Cosmetic or aesthetic surgery is usually undertaken as a lifestyle choice for many reasons. It does not treat injury or disease, and it is all the more important that patients never lose sight of the fact that surgery is never risk-free.

Unfortunately, the increased commercialisation of cosmetic surgery can often lead prospective patients to think that aesthetic surgery is a commodity that can be bought without much thought for the consequences. The International Society of Aesthetic Plastic Surgery (ISAPS) has published what it describes as the ‘patient safety diamond’. This is a simple 4 step process that patients should follow before contemplating surgery. The success of a surgical procedure (outcomes, complications, patient satisfaction) depends on four factors:

1. the patient
2. the procedure
3. the surgeon
4. the surgical facility

We will look at each of these in turn.

The Patient

Patient selection is critical in aesthetic surgery. A good surgeon will not operate on patients if they feel that the patient is not suitable for the requested procedure. A full history and physical examination are essential before surgery is agreed. Your surgeon might think that you have an unacceptably high risk of complications due to an underlying medical condition or medications that you are taking. Unrealistic expectations are a common reason why surgery may not be offered. Your surgeon also needs to be sure that you are having surgery for the right reasons.

It is critical that patients are in a good state of mind. It is known that patients having personal problems in their lives at the time of surgery potentially do worse than those that are at peace. It is therefore not a good idea to have any form of cosmetic surgery if you are experiencing relationship difficulties, grief, divorce, financial difficulty or conflicts at work.

The Procedure

Surgeons must have a frank discussion with their patients about the risks of specific procedures. Some procedures like Abdominoplasty (tummy tuck) and large volume liposuction are known to carry higher risks of complications than other operations. Detailed information on procedures and their complications can be found on the BAAPS website by following this link.

The Surgeon

In the UK, any doctor with a license to practice can call themselves a cosmetic or aesthetic surgeon. Surgery is a long apprenticeship, and there is no substitute for years of training and formal plastic surgery qualifications. Your surgeon should be on the GMC’s Specialist Register for Plastic Surgery. They will have an FRCS (Plastic Surgery) qualification and will usually be members of BAAPS (British Association of Aesthetic Plastic Surgeons) or BAPRAS (the British Association of Plastic, Reconstructive and Aesthetic Surgery). They should hold (or have held) a substantive NHS Consultant appointment.
Patients should be encouraged to ask their prospective surgeon how often they perform a particular procedure and how many of those procedures have they done.

The Surgical Facility

Surgery must take place in an accredited, fully equipped and staffed setting with access to all the backup and expertise that may be required for patient care. Hospitals such as the Spire Murrayfield in Edinburgh will only allow consultants who hold (or have held) a substantive NHS consultant post to operate on their premises. The ‘back room’ of a doctor’s office is no place for cosmetic surgery and anyone, qualified or unqualified, can operate there.

Article previously published Dec 2012 and modified.