Facebook Medical & Legal Implications of Veterinary Cosmetic Surgical Procedures

The Medical and Legal Implications of Veterinary Cosmetic Surgical Procedures

While at first, it might seem odd that pets are the recipients of cosmetic surgical procedures, upon further consideration it makes perfect sense.

The problem is the accepted definition of cosmetic or plastic surgery. In the human field, the term cosmetic surgery is usually reserved for those procedures which are beautifying, nonessential, and non-medical.  In the veterinary field, an ethical veterinarian would not subject his patients to such procedures. There is always the attendant risk of anesthesia and surgical complication (as there is in the human field) with any procedure, let alone cosmetic ones. A veterinary surgeon weighs those risks every time he contemplates a surgical procedure, and it is a judgment call of whether to proceed with surgery or not depending upon the risks versus the gain to each individual patient. It is more than a matter of semantics to consider essential veterinary plastic surgical procedures more appropriately as reconstructive dermatologic surgery rather than cosmetic surgery.

The non-pet owning public finds it fascinating that dogs are even mentioned in the same breath as plastic surgery. Pet owners, however, are well aware of the myriad number of procedures that dogs have routinely and maybe not so routinely undergone to improve their health and welfare. Among those procedures which are “cosmetic” by nature but are truly reconstructive in nature are entropion and ectropion surgery (“eye lift or tuck”), nasal alar fold and deviated septum surgery (“nosejob”), cheiloplasty (“facelift”), facial fold reductions, orthodontic and maxillofacial surgery,  breast reduction, vaginal fold and tail fold pyoderma surgery,  skin grafting and myocutaneous flap surgeries, and the placement of prosthetic implants for limb salvage procedures.

Anybody familiar with Chows and Sharpeis is familiar with their ocular problems. These breeds are consistently afflicted with congenital and hereditary tendencies, which result in the eyelids rolling in toward the eyeball and predisposing the cornea to persistent pain, discomfort, infection, and injury, which may progress to vision loss or blindness.  Saint Bernards, Newfoundlands,  Great Pyrenees, Mastiffs, and others suffer from the opposite congenital tendency, which is to have the eyelids droop outwardly predisposing these breeds to similar ocular injury. No one in their right mind would contest the necessity of reconstructive procedures to alleviate the constant ocular pain and attendant complications these congenital tendencies provoke.  The corrective procedures, however, are “cosmetic” in origin as the surgeon is basically performing an eyelift or tuck. It’s just that the procedure is being performed for a truly medical and not a cosmetic result.  No one performs an eyelift surgery to make a 10-years-old dog look likes she’s 6-years-old. All that the dog understands is that he is more comfortable and is able to see again without pain.

Nose job surgeries are similarly indicated for those breeds with inherent upper respiratory distress syndromes. Boston Terriers, Pugs, Boxers, Bulldogs, and other chondrodystrophic breeds (ie., “smushed in faces”) are compromised by narrowed nostrils. The inability to breathe through their nose and the resultant obligatory mouth-breathing leads to and exacerbates a variety of upper respiratory problems. Surgically opening these narrowed nostrils is a simple, easy, and minimally invasive surgery, which tremendously improves the quality of life for these animals. Once again, no one is performing nose surgery because the owner doesn’t like the shape of their pet’s nose. It’s nice to be able to breathe without having to consistently make a coordinated effort to do so.

Everybody who spends their time around dogs has been “slimed” at one time or another by flying saliva. Mastiffs are the poster child for droopy lips and excessive, uncontrolled salivation. In the old days, veterinarians actually removed the sub-mandibular salivary glands to decrease the amount of saliva formed and secreted in an attempt to prevent a consistently wet skin fold and resultant chronic bacterial and yeast infection in the skin below the lips. In many cases, these skin infections spread systemically causing urinary tract infection, heart valve infections, and dental disease. Rather than remove the salivary glands, a “facelift” or cheiloplasty effectively alleviates the problem. The lips are alternately pulled up and back and rolled in to prevent salivary leakage. The majority of the procedure is performed within the oral cavity to be more cosmetic, but no one can deny the medical benefits to be gained by that portion of the canine population with chronic lip fold infections. It’s also much less invasive a surgery than removing the salivary glands.

As you can see, many of the “cosmetic” surgical procedures performed on dogs are performed because of the complications associated with abnormal skin folds. It is for this reason that breast reductions and some vaginal, facial, and tail surgeries are carried out. While I am a Board certified Veterinary Surgeon, my practice is not limited to veterinary surgery. I operate a full service veterinary facility open 24 hours a day 7 days a week. As such, I see a tremendous amount of general practice cases. Many clients have recently adopted dogs from the shelters, pounds, and/or rescue groups which need to be spayed. A good proportion of these intact females have had multiple pregnancies. As a result of these pregnancies, there is a tendency for pendulous breast tissue and secondary intra-mammary skin fold infections. It makes sense to reduce the pendulous and cystic breast tissue under the same anesthetic that a spay procedure is performed to eliminate the chronic maintenance that would otherwise be required of the new owner to prevent consistent skin infections in the area. As a result of multiple pregnancies as well as for a variety of other congenital and/or hereditary reasons, many female dogs have chronic irritation of the vaginal area and secondary ascending urinary tract infections because of excessive vaginal skin folds. The removal of these folds prevents excessive vaginal licking and irritation and urine scalding, resulting in a much more comfortable pet. The same is true for tail and facial fold infections commonly observed in Bulldogs and other chondrodystrophoid breeds. Cosmetic removal of the kinked tail effectively eliminates an area of chronic irritation and infection. By the same token, cosmetic removal of excessive and deep facial skin folds removes a source of chronic irritation from persistent fungal and bacterial infection.

Many animals that have suffered through a significant trauma or cancer may require skin grafts or the movement of large flaps of skin and the attached underlying musculature, a procedure known as myocutaneous flap transfer. Once again, while cosmetic in nature, these procedures obviously are medically beneficial to the patient. Recently, advancements in prosthetic surgery are making it possible to consider osseointegrated prosthetic limb implants for limb salvage. In these procedures, a stainless steel or titanium implant is placed within the bone of a limb to act as a scaffold for placement of a prosthesis that mimics both cosmetically and functionally a normal limb. The potential benefit to dogs, which would otherwise have lost a limb to amputation, is enormous.

The question comes down to where does an ethical veterinarian cross the line with regard to the procedures that some clients would consider frivolous and other clients would consider a necessity? All of the procedures that have been previously mentioned are medically beneficial and help tremendously improve a patient’s quality of life when applied intelligently and with discretion. I have been asked to perform botox, collagen, and restylane injections as well as testicular implant surgery.  My answer, whenever I have been asked, is a resounding “No!!” In my opinion, these procedures serve no known medical benefit for the patient. The pet owners that ask for such procedures to be performed on their pets would be better off spending their money on psychotherapy in order to understand why anthropomorphization of their pets is flat out crazy.

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