It's just liposuction. Those may be the three most dangerous words in plastic surgery. For too many, plastic surgery is like a visit to the dry cleaner (in by 7, out by noon) or the hairdresser (just a little off the top ... of my thighs). Patients and surgeons who don't take cosmetic procedures seriously are at the center of the growing problem explored in "Are Your Cosmetic Procedures as Safe as They Can Be?" on page 54. As contributing editor Dianne Taylor describes, two runaway trends are colliding with increasing frequency at the corner of Nip and Tuck: consumers' push for fast and fabulous results and cosmetic surgeons' overly aggressive approaches. These crashes can be deadly.

Most plastic surgery is to beautify, to enhance appearance toward some aesthetic ideal, but fatalities and serious complications from routine face-lifts and breast augmentations may signal that vanity has become a fatal flaw. Bad outcomes rise as record numbers of doctors and patients enter an essentially unregulated field. In 2004, there were 11.9 million plastic surgeries, up from 8.9 million the year before, according to industry estimates.

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The times, they are a-changing.

1975: Going to a new, hip joint

2005: Receiving a new hip joint

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We have begun to ignore the stories of hospitals throwing sticks and stones at the new physician-owned surgery center in town. One, they've gotten a little repetitive. Two, we're the magazine for all owners and operators of outpatient surgical facilities, which means that just as many (actually, several more) hospital readers as ASC readers pass us around and Post-It note us.

That aside, CMS could unify hospitals and ASCs. More than anything, the agency's likely decisions to link ASC reimbursement rates to hospital outpatient department rates, raze the ASC procedures list and adopt an exclusionary list that would specify what procedures can't (rather than can) be performed in ASCs will legitimize and authenticate an ASC industry that can be dysfunctional.

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Is doing a good job at your facility like wetting your pants in a dark suit?

You get a warm feeling but no one else notices.

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If it's true that what's familiar is what's funny, you'll get a good laugh out of Paula Watkins, RN, CNOR, an OR nurse blessed with overactive sarcasm and sass glands. Paula's first "Behind Closed Doors" column (page 18) is an unblinking and wickedly funny look at life in the OR.