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The military says getting a nose job or breast enhancement could affect readiness.

For that reason, servicemembers in the Pacific contemplating a lift, a tuck or other physical enhancements must check with their commanders before seeking any form of elective surgery, no matter how personal the procedure may seem, military officials say.

“Any surgical procedure has risks, and elective surgical procedures could potentially be a readiness issue,†said Col. J. Gregory Jolissaint, who heads up the U.S. Army’s 18th Medical Command in South Korea. “Soldiers should inform their chains of command before undergoing any procedure that could make them miss movement or affect their duty performance.â€

The U.S. Marines require its members to get approval from one’s command before undergoing any elective or cosmetic surgery, whether it’s done at a military treatment facility or a civilian hospital, according to 1st Lt. Garron Garn, a spokesman for III Marine Expeditionary Force/Marine Corps Bases Japan at Camp Butler, Okinawa.

If surgery is not necessary to save life or limb, it’s considered elective, according to Garn.

Family members are at liberty to have surgery done wherever and whenever they choose, Garn said.

The Air Force spells out its disclosure requirement in a little-known Air Force Instruction — AFI 44-102 — that states “elective surgery, performed at the member’s expense, is prohibited without prior written approval of the member’s squadron commander†and the medical treatment facility commander.

Two recent cases at Misawa Air Base, Japan, of cosmetic surgeries gone bad prompted medical officials to remind airmen of the proper procedures. The initial surgeries weren’t performed at Misawa, but the airmen required “extensive repair and follow-up from botched procedures and infection,†Col. Mary Armour, 35th Medical Group commander, was quoted saying last month in a news story that ran on the base Web site.

“If we don’t remind people that there is an AFI that talks about elective surgery, people can get themselves in trouble — it becomes costly for them and can have a true impact on the mission, especially if they do have a complication,†Armour said in an interview with Stars and Stripes.

Military officials said elective procedures not directed by the military must be paid for in full by the servicemember and are not reimbursable under Tricare. Also, any disability or injury that occurs from elective cosmetic surgery will not be covered by disability compensation upon leaving the service, Jolissaint noted.

Marines could be subject to disciplinary action for failing to obtain command approval prior to having elective surgery, Garn said in a written response.

While Misawa’s base hospital took care of the airmen who needed follow-up treatment, Armour said that if complications from cosmetic surgery cause servicemembers to be away from their duty station, they can be charged for taking leave and may have to pay for the further care.

While Armour did not sign any approval letters for the airmen’s cosmetic surgeries, the individuals — who have since moved from Misawa — may have had approval prior to her arrival, she said.

“Our mission in the medical group is to take care of the medical needs and is where we devote our efforts,†she said in a written response. “It will be up to other agencies to determine any administrative outcomes for the care.â€

‘Surgical vacations’ can be costly and dangerous

Although Air Force doctors at some locations perform cosmetic and reconstructive surgeries to maintain their skills, airmen must meet strict eligibility requirements to qualify for such a procedure, said Col. David Blake, the former 35th Medical Group deputy commander and general surgeon, who recently moved on to a new assignment.

For this reason, some military members have been taking leave and opting to travel to countries where surgery costs less but may not meet health standards, said Blake, who was quoted last month in a news story on Misawa Air Base’s Web site.

Officials at U.S. Naval Hospital Okinawa are seeing the results of that, with active-duty servicemembers, civilians and dependents lured to neighboring countries where cosmetic procedures are marketed as “surgical vacations,†officials said.

“We have seen an increased number of patients from Thailand and the Philippines with complications from cosmetic surgery,†said Navy Capt. Susan Chittum, formerly the director of surgical services at U.S. Naval Hospital Okinawa.

Chittum recently became the executive officer of Naval Hospital Cherry Point in North Carolina.

The surgery clinic at U.S. Naval Hospital Okinawa sees two to three patients per month complaining of cosmetic surgery complications, according to hospital spokesman Brian Davis.

Most of the problems arise from breast surgeries and tummy tucks, Chittum said, “but it is hit and miss with the others as well.â€

The main complication observed from these procedures has been serious infection or scarring, Chittum said.

Some infections have been life-threatening, she said.

A botched surgery can end up costing a servicemember big bucks, officials said.

“It’s quite possible that in order to replace an implant or correct a bad cosmetic outcome, the servicemember would have to pay for more plastic surgery out of pocket,†Davis said in a written response.

A distinction between types of surgeries

Servicemembers interested in cosmetic or elective surgery not only have to run it by their commanders, but medical officials advise them also to discuss it with their physicians because of the potential risks.

But seeking approval and advice doesn’t mean a request will be granted.

“At some remote bases like us, it might be more difficult†to get an elective procedure approved, said Lt. Col. Richard Mayers, 35th Medical Group chief of medical staff and staff general surgeon at Misawa Air Base, Japan.

Among other factors, commanders assess availability of personnel, operational readiness, deployment schedules and post-operative recovery time when weighing a request, military officials said.

Mayers said there’s a distinction between cosmetic and reconstructive surgery — though both are considered elective.

Reconstructive surgery is necessary to repair a congenital defect, or something that’s the result of an accident or injury, for example, he said.

“As a clinician, my inclination would be to push a lot harder for reconstructive surgery,†Mayers said. Improvements from a reconstructive procedure “can impact their psyche, how they do their duty,†he said.

Nevertheless, he added, “The bottom line is we have to be sure we have a force that’s ready to deploy at any time.â€

Know the risks

U.S. Naval Hospital Okinawa officials recommend that anyone opting for cosmetic surgery go to a U.S.-licensed and board-certified cosmetic surgeon.

Cosmetic surgery risks include:

Death n Excessive bleeding n Infection n Damage to tissueFailed positive outcome n Anesthetic reaction n Permanent scarringSource: U.S. Naval Hospital Okinawa

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Jennifer reports on the U.S. military from Kaiserslautern, Germany, where she writes about the Air Force, Army and DODEA schools. She’s had previous assignments for Stars and Stripes in Japan, reporting from Yokota and Misawa air bases. Before Stripes, she worked for daily newspapers in Wyoming and Colorado. She’s a graduate of the College of William and Mary in Virginia.
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