SALT LAKE CITY – Plastic surgery has boomed across the country since the pandemic – and experts say they’ve seen a corresponding influx of less-skilled providers offering the procedures without proper training or residency.

This issue is especially important for patients in Utah, one of the leading plastic surgery centers in the country.

“People always think of New York, Florida, California,” notes Steven Williams, a board-certified plastic surgeon and president of the American Society of Plastic Surgeons. “But when you look at population, Utah does relatively well, too.”

According to the American Society of Plastic Surgeons, cosmetic surgery increased 19% nationwide from 2019 to 2022. In 2022, the most popular cosmetic surgeries were liposuction, breast augmentation, tummy tucks, breast lifts and eyelid surgery. (The data is not broken down by state, but showed that the largest share of these procedures, 35%, were performed in the Mountain and Pacific regions.)

Less invasive procedures – such as Botox and fillers – have also seen an upswing, increasing by 70% or more in 2022 compared to 2019.

During the pandemic, “people weren’t going on vacation, they weren’t at work, they had time to have surgery or do some self-care,” Williams said. “And so there was a real boom.”

But this increasing interest means consumers need to be cautious, he said – especially given that a provider who does not specialize in plastic surgery is not prevented from performing these procedures.

“Unfortunately, the responsibility lies with the patients,” Williams said, “because there is a certain irresponsibility in the medical community.”

Although some people believe that their doctor must be a board-certified plastic surgeon, this is not the case.

In Utah, doctors trained as gynecologists, general surgeons or family physicians are allowed to perform cosmetic surgery as long as they completed some type of internship in general surgery or plastic surgery during their training, according to the report from the state’s Division of Professional Licensing (DOPL).

Mark Steinagel, the department’s director, pointed out that no specialist certification is required to perform medical procedures, but the necessary competence is.

FOX 13 News has identified and reviewed 27 medical malpractice complaints filed in Utah since 2020 against 18 providers who perform plastic or cosmetic surgery. One-third of the defendants are not board-certified in plastic surgery, the review found.

One of the lawsuits is directed against a naturopath who, according to two patients, posed as a surgeon before performing liposuction on them.

Another lawsuit was filed against a physician and surgeon who is also a licensed dentist. An Idaho woman claimed he performed a lower body lift on her without her consent. The case was ultimately dismissed on procedural grounds.

Several other lawsuits also challenge the consent of patients who say they underwent procedures they did not ask for. Among them were two women who claimed they received breast implants that were not the size or type they agreed to.

Another woman claimed she had undergone scar revision surgery but then woke up to find she had had a butt lift. She claims her doctor, a board-certified plastic surgeon, told her the procedure he performed instead was an enhancement.

“I hate that it happened, but I think it’s going to look a hell of a lot better,” he told her, according to the lawsuit.

Other lawsuits point to serious consequences of plastic surgery. For example, one family claims that their 70-year-old mother died shortly after a nurse performed liposuction on her.

Another woman claimed she suffered sepsis and respiratory damage, as well as brain damage from lack of oxygen, after having a weight-loss balloon inserted into her abdomen. That case, filed against the board-certified plastic surgeon who performed the procedure, was ultimately settled out of court.

While the court system can provide an avenue for patients who feel they have received substandard care, Steinagel encouraged Utah residents to file complaints with the Division of Professional Licensing if they have experienced negligence or incompetence. But he also stressed that a poor surgical outcome “does not necessarily prove incompetence.”

For Susan Madsen, director of the Utah Women & Leadership Project, the allegations show that the state’s lucrative cosmetic surgery industry needs closer scrutiny.

“It’s disturbing to hear that plastic surgeons and others have ethical and even legal problems,” she said. “And people just go there and don’t know anything.”

VIDEO BELOW: Dr. Jay Agarwal of the University of Utah talks about the importance of choosing a board-certified plastic surgeon

Jay Agarwal

Why plastic surgery is so popular in Utah

Utah has long been considered one of the country’s top locations for plastic surgery.

In 2007, Forbes Magazine named Salt Lake City the “Vaiest City in America” ​​due to its population’s high spending on cosmetic purchases compared to similarly sized cities and its high concentration of plastic surgeons. A 2017 research report from Utah State University’s Utah Women & Leadership Project cited data showing that Utah has “more plastic surgeons per capita than Los Angeles.”

These statistics do not always match the state’s image and reputation, Madsen said.

“At least in my religion – The Church of Jesus Christ of Latter-day Saints – we are told that what matters most is what’s on the inside,” she said. “But we know from research – and I wish we had better and more up-to-date research – that there is more plastic surgery and that it is related to what’s on the outside. So it’s an interesting phenomenon.”

A recent study of the prevalence of cosmetic surgery among Latter-day Saints found that 14% had undergone major cosmetic surgery, while 20% sought cosmetic enhancements. Nationwide, only about 4% of Americans reported having undergone cosmetic surgery, according to the August study by the Utah Women & Leadership Project.

There are several factors that make people in Utah more susceptible to cosmetic surgery, Madsen said.

She points to the state’s “homogeneous” population structure, which makes it easier for residents to compare themselves with one another, while the high birth rate contributes to the popularity of “mommy makeover” procedures among new mothers.

“There’s a perfect combination of access to plastic surgeons and the culture that may really be more comparative,” Madsen said.

VIDEO BELOW: Madsen explains why Utah has become a hotspot for plastic surgery

Susan Madsen

Dr. Jay Agarwal, a board-certified plastic surgeon and professor in the University of Utah’s Department of Plastic and Reconstructive Surgery, said some of his patients come to Utah from out of state for plastic and cosmetic surgery, an indication that Utah has become a national destination for these procedures.

However, he said most of his patients still come from Utah.

“People in Utah are active,” he explained. “They like being outdoors. They generally have a young, healthy mentality. I think a lot of people feel young and healthy and want to look young and healthy. And I think that’s the main reason why.”

Williams of the American Society of Plastic Surgeons sees the increased interest in plastic surgery as a positive opportunity for people across the country to align their outward appearance with their “inward well-being.”

However, Madsen is not so sure whether this is a positive trend.

She’s heard stories of parents giving their daughters breast augmentation after they graduate high school, and she worries about how impressionable teens are internalizing Utah’s beauty ideals. And the social media trends that have accelerated plastic surgery aren’t always conducive to people’s mental health, she added.

There are many messages, said Madsen, that “we are not right. That we do not look right. That we can look better.”

The number of men seeking cosmetic surgery has increased in recent years—according to data from the American Society of Plastic Surgeons, there was a 207% increase in total cosmetic surgery between 2019 and 2022. But research shows that it is still primarily women who go under the knife.

“As women and girls, we just get the message that our bodies are not necessarily there to do things to us,” Madsen said. “That they are meant to be admired by others – especially men. That is deeply ingrained in us as women.”

Madsen urged Utahns to think about their motivations and external constraints before undergoing cosmetic surgery, pointing out that it is often not the solution they hope for.

If they ultimately decide to have surgery, they should do more than just a cursory Google search when selecting a provider, she said.

“In Utah, it’s a temptation” to enter the field without any special training, she said. “You can make a lot of money. You can do things like that. Because we have a breeding ground for a lot of people who want to look better.”