“A premise: rhinoplasty is not a banal nose job, as I have heard. It is a high-level surgery with major operating and also anesthetic problems, because it works on the respiratory tract. It is not stupidity.” Plastic surgeon Paolo Santanchè is keen to point this out, thinking of the news on the death of the 22-year-old Sicilian Agata Margaret Spada, after the anesthesia administered for a rhinoplasty operation in a private clinic in Rome, chosen based on information collected on TikTok. “From what has emerged so far – he analyzes to Adnkronos Salute – the only things that can be understood are that it would be a surgical clinic and not a clinic with an operating room, and local anesthesia probably performed by the surgeon, because nowhere the anesthesiologist is mentioned”.
“However, people must know – explains the expert – that the most dangerous anesthesia is local anesthesia and when it is not done in an adequate environment, that is, in a real operating room with the presence of an anesthetist, if there is a problem risks leaving you dead, as happened to this unfortunate and naive girl.” The message is first of all aimed at those who want to undergo cosmetic surgical procedures: it is very dangerous, warns Santanchè, “to have an operation performed by a doctor you have never seen in person, who has never looked inside your nose”, in case of a rhinoplasty, “and in an inappropriate environment. It’s time for these things to end, we see too many of them. Cosmetic surgery should not be trivialized, otherwise the result will be at stake, but above all safety. They are real interventions that should done in a real operating room with a team and with an anesthetist”.
Can the showcase chosen by the professional to present his work still be this, short videos on TikTok or other social networks? “Having liberalized a lot on this front has not been positive, medicine cannot be advertised as if it were a detergent – is Santanchè’s thought – However, there are laws that say that I cannot advertise qualifications not recognized by the Italian State, I cannot boast of being a plastic surgeon or a cosmetic surgeon, if I don’t have the specialization in reconstructive and aesthetic plastic surgery. But there is absolutely no one who enforces these rules. Starting from the Medical Association. So the patient is abandoned this front, he has no protection and unfortunately there are now more and more non-specialist, untrained, do-it-yourself doctors who are starting to do this job, it’s full of adventurers.”
“Another thing that is now in advertisements is to say that operations are performed under sedation – continues the plastic surgeon – In reality today general anesthesia has become the lightest and safest anesthesia and there is no longer any reason of having a facelift or breast augmentation under sedation. Why are these procedures so advertised, not realizing that total anesthesia is the safest? facilities where general anesthesia they are not authorized to do it. And if a structure is not authorized for general anesthesia, it is automatically not suitable for resuscitation. In the appropriate structure there is an anesthetist, there are his collaborators, there is a nurse, there is the surgeon, there are all people who lend a hand. some articles said that the operation was done for 3,000 euros: with these figures I can’t pay for the facility, the surgeon, the help, the anesthetist. Something I have to remove and a one of the first things they remove when they do local anesthesia, to save money, is the cost of the anesthetist, which instead is money better spent”.
“Only the compliant operating room – Santanchè points out – has all the equipment for resuscitation, but above all when the anesthetist is present the need for resuscitation can be prevented. Cardiac or respiratory arrest have prodromes. If there is The anesthesiologist who is watching his monitors, who follows the patient, prevents the worst. “In similar circumstances you have a few minutes to intervene. You may find yourself faced with a vagal syndrome, with the heart slowing down and stopping, or a respiratory arrest, which is followed by cardiac arrest, more rarely an allergy to the drug. But these steps occur in a temporal progression and then if action is not taken promptly the risk is that brain damage will occur.” In the case of Rome, the patient was rushed to hospital, but those few precious minutes to avoid the tragic epilogue ”had already passed who knows how long ago – reasons the expert – In an adequate structure, with the adequate team , and especially with the presence of the anesthetist, it is much more difficult for it to happen.”
Interview Between Time.news Editor and Dr. Paolo Santanchè, Plastic Surgeon
Editor: Welcome, Dr. Santanchè. It’s great to have you here. Let’s dive right in. The tragic case of Agata Margaret Spada has highlighted serious concerns in the world of cosmetic surgery. Could you explain to our audience why rhinoplasty is often misunderstood?
Dr. Santanchè: Thank you for having me. Many people view rhinoplasty as just a routine “nose job,” but it’s much more than that. It’s a complex surgical procedure that involves the respiratory tract, which means that any surgical intervention poses significant risks—not just operational but also anesthetic. It’s not to be taken lightly.
Editor: That’s an important distinction. You referenced Agata’s situation, suggesting that her surgery may not have been conducted in a proper surgical environment. Can you elaborate on what constitutes a safe surgical setting?
Dr. Santanchè: Absolutely. A safe surgical environment must include a properly equipped operating room and the presence of a qualified anesthesiologist. From what we understand so far, Agata’s surgery was performed in a facility that might not have met these standards. Local anesthesia can be particularly dangerous if administered inappropriately, especially without an anesthesiologist present to manage potential complications.
Editor: It sounds like a lack of regulation or oversight might play a role here. What do you believe needs to change in terms of practice and patient awareness?
Dr. Santanchè: There are significant gaps in patient protection. Many patients are seduced by flashy marketing on platforms like TikTok, which trivializes surgery and often misrepresents qualifications of the professionals involved. Patients must know the importance of having procedures done in accredited facilities by certified, trained surgeons. It’s alarming how often we see unqualified “do-it-yourself” practitioners taking on these responsibilities.
Editor: Social media certainly has changed the landscape of medical advertising. Do you think that these platforms can be used positively?
Dr. Santanchè: They can be, but we need stringent regulations. Medicine should not be likened to a consumer product. While showing techniques or sharing successful patient stories can inform and educate, misleading representations can lead to tragic outcomes like what we saw with Agata.
Editor: You mentioned the use of sedation in advertisements. Is there a misconception about this practice that people should be aware of?
Dr. Santanchè: Yes, indeed. Many clinics promote operations under sedation as a safer alternative, but in reality, general anesthesia has become the lightest and safest form we have available today. Those facilities that cannot perform general anesthesia should not be performing surgeries at all, as they lack the capacity for proper patient recovery and resuscitation.
Editor: It sounds like a comprehensive overhaul is necessary to ensure patient safety. What advice would you give to individuals considering cosmetic surgery?
Dr. Santanchè: My primary advice is to do thorough research. Seek out qualified and board-certified plastic surgeons, visit the facility in person, and understand the risks involved. Don’t let social media be your sole guide or go under the knife based on trends or hurried decisions. Cosmetic surgery is serious and should be treated with the utmost care and respect it deserves.
Editor: Thank you, Dr. Santanchè, for shedding light on this critical issue. Your insights are invaluable, especially in ensuring that patients prioritize safety and informed decisions above all.
Dr. Santanchè: Thank you for having me. I hope we can continue to raise awareness and push for necessary changes in this field.