A litany of practices at the clinics of Australia's biggest celebrity cosmetic surgeon have been described by plastic surgeons as "dangerous" and "staggering".
Dr Daniel Lanzer is a dermatologist who has made a fortune from cosmetic surgery.
He owns clinics and day hospitals around the country, hosts TV shows and, thanks to social media, has millions of followers online.
However, confronting videos, photos and messages uncovered in a joint investigation by Four Corners, the Sydney Morning Herald and The Age suggest that behind the glitz and glamour lie some ugly truths.
WARNING: This story contains graphic footage of surgical procedures and images of patients post-surgery.
'This is incredibly dangerous'
One video shows some of Dr Lanzer's colleagues singing and dancing to the Dolly Parton song Jolene while they perform liposuction on an unconscious, male patient.
Four Corners has chosen to blur their faces.
Former head of the Australian Society of Plastic Surgeons, Mark Ashton says their actions were "dangerous, disrespectful, bewildering".
"If you didn't show me these people, you'd think, 'Oh, this can't be happening in Australia', and here it is. You're showing me," Professor Ashton says.
"Where have we gone so wrong in Australia that these two individuals think that this is acceptable? Think that this is reasonable? That this is fair game?"
Dr Lanzer told Four Corners he had reprimanded the staff involved in this incident.
The cosmetic surgeon has a massive social media following, with five million followers on TikTok. Another of his doctors has millions more.
Dr Lanzer films almost everything, including procedures, in graphic detail, to share on a range of social media platforms.
In one video, he reprimands staff for not picking up the phone enough, at the same time as he is performing liposuction on a patient.
Specialist plastic surgeon Patrick Briggs says one of the risks of liposuction is the possibility of penetrating an organ, or the aorta, with the cannula.
"Not actually watching where that cannula is, is dangerous," Dr Briggs says.
Professor Ashton concurs.
"That's surgery 101, that you learn in the first week of training," Professor Ashton says. "This is incredibly dangerous."
Under current laws, anyone with a basic medical degree can call themselves a cosmetic surgeon.
Dr Lanzer is a specialist dermatologist.
Plastic surgeons have been campaigning for greater regulation of cosmetic surgery for decades.
The Australasian College of Cosmetic Surgery, on the other hand, claims plastic surgeons are just trying to protect their turf.
'Bloody, messy, gruesome, chaotic'
Registered nurses Lauren Hewish and Justin Nixon feel compelled to speak out about working at Dr Lanzer's clinics.
They both resigned after 18 months.
"I had done stuff that has gone against my own registration, against my own competencies," Ms Hewish told Four Corners.
"Speaking up, it's scary, 'cause I could lose everything."
However, she says, she has a duty of care.
"Your number one priority as a nurse is to advocate for your patients and their safety and their wellbeing."
Justin Nixon says Dr Lanzer's Melbourne clinic was "absolute chaos".
"Multiple surgeries running throughout the day, doctors going from room to room," he says.
"It's just bloody, messy, gruesome, chaotic.
"It was guilt that weighed on me, having sold people these shitty outcomes."
Hygiene practices revealed
Pictures taken inside the clinics of Dr Lanzer show human fat stored in kitchen fridges, syringes sitting alongside water bottles, and surgical instruments stored in a suitcase.
The former staff also say employees were told to take home human fat in plastic shopping bags ahead of regulator audits and then to bring it back.
Hygiene and sterility are the cornerstones of safe surgical practices.
Professor Mark Ashton was concerned by the photos of syringes sealed with masking tape, sitting next to drinking water.
"This is not even close to acceptable medical behaviour," Professor Ashton says.
"This looks like a normal, domestic fridge, that doesn't look to be any temperature-control monitoring. And there doesn't seem to be any sterility."
"These bags are open, they're not sealed. A complete breakdown in acceptable standards of medical care, and the only place that needs to be is in a biohazard, sealed medical bin."
Dr Briggs was also concerned by the images.
"It just goes against the grain for everything that we've learned while training as surgeons," Dr Briggs says.
Four Corners obtained a video of a storeroom in Dr Lanzer's Sydney practice that shows surgical instruments stored alongside shoes and other personal items.
The program showed the video to former employee Mr Nixon.
"You can see that the surgical instruments, they're actually not sterilised on site, which they should be," he says.
"They're actually just among the doctor's shoes and dirty clothes, so that's pretty horrifying."
Medical fluids and other medications can be seen on a shelf.
"I can recall in one instance where the fat had fallen down and got lodged in the floorboards, and there were a lot of ants eating up all the fat. It was pretty disgusting," Mr Nixon says.
Professor Ashton, who also watched the footage, described it as "frankly, dangerous".
"There is no sterility, there is no concept of sterility, and how this is allowed to occur, is … is bewildering."
Dr Briggs told Four Corners that he had "never seen anything like this ... it's staggering".
Nurses told to take home human fat in shopping bags before audit
State health departments are in charge of checking whether cosmetic surgery clinics are complying with regulations.
In Victoria, the Department of Health gives registered day procedure hospitals such as Dr Lanzer's six to eight weeks' warning of an audit.
Safety and quality audits are also booked weeks in advance, a practice that allows time to get things in order.
Ms Hewish said an auditor would come in and see "this lovely, empty, perfect theatre".
"But it's because all the stuff, all the clutter that was in there is in people's cars, fat that is in fridges that shouldn't be stored in there is stored in nurses' fridges at home," Ms Hewish says.
Mr Nixon said nurses were asked to take fat home and put it in their own fridges.
"There'd be big bags, or just shopping bags from Coles or Woolworths, stuffed with syringes, liposuction bags full of fat," he says, "with the intention of bringing this fat, returning it to the clinic, [so] that it could then be reused and injected into people."
Dr Lanzer denied there was an issue with sterility at his clinics.
"We have the highest standards of hygiene and safety," he says.
"And, therefore, my infection rate over the last 30 years has been minuscule.
"We're audited every year by an infectious [sic] control nurse and we've maintained that level of excellence since its inception.
"I do not think that there's a surgeon in the world who could show a better safety record than I've done over the last 30 years.
"In my 30-year career, I've never had a single ruling or recommendation against me regarding my method of surgery or my patient care by any regulator."
'Every alarm in my head was ringing'
In November 2018, nurse Kathy Hubble attended Dr Lanzer's Sydney clinic for liposuction on her legs and abdomen.
She said she found the hygiene standards very poor.
"As an experienced theatre nurse, I could tell that he didn't meet any of the standards or the guidelines for a procedure room," Ms Hubble says.
"Every alarm bell in my head was ringing."
She had two procedures over two days. Then the pain set in.
"I got to the point where I couldn't sit, I couldn't stand, I couldn't lie down," Ms Hubble says.
"I was in extreme distress and pain. And I've never had such agony in all my life."
Ms Hubble was taken to Gosford Hospital where she was diagnosed with cellulitis, a potentially serious bacterial infection.
"I was bordering on septic shock."
After the hospital told Dr Lanzer where she was, the phone calls began.
"He was trying to convince me to leave the hospital and go back to the clinic in Sydney, or he was going to send one of his doctors, up to get me," she says.
"The doctors that actually were looking after me were absolutely horrified of what had occurred. The extent of the cellulitis, which was literally from my naval to my knees."
Dr Lanzer refunded Kathy the cost of her surgery but she was told in a message that it was only because he "felt sorry" for her and was "despite the fact" that Kathy did not take the antibiotics prescribed post surgery.
"There was absolutely no truth to any of it," Ms Hubble says.
"And I flatly refused to sign any gag order that would stop me from complaining."
Three years after her procedure, Ms Hubble says, she's still suffering from chronic pain.
"The abdomen is now hard and rubbery and the tissues are so damaged that I get nerve pain across my abdomen in flashes sometimes," Ms Hubble says.
Dr Lanzer told Four Corners that "unfortunately, complications do happen and I'm sorry about that".
"The key thing is, was the patient warned and how did the doctor take care of the patient? I've just looked through the patient's notes and I can see on eight occasions, the patient was warned about infection," Dr Lanzer says.
"So the patient knew that it's a risk, even though it's one in a thousand, it's so rare.
"I called this patient many times because I cared about her as a person. And I cared about her getting the best treatment."
'Never ever, ever, ever, own up to anything'
In an audio message sent to staff in October 2020, Dr Lanzer stresses the importance of not admitting fault:
"Never, ever, ever, not slightly ever, ever, ever, ever, ever, ever, ever admit to a patient that something's bad or wrong. They'll use it against you 100 times for the rest of your life. You never tell a patient you're infected, no … You never tell a patient you haven't got gowns, gloves, this that, no! You say, 'this is how we do it' … You do not own up to nothing! Zero! … Never, ever, ever, ever own up to anything."
Another audio message to staff gives more instructions:
"I never, ever, ever, ever wanna hear any staff sending anybody to a GP. You page me first, okay? We can handle everything. Sending to a GP is the worst possible thing you can do, or to a hospital, never, ever, ever … and it always creates problems."
In a response to Four Corners, Dr Lanzer says his clinics have a general physician who can admit patients to hospital "in the extreme, rare occasion if it's required".
"The procedures I perform are very specialised and not something that other doctors are familiar with and it could really compromise their results," Dr Lanzer says.
"The best person to treat a possible complication such as infection is the treating surgeon, because he knows the procedure."
Four Corners has also obtained messages that appear to show Dr Lanzer has signed blank prescriptions for nurses to later fill out.
This message is from a senior nurse:
"To nurses that are working between Xmas and start-up nxt [sic] year. DL has left some signed scripts for emergencies. They will be kept in locked DD cubboard [sic]."
"DL" refers to Daniel Lanzer.
A patient also says they witnessed Dr Lanzer sign a blank prescription and hand it to a nurse to complete.
Dr Lanzer says his clinics do not use blank scripts.
"I think you've been given false information. In the example you mentioned, see antibiotics are not a Schedule 8 drug, which is actually the classification for opioid painkillers," he says.
"Our audited practice policy is to provide scripts according to the guidelines of the Pharmaceutical Society of Australia."
There's also evidence the practice may have used medication that was out of date.
A message from a senior nurse to staff in Feb 2020 says "… please don't use new stock until the old stock is used. We have stock that expired in Nov and Dec 2019 that needs to be used first".
Specialist plastic surgeon Dr Craig Rubinstein said he suspected that would be illegal .
"Drugs have an expiry date for a reason," he says.
"It can be due to toxic compounds, lack of efficacy.
"You'd think if something is out of date, you just don't use it. It gets discarded."
'Mega-liposuction'
One procedure Dr Lanzer spruiks is so-called "mega-liposuction", where more than 6 litres of fat and fluids are removed from a patient in a single procedure.
In an Instagram video, Dr Lanzer and a colleague guess how much fat they'll remove, in front of the patient about to undergo the surgery.
He later excitedly announces the result: "8, 9, 10 litres! 10 litres!"
Professor Ashton described the remarks as "staggering".
"If this person went home after having 10 litres of liposuction, that is flat out dangerous," Professor Ashton says.
Internationally recognised plastic surgeon Lawrence Gray says the standard in the US is to not take out more than 5 litres at a time, unless the person is being monitored in a hospital.
"It's very dangerous," Dr Gray says.
"You can worry about fluid overload and a patient having breathing problems and even cardiac arrest, if you're talking about removing that amount of tissue."
Dr Lanzer says he's proud to be "a pioneer" of mega-liposuction.
"I've performed literally thousands of cases over the last 30 years, without a single serious complication," Dr Lanzer insists.
"I've written a chapter in the book of liposuction about how to avoid complications.
"I've spoken in America about my method of mega-liposuction at both the American Academy of Dermatology and the American Academy of Cosmetic Surgeons."
In a recent online chat that Dr Lanzer hosted with a US-based plastic surgeon, the pair discussed the risks of cosmetic surgeons being sued.
"You know, we're lucky in Australia," Dr Lanzer said.
"The government changed the law a number of years ago. You have to do something pretty bad to get sued. There's no such thing anymore."
https://news.google.com/__i/rss/rd/articles/CBMiamh0dHBzOi8vd3d3LmFiYy5uZXQuYXUvbmV3cy8yMDIxLTEwLTI1L2RhbmllbC1sYW56ZXItY29zbWV0aWMtc3VyZ2VyeS1jbGluaWMtdmlkZW9zLWZvdXItY29ybmVycy8xMDA1NDc0NDLSAShodHRwczovL2FtcC5hYmMubmV0LmF1L2FydGljbGUvMTAwNTQ3NDQy?oc=5
2021-10-25 09:30:58Z
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