Cosmetic surgery is defined by the Department of Health as “Operations or other procedures that revise or change the appearance, colour, texture, structure or position of bodily features to achieve what patients perceive to be more desirable”.
Obvious tensions exist between the patient’s best interests, ethics and the surgeon’s goal of profit.
What should cosmetic surgery shoppers look for and how could the industry improve its image? Should advertising in public places be banned or subject to a separate code of conduct? The British Association of Aesthetic Plastic Surgeons (BAAPS) wants a ban and a code of conduct!
Under the Care Standards Act 2000 the Government has published national minimum standards for independent hospitals. There efficacy of these standards has been debated. For example there is a requirement to provide dated documented criteria which set out the risk factors associated with individual procedures and guide the selection of patients for different treatment options. It is required that these are discussed with the patient prior to surgery. There is however, no requirement to provide the patient with written information.
There is no requirement for the treatment provider to obtain relevant medical history from the Claimant’s GP, which puts patients at increased risk.
Unregulated cosmetic injectables
The so-called “cosmetic injectables” such as dermal fillers and Botox are excluded from the statutory definition of cosmetic surgery and therefore not regulated. Procedures such as Botox and derma filler injections are often perceived to be minor procedures and hence low risk. A survey of the British Association of Aesthetic Plastic Surgeons however revealed that 25% of its members had seen patients who required surgery to correct significant cosmetic defects from permanent filler complications.
There is no General Medical Council (GMC) specialist register specifically for cosmetic surgery – there is for plastic surgery, but that is an entirely different specialism. The national minimum standard does require all surgeons to be on one of the many GMC’s specialist registers demonstrating that they are competent in the procedures they undertake, however there is no requirement that a surgeon on a specialist register should restrict himself to a certain type of procedure. For example an ear, nose and throat specialist with a history of performing rhinoplasty (nose jobs) would be breaching nothing by deciding to branch out into breast augmentation. The practitioner must demonstrate that they have the necessary skill and expertise to be able to competently and safely offer the treatment.
Counselling should be offered
Many clinics do not offer counselling by medically qualified counsellors, do not have a high dependency unit on site or even fully equipped theatres. Many do not have an emergency readmission policy, hence if their patients have complications they are simply “bounced” to the NHS, often via A and E.
Patients adversely affected by poor results are particularly vulnerable, however society increasingly trivialises cosmetic surgery Often teenagers are influenced by advertising and have unrealistic expectations, which require assertive management by skilled professionals.
The multi-million pound industry could be greatly improved by giving patients more basic information, assessment, counselling and aftercare.
Patients require better regulation of the industry to protect them against the power and commercial interests of those who provide cosmetic services. Advertising and profit-related incentives such as reduced price services, tied to a limited time frame, should be restricted and vetted, in order to protect cosmetic surgery shoppers who are frequently emotionally fragile and vulnerable.