Your first consultation - what to ask

The initial consultation with a specialist cosmetic surgeon should help you set realistic expectations of what your chosen procedure can achieve for you.

The consultation will also allow the surgeon to make a professional assessment of your motivation for wanting cosmetic surgery and whether they can offer treatment that will meet your expectations. With this in mind, you should expect to be asked a number of questions about your reasons for wanting surgery. This should not make you feel uncomfortable and is not designed to make you prove you are a ‘deserving case’. It is simply to check that your motivation seems in line with realistic expectations for the chosen procedure. Your surgeon should show you before and after photographs of similar operations that they themselves have performed.

You may find it helpful to bring a friend, partners or relative with you to a consultation as there will be a lot of information to absorb and consider. Make sure that you are given a full explanation of any risks associated with the operation, in terms of side effects and possible complications. It can seem very exciting to discuss the potential benefits of an operation and this can lead to a tendency to avoid discussing complications but it is better to be fully aware of both the risks and the benefits so that you can make the right decision for you. You should be given access to written information about the operation and associated risks so that you can study this carefully at home and in your own time. In addition, your surgeon may write to you afterwards to reiterate the medical information that has been provided during the consultation.

If you are offered a free consultation always ask about the credentials of the person you will be seeing. Some providers only offer free consultations with a sale advisor rather than a specialist plastic or cosmetic nurse or cosmetic surgeon. Rapport with and confidence in your surgeon is vital as you will be putting great trust in them. You can really only get a feel for this at the consultation stage so it is essential to make sure that you meet the surgeon who will be carrying out your surgery before you make any decision to proceed.

Absolutely do not let anyone rush you into making up your mind. You do not need to make an immediate decision and you may wish to go away and discuss it with friends or family, gather more information and even seek a second medical opinion. Take time to consider your decision and perhaps return for further consultations before deciding to go ahead. It is best to allow at least two weeks between consultation and the operation date so that you have plenty of time to reflect and make sure that you are entirely comfortable with your decision. Financial incentives for proceeding quickly are wholly unethical and should raise your suspicions if they are offered to you.

How do I make an informed decision? Ask questions!

Being well informed will maximise your chances of being satisfied with your treatment. It is worth investing time to find out the answer to the following questions before or during your consultation. You will usually be paying for the surgeon’s consulting time so do not be afraid to use this time to ask plenty of questions.

1. What qualifications does the surgeon have?

Check whether they have just FRCS (which all surgeons have) or if they have FRCS (Plast) which is a further specialist qualification in plastic surgery and evidence of training in cosmetic surgery.

2. Is the surgeon on the GMC specialist register and for which specialty?

You can check this on the GMC website or by calling the registration helpline – see previous section for details on this. Remember, some surgeons do call themselves, for example, ‘facial plastic surgeons’ or ‘oncoplastic breast surgeons’ without being on the register for Plastic Surgery. You should expect clarification on this.

3. What professional organisations is the surgeon a member of?

Being a member of BAAPS (British Association of Aesthetic Plastic Surgeons) ensures the surgeon has undergone further specialist training in cosmetic surgery.
Being a member of BAPRAS (British Association of Plastic Reconstructive and Aesthetic Plastic Surgeons) ensures the surgeon has undergone specialist training in plastic and reconstructive surgery and may also perform cosmetic surgery work. There are no criteria for cosmetic surgery experience or workload when becoming a member of BAPRAS.

4. What experience does the surgeon have in performing your procedure?

Ask how many operations they performed in the last year and how they measure their results. It is important to know how many of their patients need further corrective surgery (revisions). These are perfectly reasonable questions to ask and a good surgeon will be more than happy to explain their results and experience to you. This can feel a little awkward and confrontational but a reputable practitioner should put you at ease in this regard and be willing to discuss his or her experience in detail.

5. Can you speak to some of the surgeon’s previous patients that have had the operation you are considering?

Specialist cosmetic surgeons often have a list of previous patients who are willing to speak to other patients about their experiences. For confidentiality reasons you will need to be prepared to give a telephone number so that the patient can contact you rather than calling them.

6. If you will be having a general anaesthetic, who will be the anaesthetist and what are their qualifications?

The anaesthetist should be listed on the GMC specialist register. You can again check this on the GMC website or by calling the registration helpline. Moreover you should ask how often the surgeon works with this particular anaesthetist and what are their shared experiences in cosmetic surgery. Anaesthesia for cosmetic surgery is a very specialised area and makes a significant difference to outcome in many cases.

7. How many cosmetic surgery operations in total does the hospital or clinic perform each year? And how many of the procedure that you are considering?

The registered manager of the hospital or clinic should be able to provide you with this information.

8. What quality standards does the hospital or clinic have?

You can check clinical quality standards by requesting a copy of the latest Care Quality Commission report from the registered manager of the hospital or clinic or by checking the Care Quality Commission website. Some care providers also publish clinical outcome information on their own website.

9. What medical back-up facilities and staff are in place to support cosmetic surgery operations?

If you will be staying in hospital overnight, ask about the resident doctor arrangements should any problems arise during the night and what arrangements are in place for contacting your surgeon should you need to be reviewed.

10. How can you best prepare for the procedure?

This will depend to some extent on the type of surgery you are having. Ask the surgeon for more details. Once again, you should be provided with written information on how best to prepare yourself and your home for your surgery and recovery.

11. What results can you expect and how long will they last?

Ask the surgeon to define subjective terms such as ‘significantly improved’. Ask the surgeon if the procedure will need to be repeated in future to maintain the result. If you are having implants or fillers ask how long they will last and if they need to be removed or replaced at any later date.

12. What are the side effects and potential complications of the procedure?

All operations carry risks as well as benefits. The chance of complications depends on the type of operation and other factors such as your general health. Your surgeon should explain how the risks apply specifically to you. Feel free to ask about the psychological aspects and how most patients feel afterwards; a change in appearance can have a profound emotional effect that you may not be expecting. Knowing the normal pattern of recovery is an extremely important and reassuring part of preparing yourself for surgery.

13. How long will it take to recover and what will this involve?

Ask the surgeon how you should expect to feel and what extent you will need to ‘take it easy’. You may need to make additional childcare arrangements or organise other help at home.

14. How much time off work should you allow?

This will clearly depend on the type of surgery or treatment you are having. Ask the surgeon for more information so that you can arrange time off in advance. You will need to be flexible in this regard and take account of the possibility that your recovery may be faster or slower than average.

15. What are the follow up arrangements at the hospital or clinic if you have any worries or feel that your recovery is not going well?

Ask how you will contact the hospital in the event of a concern and whether you will be able to see the same surgeon that performed your original operation.

16. How much scarring is there after the procedure and how will it change over time?

This will depend on the type of surgery you are having. Ask the surgeon for more details. The surgeon should be able to illustrate the scarring process with clinical photographs of previous patients.

17. If you are not happy with the results of your procedure, what corrective treatment will the hospital, clinic or surgeon provide and will there be a charge for this?

Occasionally there are times when patients are not happy with the results of their surgery. It is important to have realistic expectations of what surgery can achieve, however you should ask what corrective treatment will be provided if you are unhappy and whether you will need to pay for this.

What’s included in the price?

When you approach a hospital or clinic for initial information about cosmetic surgery they should be willing to give you an approximate guide price that should cover all the costs of the treatment that you are considering. However most hospitals will not give you a firm quotation until you have attended a consultation. This is because the final price is often determined by the exact nature of the surgery and the choice of technique or implants that may be involved. In addition, length of postoperative stay and the intensity of follow up, treatment and dressings will influence the overall price.

Once you have had your consultation, you should be given a personal written price quotation and a document explain the terms and conditions of the contract with the facility, which you will need to sign for you to go ahead with the treatment. You must make sure that you understand exactly what is included in the price you have been quoted. Some or all of the items listed below may be in the package price, but if they are not included, you will need to find out the additional price for the relevant items.

Before treatment

Initial consultation with your cosmetic surgeon
Further consultations should you require them
Before and after photographs
Blood tests and X-rays

During treatment

Surgeon’s fee
Anaesthetist’s fee (if you are having a general anaesthetic)
Hospital or clink charges for operation theatre, nursing care and accommodation postoperatively
Drugs and dressings
Treatment of complications and/or medical emergencies
Cost of care if you need to stay longer than expected in the hospital or clinic.

After treatment

Follow up consultations
Treatment for any complications you have after you leave hospital (‘revision’)

You should also ask about cancellation charges just in case you want to postpone or cancel your treatment. You should be wary of certain hospitals and clinics that charge a high cancellation fee as this will make you feel pressurised into going ahead at an inappropriate time.

Overall, you should not feel embarrassed to ask any of these questions. Both your surgeon and your chosen facility should be more than happy to provide you with this information in order to reassure you and to demonstrate their sense of professionalism and expertise in the area of cosmetic surgery.