surgeon who’s also licensed as a dentist. An Idaho woman alleged that he performed a lower body lift on her without her consent, in a case that was ultimately dismissed for procedural reasons.
Several other lawsuits also raise concerns about consent from patients who say they underwent procedures they hadn’t asked for – including two women who alleged that they received breast implants that were not the size or type they’d consented to.
Another woman claimed she went in for a scar revision surgery but awoke to realize she’d received a butt lift. She alleges that her doctor, a board-certified plastic surgeon, told her the procedure he performed instead was an improvement.
“I hate that it happened but I think it is going to look a hell of a lot better,” the lawsuit says he told her.
Other complaints allege significant consequences from plastic surgery – such as a family who contends that their 70-year-old mother died shortly after a nurse practitioner performed her liposuction.
A separate woman claimed she suffered sepsis and respiratory damage, as well as brain injury from lack of oxygenation, after a procedure to place a weight-loss balloon in her stomach. That case, which was filed against the board-certified plastic surgeon who performed the procedure, was ultimately settled out of court.
While the court system can provide one avenue for patients who feel they’ve received substandard care, Steinagel encouraged Utahns to submit a complaint with the Division of Professional Licensing if they’ve witnessed negligence or incompetence. But he also stressed that a bad surgical outcome “does not necessarily demonstrate incompetence.”
For Susan Madsen, director of the Utah Women & Leadership Project, the allegations demonstrate a need for more scrutiny of the state’s lucrative plastic surgery industry.
“It is disturbing to hear of cosmetic surgeons and so forth really having issues ethically and even legally,” she said. “And people just go and don’t know.”
VIDEO BELOW: University of Utah's Dr. Jay Agarwal discusses the importance of choosing a board-certified plastic surgeon
WHY PLASTIC SURGERY IS SO POPULAR IN UTAH
Utah has long been considered one of the top spots for plastic surgery in the country.
In 2007, Forbes Magazine ranked Salt Lake City the “vainest city in America,” due to the population’s high spending on cosmetic purchases compared to cities of similar size and its high concentration of plastic surgeons. A 2017 research brief from the Utah Women & Leadership Project at Utah State University cited data showing that Utah has “more plastic surgeons per capita than Los Angeles.”
Those statistics don't always square with the state's image and reputation, Madsen said.
“We’re told, at least in my religion — which is The Church of Jesus Christ of Latter-day Saints — that what’s on the inside really matters most,” she said. “Yet we know from the research – and I wish we had better research that’s up to date — that we do have more cosmetic surgery, and that is linked to the outside. And so it’s an interesting phenomena.”
A recent study on the prevalence of cosmetic surgery among Latter-day Saints found that 14% had undergone major cosmetic surgery, while 20% had sought cosmetic enhancements. Nationwide, only about 4% of Americans reported having cosmetic surgery, according to the August brief from the Utah Women & Leadership Project.
There are several factors that make Utahns more prone to plastic surgery, Madsen said.
She points to the state’s "homogenous” demographics, which make it easier for residents to compare themselves against one another, while high fertility rates contribute to the popularity of “mommy makeover” procedures among young mothers.
“There’s that perfect storm of having access to plastic surgeons and the culture possibly really leaning into comparison more,” Madsen said.
VIDEO BELOW: Madsen discusses why Utah has become a hot spot for plastic surgery
Dr. Jay Agarwal, a board-certified plastic surgeon and professor in the University of Utah’s Division of Plastic & Reconstructive Surgery, said he does see some patients come from out of state to Utah for plastic and cosmetic surgeries — an indication that Utah has become a national destination for these procedures.
But he said most of his patients are still from Utah.
“Folks in Utah are active,” he explained. “They’re outdoorsy. They generally have a young, healthy mentality. I think a lot of people feel young and healthy and they also want to look young and healthy. And I think that’s what drives a lot of it.”
Williams, with the American Society of Plastic Surgeons, sees the increased interest in plastic surgery as a positive way for people nationwide to help match their outside appearance with “how you feel internally.”
But Madsen’s less sure the trend is a positive one.
She’s heard anecdotes of parents giving breast augmentation surgeries to their daughters when they graduate from high school, and she worries about how impressionable teenagers are internalizing Utah’s beauty standards. And the social media trends that have helped accelerate plastic surgery are not always beneficial for people’s mental health, she added.
Messages abound, Madsen said, that “we’re not right. That we don’t look right. That we can look better.”
The number of men seeking plastic surgery has risen in recent years – with a 207% increase in total cosmetic procedures from 2019 to 2022, according to data from the American Society of Plastic Surgeons. But research shows women are still primarily the ones going under the knife.
“We just get the messages as women and as girls that our bodies are not necessarily for us to do things with,” Madsen said. “That they’re to be admired by others — especially men. That is engrained in us as women.”
Madsen urged Utahns to be thoughtful about their motivations and outside pressures before undergoing cosmetic surgery, noting that it’s often not the solution people hope it will be.
If they do ultimately decide to seek surgery, she said they should do more than a cursory Google search when choosing a provider.
“In Utah, it is a temptation,” to get into the field without specialized training, she said. “You can earn a lot of money. You can do those kinds of things. Because we have a breeding ground of a lot of people that want to look better.