In Toronto, Canada, the coroner's office is examining the death of a woman who had a liposuction operation carried out on her at a private cosmetic clinic.
The coroner is expected to determine the cause of death and investigate the doctor who performed the liposuction on Krista Stryland, 32.
A successful real estate agent, Stryland was in the recovery room of the clinic in North York when complications arose. She was rushed to North York General Hospital where she died.
According to Dr. Jim Edwards, the regional supervising coroner for Toronto east, the coroner's office will do more lab work on tissue and blood samples but it could take weeks before more is known about how Stryland died.
"One of the issues we'll be looking at is the qualifications of the physician that did the surgery and also actually what went wrong — assuming something did go wrong," says Edwards.
"There is an inherent risk in any surgical procedure and certainly the fact that somebody died following the procedure doesn't necessarily mean that there was a problem with the surgery but that's one of the things that we'll be looking at", he added.
In addition, the College of Physicians and Surgeons will be reviewing the guidelines on who should be allowed to perform cosmetic surgery.
Meanwhile, medical associations are recommending that consumers check the qualifications of practitioners to ensure that they are licensed surgeons.
Family doctors or general physicians perform cosmetic procedures such as Botox, breast implants, liposuction, and even tummy tucks with sometimes disastrous consequences.
According to Dr. Frank Lista, who has served as the president of the Canadian Society for Aesthetic Plastic Surgery, the Society would like to see doctors who perform such surgeries be certified specialists. "Every single doctor has to be a specialist in something, even in family practice.
"It makes sense that those doctors are restricted to practicing within their specialties.
"Cosmetic surgery is one type of surgery that plastic surgeons do," he added. "There is no specialty called cosmetic surgery."
Regarding Stryland's death, Lista says: "It's a shock.
"It's a shock for patients, for doctors, for plastic surgeons. It's a shock for everyone."
Lista says that the death was particularly surprising because liposuction has one of the lowest complication rates of any procedure carried out by plastic surgeons.
In 1991, another real estate agent, Toni Sullivan, died of a blood clot two days after undergoing a liposuction procedure.
An inquest into her death recommended that the College of Physicians and Surgeons of Ontario create clearer guidelines between plastic and cosmetic surgery. The college set up a cosmetic surgery task force in April with a mandate to forge new regulations and policing procedures.
Meanwhile, the Toronto Cosmetic Clinic has issued a statement saying the death was an isolated event and that its physicians maintain a strong record of clinical safety, and "...are fully trained in accordance with the requirements of the College of Physicians and Surgeons and perform only those procedures for which they have been approved by the College."
Though provinces such as Alberta and B.C have tried to curb the explosion of cosmetic clinics by regulating who is allowed to perform surgical procedures in free standing clinics, in other provinces, like Ontario, the customer has to take absolute responsibility for all cosmetic procedures.
Lista recommends that anyone considering liposuction should conduct their own research by questioning the doctor and checking his or her credentials with the College of Physicians and Surgeons of Ontario.
Dr. Brian Gallagher of the Canadian Society for Aesthetic (Cosmetic) Plastic Surgery says patients should look for the initials on a doctor's certification that say FRCSC, which stands for "Fellow of the Royal College of Physicians and Surgeons of Canada."