Joan Rivers was a talented and entertaining comedian that had a long and successful career in Hollywood. Not only was she known for her outrageous comedy, but she was known for her love of plastic surgery. I credit her for being someone who both aided and hurt the reputation of plastic surgery. I believe she aided plastic surgery because she was so willing to talk about it. She openly discussed and was proud to undergo plastic surgery at a time when many were not comfortable talking about it. I believe she helped create the new paradigm of plastic surgery where it can be openly discussed and it is overwhelmingly accepted by society. She had some great quotes regarding plastic surgery. Some of my favorites are:
“Looking 50 is great, if you are 60.”
“I’m never without a bandage.”
“I’ve had so much plastic surgery. When I die, they will donate my body to Tupperware.”
In my opinion, Joan Rivers’ plastic surgery procedures changed the character of her face. As a facial plastic surgeon, I believe aesthetic surgery should enhance the natural beauty of one’s face. Joan was a beautiful woman before she had plastic surgery. She does not represent the conservative approach I take with my patients and she would not be a representative of the results I attempt to achieve with my patients in Charlotte
What was the Cause of Joan Rivers’ Death?
While I do not know the exact cause of her death, I will do my best to explain what I think happened after reading the available information. Immediately after the news that Joan Rivers had died undergoing a medical procedure, many people thought she was undergoing an aesthetic procedure. It now appears that she was undergoing an endoscopy. An endoscopy is:
A nonsurgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a color TV monitor.
The most common endoscopy is a colonoscopy. Endoscopies are commonly performed at an outpatient surgery center or endoscopy center as long as the patient is healthy.
During Joan Rivers’ endoscopy, the endoscopy doctor visualized something “unusual” on her vocal cords. There was an ENT that was present during the procedure. There are ENTs that specialize as voice specialists, laryngologists. Regardless, ENTs are trained to inspect and examine vocal cords to ensure that they appear normal. If they are not normal, it could be due to multiple causes including:
- Vocal cord nodules
- Vocal cord hemorrhage
- Vocal cord polyp
- Vocal cord cancer
- Vocal cord swelling
- Other causes
It appears the doctor performing the endoscopy noticed an abnormality and notified the ENT that was present. From this point, it appears that poor decisions were made.
At this point, the endoscopy should have been completed and Joan should have followed up in the ENT’s office so that the ENT could do an exam of her vocal cords while awake. Instead, the ENT came into the procedure room where Joan was under anesthesia to exam her vocal cords. If this doctor did not have privileges at the endoscopy center, he should not have been allowed in the room. The area between the vocal cords is the narrowest part of the airway below the nose. This area should be approached with caution.
It appears the ENT did a biopsy near or around the vocal cords. After the biopsy, the vocal cords can sometimes go into spasm (laryngospasm). When this happens, the vocal cords shut and air cannot pass to the lungs. I have seen a laryngospasm, and a good airway team composed of an anesthesiologist, ENT, and the proper equipment can effectively treat laryngospasm. For whatever reason, the doctors were unable to treat the laryngospasm in the endoscopy clinic and Joan ultimately died. (Please note none of this is confirmed and is my best interpretation of the information currently available)
How Do I Ensure My Patients Have a Safe Experience Undergoing Surgery?
Since this incident with Joan Rivers, I have had many patients asking me about the anesthesia and its safety. I want to explain the many steps we take to ensure the highest level of safety when our patients undergo surgery.
Step 1—The Surgical Clearance
All patients must be in great health to undergo surgery. I ensure that my patients are in great health by 3 methods:
- I personally examine the health history of all patients undergoing surgery and their physical examination. I will listen to their heart and lungs. In this manner, I can detect if some aspect of their health needs to be further evaluated
- All patients are examined by their primary care doctor within 30 days of their surgery. The primary care doctor will do a complete checkup. All patients over 50 years old will have a cardiac EKG to ensure heart health.
- All patients have basic laboratory values evaluated including electrolytes and functioning of the clotting system of the bloodstream.
By completing all of the above steps, I ensure only healthy patients will undergo facial plastic surgery. There have been many times that I have had to cancel surgery due to someone’s health. These patients are often very thankful because they are typically not aware that their health might be at risk.
Step 2- The Surgical Team
The team I use in the operating room is experienced and qualified. I always have a board certified anesthesiologist participating in the case.
Step 3- Surgery Location
I only operate at locations that have dedicated protocols and systems in place to handle an emergency. These locations are equipped with all the necessary tools to take care of most if not all medical issues. If I believe it is necessary or if a patient wishes, I will do the procedure at a hospital where all medical services would be available.
Step 4- Overnight Stay
If the procedure is over 7-7.5 hours, I will recommend the patient stay in the hospital overnight. This will allow the patient to recover under the care of a registered nurse. I will see the patient in the hospital the next morning before they go home. This is comfortable and convenient to the patient.
Step 5- The Anesthesia
The anesthesia for a facial plastic surgery is lighter than anesthesia for many surgeries. Before doing any plastic surgery on the face, I numb the entire surgical area with medication. For this reason, it takes less anesthesia to keep the patient comfortable. Surgery that interferes with internal organs or bone requires considerably more anesthesia which is not an issue in the procedures I perform.
Step 6- Trust in Your Surgeon
Safety and the well-being of the patient is my number 1 priority. I promise that I will do everything the right way to ensure that my patients are safe. I will make good judgments and always err on the side of caution for my patients. If I thought I was placing my patients at risk for serious injury, I would never perform the procedure.