Thursday, May 7, 2009

What to Know Before Going Under the Liposuction Knife

From a swank office on Beverly Hills' Rodeo Drive, Craig Alan Bittner built a busy cosmetic-surgery practice that specialized in a procedure he called liposculpture.

He spread the word through magazine ads in which he referred to himself as Dr. Lipo 90210. He sent out mailings showing before-and-after pictures of women's love handles, thighs and abdomens. Though he touted liposculpture as "an advanced technique," the procedure is essentially a marketing term for common liposuction surgery, medical experts say.

Body Sculpting

What to do before going for liposuction:

  • Learn about liposuction and find surgeons at and
  • Check if a doctor is certified in plastic surgery or dermatology at
  • Ask how a doctor would handle a medical emergency.

Then, in December, Dr. Bittner, who is in his early 40s, shuttered his Beverly Hills Liposculpture practice. The California Medical Board is looking into patient claims that Dr. Bittner allegedly allowed unlicensed office staff to perform cosmetic surgery. Investigators from the board's enforcement arm executed a criminal search warrant of his offices in Beverly Hills and Irvine, Calif., and his Santa Monica residence in November. The warrant, signed by a state superior court judge, sought information concerning at least 15 of Dr. Bittner's patients, whose names were listed on the warrant; employment records for office staff; and "evidence tending to show the unlicensed practice of medicine."

No charges have been filed against Dr. Bittner, and it remains unclear whether he engaged in any wrongdoing pending the outcome of the California board's inquiry. "Investigations are not public record," said Candis Cohen, a board spokeswoman.

Dr. Bittner's current whereabouts couldn't be confirmed. In a farewell letter to patients left on his Web site, he wrote that he was relocating to South America to do volunteer work with a small clinic "where I can help those most in need." In a telephone interview last month, Dr. Bittner denied any wrongdoing and said he "retired" because he wasn't enjoying his work anymore. He didn't say where he was calling from, and the line went dead midconversation.

Dr. Bittner claimed that what prompted the board's scrutiny of him was an unusual element of his practice -- using his patients' harvested fat to fuel his car. Dr. Bittner publicized this unorthodox use of body fat on a now-defunct Web site,

The field of cosmetic surgery is rife with inflated promotional claims and malpractice suits. Still, the controversy over this high-profile practitioner of liposuction, the most common form of cosmetic surgery, spotlights some lessons for patients in how to pick a doctor in this popular field.

[dr. lipo]

Dr. Craig Alan Bittner promoted "liposculpture" in ads until closing his practice.

Plastic surgery has for years attracted doctors from unrelated specialties who are able to acquire a minimum level of training in cosmetic medicine by attending courses for brief periods, medical experts say. Liposuction surgeons may end up competing for patients mainly on the basis of aggressive marketing and advertising claims that tell consumers little about their medical qualifications. Fully trained plastic surgeons and dermatologists frequently complain about having to compete with newcomers who have little experience in the field.

State records show that Dr. Bittner graduated from the Johns Hopkins University School of Medicine in 1993. He is a licensed doctor with board certification in interventional radiology, a field unrelated to cosmetic medicine. In the telephone interview, he said his liposuction training came from a two-month apprenticeship with a dermatologist in South Florida, who he said is now deceased. He also said he trained with surgeons in Europe and attended programs at meetings of the American Academy of Dermatology.

Consumers seeking cosmetic surgery are able to check a doctor's credentials by going online. Details about a physician's board certification can be found at the American Board of Medical Specialties Web site ( Medical experts generally recommend choosing someone who is board certified either in plastic surgery or dermatology and has performed large numbers of liposuction surgeries. Patients also should check with a state medical agency Web site to see if any action has been taken against a physician's license.

John Canady, professor of plastic surgery at the University of Iowa and president of the American Society of Plastic Surgeons, said patients should question a surgeon about plans for handling a medical emergency. He says prospective patients should ask what the doctor's procedure is for handling events such as a heart attack during surgery, or an infection which could develop later. If doctors seem to be "dancing around" answering questions about their credentials, training or emergency procedures, "I would start to feel very uncomfortable," Dr. Canady said.

There were 456,828 liposuction procedures performed in 2007, the latest data available, an increase of 13% from a year earlier, according to the American Society for Aesthetic Plastic Surgery. To perform liposuction, a practitioner must be a doctor, but isn't required to have any special licensing or certification. In many states, a licensed physician assistant can participate in the surgery, but only under a doctor's supervision.

Cosmetic surgeons say they are seeing fewer patients because of the recession. Still, magazines, newspapers and the Internet continue to be full of ads for liposuction, many offering steep discounts.

One liposuction patient drawn by Dr. Bittner's marketing was Kelli Michael, a 35-year-old nutritional-products salesperson in Southern California. Ms. Michael said she contacted Dr. Bittner two years ago after doing an online search. "Every time I put in anything that had to do with liposuction, his name was the first to pop up," she said. "He was on Rodeo Drive, so you would think he would be good," she added.

Ms. Michael said she complained to Dr. Bittner repeatedly about the results of her surgery, which she claims left her with uneven scar tissue "as hard as a rock" above her belly button. She said Dr. Bittner dismissed her complaints. Ms. Michael said she told a medical board investigator late last year that Dr. Bittner appeared only at the end of her surgery and that most of it was performed by "a man and a woman, taking turns." She didn't recall their full names.

Ms. Michael was among the patients whose names were listed on the search warrant seeking records from Dr. Bittner's practice.

Other patients have filed malpractice suits against Dr. Bittner, claiming that he allowed unlicensed staff in his office to perform parts of their operations.

Benjamin Gluck, a Los Angeles criminal attorney representing Dr. Bittner and his practice, denied any wrongdoing by anyone in Dr. Bittner's office. "No criminal charges have been filed against him," Mr. Gluck said, adding, "We are litigating the search warrant and the manner in which it was executed." He said the investigators improperly took legal files and correspondence with attorneys.

"We believe the evidence supports our actions," said Ms. Cohen, the medical board spokeswoman, in response to Mr. Gluck's challenge of the search warrant.

Dr. Bittner said he faces four malpractice suits. "It's not surprising that after 7,000 cases, there are four lawsuits, especially in a bad economy," he said in the telephone interview. As for the criminal probe, he said that certain parts of the surgeries done at his Beverly Hills practice were lawfully performed by licensed physician assistants under his supervision. "On every single patient, I did the final work, the sculpting," Dr. Bittner said.

This isn't Dr. Bittner's first run-in with the California Medical Board. Before turning to liposuction, he operated a chain of radiology-imaging shops in California and other states. He offered magnetic resonance imaging, or MRI, that he claimed was better than mammography for detecting breast cancer. In 2003, the California board claimed this was false advertising in a civil suit it filed against him and the company he founded, HealthScan America Inc. The shops closed at about the same time. In 2004, a California state court ruled against the business and ordered it to pay $1 million in penalties. The court dismissed Dr. Bittner from the suit.

Dr. Bittner said in the telephone interview that his approach to preventive medicine using MRI to screen for breast cancer was "ahead of its time."

Annual mammograms are still the staple prescription for women at average risk of breast cancer. But the American Cancer Society in 2007 issued new guidelines recommending annual MRIs, in addition to mammograms, for women with certain genetic mutations tied to breast cancer and those whose family history signaled a significantly elevated lifetime danger of the disease, among other high-risk categories.

In promotional materials for his liposuction practice, Dr. Bittner identified himself as Alan Bittner, using his middle name. Earlier, in promotional materials for his radiology shops, he identified himself as Craig Bittner, using his first name.

Dr. Bittner defended his use of discarded body fat from his patients to fuel his car and said he received signed consents from patients who were told of the intended use. Still, "the medical board went ballistic" about this practice, he said.

Using medical waste obtained from liposuction as a biofuel "is not currently an approved alternative treatment technology," according to the California Department of Public Health. To seek approval, an individual would have to submit an application to the department for this alternative use. There is no record of Dr. Bittner filing such an application, a department spokesman said.

The practice spurred "death threats against me and my staff," Dr. Bittner said. "I thought it was a great thing to demonstrate to the world how many ways there are to solve the energy crisis."