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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.

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.

• 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.

• 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.

Most popular operations

• breast enlargement
• breast reduction
• facelift
• liposuction.

• rhinoplasty (‘nose job’)
• liposuction
• eyelid lift.

• 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).

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