Feeling good about your decision

I understand that you will have some important questions to ask before you make any firm decisions about cosmetic surgery.

In order to get the best from your treatment, I have produced this step-by-step guide covering everything you need to consider before you go any further. In this way, I am aiming to prepare you for your initial consultation with a cosmetic surgeon, help you ask the right questions which will, in turn, make you feel more relaxed and well informed before any decisions are made.

Choosing a hospital or clinic

With so many cosmetic surgery providers to choose from, you will need to create a shortlist of hospitals or clinics in your area that offer the procedure of your choice. If the treatment involves an operation then doing this based on factual information is particularly important.

Do your research properly

Having narrowed down your options you may well want to visit potential providers or call them before attending a consultation with a cosmetic surgeon. This can give you a good feel for the place and gives you an opportunity to ask some of the other staff about the services that are provided there.

Care Quality Commission

In accordance with the Care Quality Commission Regulations of 2009 and the Health and Social Care Act of 2008, all hospitals and clinics in England providing cosmetic surgery are now regulated by the Care Quality Commission. They are inspected regularly against the Essential Standards of Quality and Safety and are set by the Care Quality Commission.
The essential standards are designed to ensure that you can expect:

  • to be told what is happening at every stage of your care
  • care, treatment and support that meets your needs
  • to be safe
  • to be cared for by qualified and fully trained staff
  • your care provider should constantly check the quality of its services.

The Essential Standards aim to provide assurances about the quality of treatment and services that patients receive. There should be a registered manager of the hospital or clinic, who is responsible for ensuring that essential standards are maintained and the Care Quality Commission has the power to close premises that do not meet these standards.
You can check the registration details of a hospital or clinic on the Care Quality Commission website. If you are in any doubt about a hospital or clinic’s standards or capability you should ask to see a copy of its latest Care Quality Commission inspection report. The registered manager of the hospital or clinic should be able to provide this report, or you can obtain it from the Care Quality Commission directly.

Independent Healthcare Advisory Services

The Independent Healthcare Advisory Services (IHAS) is a membership organisation representing many of the UK’s independent hospitals and hospital groups. IHAS in conjunction with the Cosmetic Surgery Interspeciality Committee (CSIC) has produced a booklet ‘Good Medical Practice in Cosmetic Surgery’ to support and complement the General Medical Council (GMC) code for good medical practice. IHAS also operates a comprehensive complaints code for handling patient complaints.

Do I need to see my GP first?

You will that most cosmetic surgeons are happy to see you for an initial consultation without a referral letter from your GP. However, if you plan to go ahead with cosmetic surgery procedure, the surgeon should seek your permission to contact your GP for details of your medical history. This is an important safety precaution especially if your operation means you will need a general anaesthetic.

How do I choose a surgeon?

As a private patient seeking cosmetic surgery, you are of course able to choose the surgeon that you want. With so many surgeons to choose from you will need to give yourself time to research potential surgeons’ qualifications, reputation and experience. Here are some useful tips when weighing up your choices.
Ask your GP’s advice about the specialist surgeon in your area. They may not know all the surgeons that practice locally and some GPs do have a negative attitude to cosmetic surgery but it is more than likely that they will have seen patients who have had previous surgery and will get a good sense of the standard of care that is provided by various surgeons.
Private hospitals and clinics should be able to give you details of the surgeons available, their qualifications and particular areas of specialisation within the field of cosmetic surgery.
Some hospitals or clinics run open days or information events where cosmetic surgeons give talks about their work. This gives you the opportunity to meet the surgeons and clinical staff on an informal basis. However, be wary if you are offered a special price or discount for making an immediate booking. This practice contravenes the Good Medical Practice in Cosmetic Surgery guide from the IHAS.
Personal recommendations are always valuable but bear in mind that surgeons tend to specialise in particular types of cosmetic surgery. Be careful about making a judgement based on someone else’s recommendation alone unless their situation is very similar to yours. The surgeon should satisfy specific criteria to give you a level of confidence in their ability.
The surgeon should appear on the specialist register of the General Medical Council (GMC)
Almost any doctor can call him or herself a cosmetic surgeon. Even letters after their name, such as FRCS (Fellow of the Royal College of Surgeons) do not mean that the surgeon has any specialist training or experience in performing cosmetic procedures. Surgeons, who have completed six years of specialist training and have obtained the further qualification FRCS (Plast), are then added to the specialist register for plastics surgery.
To check whether a surgeon appears on the GMC specialist register you will need to know their full name and, if possible, their GMC registration number. You can then carry out the check on the GMC website or by calling the GMC registration helpline.

Surgeons who are on the specialist register but not in the plastic surgery section

Cosmetic operations such as nose reshaping (rhinoplasty) and ear pinning (pinnaplasty) may be performed by ear, nose and throat (ENT) surgeons; cosmetic facial surgery may be performed by maxillofacial surgeons, cosmetic eyelid surgery may be performed by ophthalmic surgeons and cosmetic breast surgery may be performed by general surgeons with an interest in breast surgery. Although they will not appear on the plastic surgical section of the register, these surgeons may be qualified to perform these procedures. Unlike plastic surgical trainees, these surgeons can complete their specialist training without any cosmetic surgical training at all. Any surgeon with this background should have undergone sub-specialist training in cosmetic surgery techniques within their area of expertise and, most importantly, should be able to demonstrate this experience to prospective patients.
In such cases, it is important to check that the surgeon does appear on the relevant GMC specialist register (for example, ENT surgery). You should only consider them for cosmetic surgery on the area of the body in which they specialise. Some hospitals, clinics or individual surgeons will use the term ‘plastic surgery’ to make themselves appear more qualified in this area than they are. It is important to establish whether an individual who calls himself a ‘facial plastic surgeon’ is on the specialist register for plastic surgery rather than someone who has trained in a different specialty and has then turned their hand to cosmetic procedures within that field.

Other health practitioners offering cosmetic treatments

Many cosmetic surgeons also offer non-surgical treatments such as anti-wrinkle treatments by injection, laser and pulsed light therapy. These treatments may also be performed by other health practitioners, for example GPs, dentists and nurses. Non-surgical treatments are also known as aesthetic treatments or cosmetic dermatology.
In England, the Care Quality Commission only regulates cosmetic treatments involving surgery. If you are considering non-surgical treatments such as wrinkle relaxing injectable treatments (Botox), dermal fillers or non-surgical laser and intense light treatments for hair removal etc, you will need to check that you are seeing a properly qualified specialist. As a minimum, any doctor or dentist carrying our aesthetic treatments should be registered with the General Medical Council or General Dental Council and any nurse should be registered with the Nursing and Midwifery Council (NMC) and work within its code of conduct. You can check the registration status of any doctor, dentist or nurse on the GMC, GDC or NMC websites.
Nerve-blocking drugs, such as Botulinum toxin, are prescription only medicines which means they must be prescribed by a doctor or dentist. However, they may be administered by a nurse under the supervision of a doctor.

Membership of plastic and cosmetic surgery professional organisations

British Association of Aesthetic Plastic Surgeons (BAAPS)

Generally, only fully qualified plastic surgeons, who appear on the GMC specialist register for plastic surgery and have held consultant posts within the NHS, can apply to become a member of BAAPS. This organisation is recognised by the Surgical Royal Colleges as a legitimate professional body representing the field of aesthetic surgery. BAAPS members are expected to undertake continuing medical education in aesthetic surgery and provide audited accounts of activity with complication rates etc recorded. There are a small number of non-plastic surgeons who are invited to become members of BAAPS.

British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

Surgeons on the GMC plastic surgery specialist register can apply to become a full member of BAPRAS. Many BAPRAS members focus on reconstructive surgery, but they may dedicate some of their time to performing cosmetic surgery procedures.

Care Quality Commission Registration

Cosmetic surgeons working in hospitals and clinics are covered by the organisation’s registration with the Care Quality Commission (see above). The hospital or clinic is responsible for ensuring the surgeons working there are suitably qualified to practice according to the Essential Standards of Quality and Safety. All surgeons working in hospitals or clinics must participate in clinical performance measurement arrangements, which are monitored by the Care Quality Commission.

James Murphy
Plastic Surgeon