Choosing a cosmetic surgeon

Cosmetic surgery is booming. Americans spent more than $13 billion on 11.7 million cosmetic surgery and non-surgical procedures, such as Botox in 2007 (data from the American Society for Aesthetic and Plastic Surgery). And the UK is catching up fast. According to the British Association of Aesthetic and Plastic Surgeons (BAAPS), cosmetic surgical procedures in 2007 were up 12.2% from the previous year. Men are also increasingly going under the knife. Tummy tucks for men were up 60% in 2007 compared with the previous year, although rhinoplasty (nose job) remains the most popular procedure for men.

This is big business, so it is not surprising that some clinics use aggressive marketing techniques and advertise persuasively. Therefore you have to be very careful.

What do the words mean? Cosmetic surgery is surgery to improve appearance Aesthetic surgery is another name for cosmetic surgery. It comes from the Greek word for beauty Plastic surgery is surgery to change the shape or form of the surface and sometimes the deeper structures of the body. The word ‘plastic’ comes from the Greek word for moulding. Plastic surgery includes cosmetic surgery, repair operations after burns and other injuries, correction of inherited deformities, breast reconstruction after operations for breast cancer, and removal of skin tumours

Before undergoing any cosmetic procedure, it is essential to do a lot of homework. The following advice is mainly about the UK; if you live elsewhere, find out about surgeons’ qualifications in your country.

Do not rush into anything. Read as much as you can about cosmetic surgery, and note down the names of surgeons who are mentioned or quoted. Remember that all surgery has risks. Think carefully about why you want the procedure done. For example, cosmetic surgery is unlikely to improve a relationship that is going nowhere. If you are going through a life crisis, do not make any decisions about cosmetic surgery.

Do not be pressured by anyone else. You will be the one undergoing surgery, so do it only if you want it for yourself.

Be very clear what you are hoping to achieve. For example, if you want your breasts enlarged, what size do you want them to be? Having a clear idea is essential for a proper discussion with the surgeon.

Find out as much as you can about the procedure itself. Even a simple-sounding procedure such as liposuction requires a lot of skill. Look at the good cosmetic surgery websites (see useful contacts). Various cosmetic procedures are also discussed elsewhere: for example, breast reduction, breast enlargement, thread veins, ageing skin and ears.

Locate a good, reputable surgeon. Do not just answer a persuasive advertisement in a magazine or on the web.

The best plan is to ask your own doctor for a referral. If you think your doctor would be unsympathetic, contact BAAPS for a list of their members and their different specialities.

• Check your surgeon’s qualifications in the Medical Directory. The letters MRCS or FRCS mean that that he/she is a Member or Fellow of the Royal College of Surgeons, having had several years experience and passed a stiff exam in general surgery. They do not signify special training in cosmetic surgery. Many cosmetic surgeons now have the ‘FRCS (Plast)’ qualification, which means that the surgeon has additional experience in plastic or reconstructive surgery and passed an extra examination. However, some experienced cosmetic surgeons do not have FRCS (Plast) because they trained before it was introduced.
• In the UK, most cosmetic surgeons will be members of BAAPS, the main organization responsible for maintaining high standards in cosmetic surgery. However, membership of BAAPS is not an absolute guarantee. To join BAAPS, surgeons have to have had 6 years training in plastic surgery and provide a log book of operations they have done, and other members have to testify to their experience. Once he/she has joined, there is nothing to stop the surgeon doing other cosmetic operations in which he/she is less experienced.
• Some surgeons are members of the British Association of Cosmetic Surgeons (BACS). This organization represents mainly surgeons in private clinics. To join BACS, they do not need to be qualified plastic surgeons, but have to show they have cosmetic surgery experience. Many BACS surgeons have good experience with certain procedures, but BACS membership is not a guarantee of anything.
• The General Medical Council has a list of specialist plastic surgeons who are eligible to work as NHS consultants in plastic surgery.

Check that the clinic is registered with the Healthcare Commission. This is the official body responsible for regulating and assessing healthcare in both the independent sector and the NHS in England. All private clinics and hospitals in the independent sector that provide cosmetic surgery and laser and intense pulsed light (IPL) treatment must now be registered and inspected by the Healthcare Commission. If they are not registered, they are practising illegally. The commission checks each provider for quality of treatment and services, safety and cleanliness of premises and equipment, qualifications and skills of staff, and procedures for handling any complaints.

Make sure you have a proper consultation with the actual surgeon who will be operating on you. UK government regulations insist on this. Be suspicious if you are not charged a fee for this consultation – a good surgeon’s time is valuable. A ‘free’ consultation will probably be with a counsellor, nurse or salesperson.

• Take a good friend with you.
• Write down a list of questions beforehand. Make sure you ask them all (even if it feels embarrassing). If the answers are not absolutely clear to you, say so and ask for a further explanation. Do not just think you are being stupid. Remember that you are paying for this consultation.
• Ask about any preparations you will need to make, what aftercare is provided, and what the risks are. Does the clinic have resuscitation equipment and doctors actually in the building 24 hours a day? Who will you be able to contact if you need advice after the operation?
• Find out about the recovery period. How much pain and bruising should you expect? How long will you need off work? When will you have stitches out? What will the scar be like?
• Ask how long the results will last.
• Ask the surgeon how many of these procedures he/she has done before. If you are shown ‘before-and-after’ photographs, ask if the operation was done by your surgeon personally. (You could be shown pictures of operations done at the clinic by a different surgeon.)
• Make sure you know how much the procedure will cost.

Do not ignore the pitfalls. All surgery has risks. If you are really keen on a procedure, it is tempting to disregard possible problems, but this is a big mistake. Weigh up all the pros and cons carefully before making your decision.

Shop around. Do not just go to the first clinic that you contact. Make a short-list of several surgeons and clinics, and have a consultation with more than one. Although this will cost you, it is money well spent.

Consider location. It is tempting to travel overseas for cheaper surgery, but do not do so unless you are sure about follow-up arrangements and what would happen if there were problems.

Allow yourself a ‘cooling off ‘period of about 2–3 weeks after the initial consultation, so that you can think clearly about the procedure before making the decision to go ahead. A respectable clinic will encourage this, and will not hassle you into making an immediate decision. UK government regulations from the National Care Standards Commission (set up to regulate private clinics) ban having the surgery within 2 weeks of the consultation, but you could still be pressured into making the decision too quickly. Go ahead only if you feel you can trust the surgeon and that he/she has explained everything properly to you and understands what you are hoping to achieve.

Remember you can always change your mind. You can cancel right up to the moment you go to sleep for surgery.

Most popular operations In the UK, 32 453 cosmetic surgery operations are done each year. The most popular operations requested by women are: breast enlargement breast reduction facelift liposuction. For men, the most popular procedures are: rhinoplasty (‘nose job’) liposuction eyelid lift. In the USA, the most popular operations are: liposuction (456 828 in 2007) breast enlargement (399 440 in 2007) eyelid lift (240 763 in 2007) tummy tuck (185 335 in 2007) breast reduction (153 087 in 2007). In addition, more than 4 million chemical peels and antiwrinkle injections (such as Botox) were done in the USA in the year 2007. Information from the British Association of Aesthetic Plastic Surgeons and the American Society for Aesthetic and Plastic Surgery.

Useful contacts
UK Department of Health Cosmetic Surgery website is a UK government website that should be your first port-of-call for information. It has an A–Z of cosmetic procedures, questions you should ask, and a section on ‘Qualifications – what they mean’ which lists the qualifications of surgeons, other doctors, nurses and other practitioners. It also has advice if you are considering going abroad for a cosmetic procedure.
www.dh.gov.uk/en/Publichealth/CosmeticSurgery/index.htm

UK Healthcare Commission; an important website for up-to-date information on the regulation of cosmetic surgery in the UK. Use it to check if a clinic is registered and also for information about cosmetic procedures.
www.healthcarecommission.org.uk/cosmeticsurgery

British Association of Aesthetic and Plastic Surgeons (BAAPS) will send you a fact sheet on cosmetic surgery and a list of their members, but will not give recommendations. The list is also on their website. The website also gives details of the common cosmetic surgery procedures, and tells you the risks and limitations of each, and has a list of points for you to think about beforehand. Write to: BAAPS, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, UK (send an sae). Advice line: 020 7405 2234.
www.baaps.org.uk

The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) is an association of surgeons who carry out cosmetic procedures and non-cosmetic procedures. (Many cosmetic surgeons are members of both BAAPS and BAPRAS.) Look at the ‘Cosmetic Surgery’ section of their website for explanations of various procedures.
www.bapras.org.uk

The Medical Directory is a two-volume book listing UK doctors and their qualifications. It is published every year, and should be available in your local library. Look up your surgeon, and check his/her qualifications. The Directory may also mention that he/she is a member of the BAAPS.

General Medical Council. The website gives details of UK doctors. The site also tells you whether a doctor is a specialist in plastic surgery (if they were appointed as an NHS consultant since 1997).
www.gmc.org

British Association of Cosmetic Surgeons (BACS). Write to: Highgate Private Hospital, 17-19 View Road, Highgate, London N6 4DJ UK.
www.b-a-c-s.co.uk/bacs.htm

The American Society for Aesthetic Plastic Surgery (ASAPS) can provide the names and qualifications of surgeons in all areas of the USA. Its website has web pages giving information about various cosmetic surgery procedures, and videos. Some of the information may not be applicable to other countries. www.surgery.org/public/procedures.php

Wendy Lewis website. Wendy is an expert on cosmetic surgery procedures and her website is informative. The ‘Ask the Beauty Junkie’ section is a mine of information.
www.wlbeauty.com