VANITY plays no role in Soulla Elia’s nightmare. She was never happy with the size of her nose but only decided to take action when her two young adult sons needed surgery to correct nasal-related breathing problems. They wanted nose reductions at the same time, so Soulla decided to join them.
Now, after 7,000 euros-worth of plastic surgery, all three have breathing problems – and badly misshaped noses. “My nose was straight before but is now very bent,” said Soulla, a personable Limassol high-school teacher in her 40s. “I can’t breathe properly and my nose is often runny. I had none of these problems before the operation.”
The three were operated on by a private sector ear, nose and throat (ENT) doctor in Limassol between May and June last year: the family had initially approached a state hospital but were told they were not urgent cases. It was only after the badly botched operations that Soulla discovered the ENT doctor was allegedly unqualified to perform the plastic surgery part of the operations.
What Soulla finds particularly galling is that she herself had suggested that a plastic surgeon be present during the operations. “He assured me that he was qualified to do all aspects of the operations including plastic surgery. When I asked him how, he said that he had done training in Germany,” said Soulla.
To her dismay, the Cyprus Medical Association and the Ministry of Health have told her they are powerless to intervene and that her only recourse is legal action – which is time-consuming, expensive and comes with no guarantee of success.
“No-one is doing anything about this doctor, who is still performing plastic surgery on people,” said Soulla. The ENT doctor acknowledged to the Sunday Mail that there were some “minor imperfections” with all three noses and offered corrective surgery free of charge.
But Soulla and her sons – Richard, 19, and Efthivoulos, 24 – no longer trusted him with a scalpel. Instead, she asked him to reimburse half the cost of the operations to help pay for new ones by another surgeon. “He laughed rudely and refused, saying that nobody can make him do anything,” Soulla said.
The doctor did little to contradict her account – apart from insisting that he is fully qualified to perform plastic surgery. “I offered to fix her nose, but she can’t tell me what to do. Beyond that, she can go to court and can do as she pleases,” he told the Sunday Mail, which is not naming him for legal reasons. Soulla is taking the case to court and her lawyer is now preparing a case for medical negligence.
The doctor, who said he has numerous, proven credentials from the University of Munich in Germany, claimed: “I have performed over 20,000 such operations… all ENT doctors are allowed to do rhinoplasty [nose] operations – I do them every week and half of them are corrective.”
Richard, still reeling from his first experience, is unwilling to risk further surgery. But Efthivoulos was operated on for a second time by a highly qualified and renowned plastic and reconstructive surgeon in Limassol. He discovered that the previous doctor had not left any cartilage inside the patient’s nose from which to extract tissue for the corrective surgery – requiring him to use cartilage from Efthivoulos’s ears to complete the operation.
Dr Vassos Economou, president of the Ethics Committee of the Cyprus Medical Association, acknowledged that Soulla’s case may really be “desperate” but said “unfortunately we cannot intervene”. He added: “Based on the law, we have no authority over mistakes by doctors, even in case of negligence – even in the case of a gangrene patient, when the doctor amputates the wrong leg, we cannot do anything. We do not deal with malpractice or negligence, but the courts do.”
The relevant law in Cyprus is from the British colonial period and “out of touch”, Economou continued. “When a doctor registers in the Medical Records, he then gets a document stating that he is entitled to do anything, including childbirth.”
Frustrated by this response, Soulla then approached the Ministry of Health. In its written reply, the Department of Medical and Public Health Services told her, remarkably it seems, that the state has “no authority over any complaints made against private doctors”.
“For any actions that need to be taken against the specific private doctor in Limassol, you should contact the Cyprus Medical Association,” the reply letter read, citing the very organisation which had already told Soulla was powerless to help.
In other words, there is no public or private body responsible for examining patients’ complaints against doctors. At the very least, there is no body willing to take that responsibility.
For Soulla the issue goes far beyond her own terrible experience.
“I do not understand why this is allowed to go on. We are EU members now and definitely there should be some body responsible for such issues. How can private doctors in an EU country not be accountable to the state or to anyone?” said Soulla.
“All I wanted was for the state to at least say that they will look into whether he was negligent and put it on his file. Then, if someone else complained he’d get struck off.”
Meanwhile, three independent plastic surgeons have confirmed that there are mistakes in all three rhinoplasty operations. Soulla’s nose is bent on one side, she has a constantly runny nose and cannot breathe properly after the operation. Both of her sons cannot breathe from their nose after their operations and their noses “don’t look right”.
The plastic and reconstructive surgeon who operated on Efthivoulos the second time also wrote a report which explained in great detail what had gone wrong in Soulla’s case (see box left).
For Economou from the Medical Association the presence of reports like this should put the onus on other doctors to name and shame those who perform bad operations.
“If there are in fact plastic surgeons who have written reports on these cases and feel that the ENT doctor in question should be sanctioned, they should publicly stand up and say it,” he said.
“Why don’t they send these reports to us? When it comes down to it doctors support their fellow doctors and refrain from reporting them.”
But Soulla feels it’s unfair that doctors should be put under such pressure.
“Shouldn’t there be an independent body of specialists that examines patients’ complaints and can say if a doctor has been negligent? Surely, doctors should not be placed in the difficult situation of naming and shaming their fellow practitioners?” she said.
With all other options now closed to her, Soulla has decided to take the case to court. Her lawyer is currently preparing the case which will be filed as a medical negligence case.
“It is in my character to fight for what I believe is the right and just thing to do. However, what about other people who had bad operations, but cannot cope with the pressure of speaking up? There are people who cannot fight their battles – what happens to them?”
Her lawyer has said that Soulla is entitled to the cost of the initial operations, the cost of any new operations, plus psychological damages.
“I guess that if this happened in a country like the USA I’d be rich, but it is not money that I am after – I just want my nose and my sons’ noses fixed.”
What went wrong with Soulla’s operation
“There is a mild angulation of the nose on antero-posterior view at the cartilaginous-bony junction to the left; the lower lateral cartilages are not aligned and there is great discrepancy at the tip of the nose. The left lower cartilage is lower; as a result of the above the apertures of the nostrils are also unequal in size; The l
eft tip of her nose is deviated to the left; the lateral osteotomies appear to have been placed rather high on the nasal bone hence the broad nasal base, even postoperatively,” reads a report from a doctor commenting on Soulla’s operation.
“In summary, Mrs Elia is unhappy with the result and requests further surgery to correct her deformities. I advised that such secondary surgery could only take place after at least one year has passed since the original surgery. The proposed procedure would be an open rhinoplasty, realignment of the lower lateral cartilages, possible osteotomy on the left to correct the asymmetry of the lateral walls of the nose and straightening of the cartilaginous-bony junction,” the report continued.
How to choose your plastic surgeon
In Cyprus making an informed choice is particularly difficult, as there is no accreditation body – comparable to organisations such as the American Board of Plastic Surgeons in the USA – that can provide patients with information on surgeons’ credentials.
“The problem in Cyprus is that there is no Medical School or accreditation body that specialist doctors can join,” explained Professor George Psaras, plastic and reconstructive surgeon. “This applies to all medical fields, and not just to plastic surgery. Certainly, however, all doctors must be licensed by the Ministry of Health. Also, most doctors have their qualifications on display in their office so patients can view them”
In addition to checking doctors’ credentials, however, patients can ask around for feedback on a surgeon, from friends or even from their family doctor.
“Patients can receive information from other patients who had surgery with a specific surgeon, but they must not base their decision on information received from just a single patient,” the doctor warned. “However, the fact that Cyprus is a small country means that people more or less know which doctors have good track records.”
Another highly significant factor that can help patients choose their surgeon is the pre-operation consultation.
During the consultation, the surgeon should be able to answer patients’ questions in a language they can understand, discuss expectations, the risks involved, as well as after care.
Patients should always be wary of impatient or rude surgeons.
Surgeons should always inform patients of the risks involved in undertaking the procedure.
They should show patients before and after pictures of other cases whenever possible and ensure that patients have all the information they require to make an informed choice.
The patient should feel that they have had a thorough consultation with their surgeon and that they know exactly what will happen during the procedure, how long it will take and what to expect in the postoperative period. “When patients’ expectations and motivations are reasonable and realistic the ultimate result is successful in the vast majority of cases,” said Psaras.
