In July, 51-year-old Isel Pineda went into cardiac arrest while undergoing “SmartLipo” in the New York office of one Dr. Oleg Davie. She died shortly after.Davie was not certified to perform the liposuction surgery—or any surgery for that matter. As an internist his specialty is in non-surgical diagnosis and treatment. Yet he took Pineda’s money and put her on the table from which she never got up.Pineda’s story is just one in a tragically long list of deaths occurring as a result of plastic surgeries performed at the hands of unqualified physicians without certification from the American Board of Plastic Surgery, the only body in the U.S. approved to certify doctors in the specialty.QUIZ: Are You Happy With Your Face?A Framingham, Massachusetts mother died at 39 following breast augmentation done by a family practitioner with a two-day plastic surgery training course under his belt. Sharon Carpenter Nicholson, 61, died in Beverley Hills when a gynecologist botched her liposuction. Peter Normann, an internist in Arizona, lost two patients before having his license restricted, then handed the scalpel to a homeopathic doctor who caused the death of a third patient in Normann’s office. An eye doctor in Georgia was sanctioned for doing implants. In August, an Oregon internal medicine specialist gave her friend a deadly tummy-tuck. The stories, sadly, just keep coming.“This is a huge problem. There are hundreds of deaths in the U.S. every year from improperly trained doctors doing real surgery,” says YouBeauty Cosmetic Surgery Expert Arthur Perry, M.D. “If you have $100,000 you can build an operating room in your office and do surgery without ever doing a day of surgical residency.”Cosmetic surgeries are up virtually across the board, with about 14 million procedures performed annually. And from Botox, chemical peels and laser hair removal to facelifts, liposuction and boob jobs, more and more doctors are jumping on the bandwagon. Unfortunately, they’re jumping right through enormous legal loopholes dating back to the 1930s that allow just about anyone with a medical license to get in on the action.“Right now it’s the Wild West of plastic surgery,” Dr. Perry decries. “There are vascular surgeons injecting Resylane into wrinkles, tummy tucks by gynecologists, dentists doing facelifts and rhinoplasty.”MORE: Guide to the Cosmetic Surgery ConsultationWhy the rush into cosmetic work? The simple answer, says South Dakota plastic surgeon Ahmed Abdullah, M.D., is money: “Reimbursements from insurance companies have decreased significantly in recent years, so much so that physicians have had to diversify their practices to maintain profits.”Plastic surgery is a cash business, and business is good.Why Board Certification MattersEveryone who graduates from medical school has a degree that allows him to go on to practice medicine. But that doesn’t mean that he has a specialty, or the years of training that go along with that. To go into family practice requires three years of training after med school. Dermatology takes four. To become specialized in plastic surgery, you have to do a six-year residency, just one year less than a cardiac or neurosurgeon.After all that, there’s a board exam, designed to identify a minimum level of competence. The exam tests a doctor’s book knowledge, ability to take care of patients, ethics, billing procedures, and reviews the cases he’s managed over the last two years. And while it’s the baseline mark of approval for any specialist in the field, it’s not just a rubber stamp affair. Fully 20 to 30 percent of doctors fail the American Board of Plastic Surgery exam each year—even after six years of residency in a hospital or clinic.Indeed, Perry explains that it’s during that residency that doctors really get the know-how they need. “The first year is patient care, where you learn the fundamental skills of operating, how to make an incision, putting in stitches, how to stop bleeding. You think this happens in med school, but it really doesn’t.” During his sixth year a plastic surgery resident is performing his own procedures, under the watch of an attending surgeon. And only after that is he ready to get board certified.QUIZ: Get Your Body Skin Healthy“Board certification is a reliable marker for patients that they are working with a plastic surgeon who has not only been thoroughly trained, but also had real-world experience” says Dr. Abdullah, who is himself certified by the American Boards of Surgery and Plastic Surgery. “The most difficult part of plastic surgery isn’t the technique, it is understanding what not to do. Complications can arise during surgery and, when they occur, a board certified plastic surgeon will be far more prepared than someone who didn’t experience the rigor of board certification.”Board-certified doctors also must take continuing education classes and retake the boards every ten years.Will The Real Board Certified Plastic Surgeon Please Stand Up?The twisted part (if this all wasn’t twisted enough already) is that pretty much any doctor can call himself “board certified” in just about anything. Patients be aware: There are exactly 24 Boards that are recognized by the American Board of Medical Specialists (A.B.M.S.). If you’re angling for a nose job, says A.B.M.S. president Dr. Lois Margaret Nora, M.D., you should look for a physician who is board certified by the American Board of Plastic Surgery or the American Board of Otolaryngology (that is, ear, nose and throat). Better yet, find one who’s both. A family doctor who offers Botox injections might really be board certified, but in family medicine only.Patients can check a doctor’s certification for free on the A.B.M.S. website at CertificationMatters.org. There’s also a list of the 24 official boards on the homepage. If a doctor advertises being certified by any board other than those 24, you probably want to find yourself another guy.Oleg Davie, the New York internist whose patient died after a mangled fat removal in July, is still practicing and calls himself “Board Certified in Aesthetic Medicine.” No surprise, there’s no board of aesthetic medicine under the A.B.M.S. umbrella.COLUMN: Beware of DIY Plastic SurgeryIn fact, according to the website of the “American Academy of Aesthetic Medicine,” of which Davie claims in his bio—and in his fat-zapping deal on Lifebooker.com—to be a member, physicians need only do the following to achieve board certification: take a three-day certificate course followed by a five-day Level 2 Diploma Course, during which “Management of Complications from Lasers and Intense Pulsed Light” is given half as much class time as the 30-minute coffee break. Then, after four months practicing aesthetic medicine, doctors are eligible to take the two-hour multiple choice board exam. A passing score is 70 percent.While a tiny fraction of the six years required for certification by the American Board of Plastic Surgery, this process is grueling compared to some weekend seminars that bestow certification to perform liposuction, Botox or sclerotherapy for spider veins in as little as one to three days.There are hundreds of self-designated boards, warns Perry. Just like that a person can incorporate his own, call himself a member and slap it on a brochure in his waiting room.MORE: Watch Out for “Wannabe” Plastic SurgeonsHow to Spot a FraudIf you’re in the market for wrinkle filler, laser treatments or a nip, lift or tuck, here are some red flags to watch out for:Doctors billed as cosmetic surgeons. “There is no board of cosmetic surgery. There is no board of aesthetic medicine. Plastic surgeons call themselves plastic surgeons,” Perry says.Prices are lower than at other facilities. Cosmetic work is expensive. Breast lifts and buttock implants average over $4,000 apiece, according to the American Society of Plastic Surgeons. Wrinkle fillers range from $400-plus to over a grand. But surgery is no place for bargain hunting. You get what you pay for.Botox sold by the unit. Perry says there’s a rule in medicine to use the lowest possible dose of a drug to achieve a result. So what does it say if a doctor is treating Botox injections like a special at the supermarket?The facility is not accredited. The American Society of Plastic Surgeons gives accreditation to surgical facilities to ensure safety. This includes checking for sterilization, proper equipment and drugs, essential monitors and sufficient staff.Perry, who spent ten years on the New Jersey board of regulators, once reviewed a case in which a non-certified pathologist (a doctor who studies diseases under a microscope) let a patient die during a tummy tuck because there was no elevator in the building to get her downstairs and to a hospital.QUIZ: Are You Happy With Your Body?Beauty Is in the Scalpel of the BeholderBeyond the basic requirements to a successful surgery is the artistry that comes with years of experience in plastic or cosmetic surgery. It’s a unique discipline in which physicians must balance medicine with aesthetics to ensure safe and attractive results.Non-surgical procedures, like laser peels and wrinkle fillers seem deceptively easy. They’re not. A four-hour course can’t possibly imbue newbie physicians with the finesse to understand the nuances of the anatomy or how certain minute decisions can affect outcome.“If you want to look like a freak, that’s how you do it,” says Perry. “O.B.s are advertising Botox because their patients are women. I would not try to deliver a baby. I respect the limits of my training and so should other people.”He has fixed many botched procedures by non-surgeons. And as Abdullah points out, the revision surgery can be more costly than the original bargain hack job.Fillers fade and some mistakes are correctable. But others can result in permanent disfiguration or worse. Even board certification can’t guarantee perfection. But, really, why gamble on anything less?MORE: Will Plastic Surgery Make You Happier?