Cosmetic surgeons: responsible and skilled professionals?

Cosmetic surgery remains a booming industry in the UK, with the British Association of Aesthetic Plastic Surgeons (“BAAPS”) announcing in its annual audit nearly 27,000 recorded procedures took place in 2019.

Cosmetic surgery is an operation, or invasive medical procedure, undertaken for aesthetic rather than medical reasons. For many, careful consideration is given when opting to undergo a cosmetic procedure, so it’s surprising a poll conducted for the Royal College of Surgeons (RCS) revealed most patients would not check the qualification of a surgeon before consenting to an operation, as they would expect a surgeon to be “fully qualified” in the procedure they were to undertake.

Sadly, competency can be an issue.

Cosmetic procedures are rarely available through the NHS and primarily take place in the private sector. Regulation of this sector is limited. Whilst providers are expected to employ surgeons who are fully competent and revalidated with the General Medical Council (“GMC”) to practice medicine, those doctors do not need to have specific skills or advanced training qualifications in reconstructive or cosmetic procedures to undertake surgeries.

As it stands in the UK any qualified doctor is permitted to carry out cosmetic surgery.

Limited governance standards mean private patients remain largely unprotected and often when surgery “goes wrong” the NHS is left to pick up the pieces.

Under-regulated and under-legislated

The ‘PIP’ silicone breast implant scandal raised many questions regarding the safety and regulation of cosmetic surgery. Following, the ‘Review of the Regulations of Cosmetic Interventions’ was commissioned in 2013. The Review cited patients were unable to find and choose a practitioner with the appropriate qualifications and identified several reasons: –

• There was no individual or professional organisation responsible for setting standards that could be used in training or to assess competence in cosmetic surgery as part of revalidation.
• There was a lack of professional regulatory oversight in the private health sector, sitting outside the framework of the NHS.
• There was a lack of data on how many cosmetic procedures were carried out each year, by whom, or with what outcomes. The BAAPs annual audit was taken from its members only – totaling around 30-40% of cosmetic surgery procedures conducted in the UK, so provided limited insight into activity in the sector. 

The Review Committee recommended the creation of approved training schemes and accreditation qualifications as well as associated registers for surgical and non-surgical cosmetic procedures.

Has there been a change? 

Seven years have passed with little change.

The RCS ‘Cosmetic Surgery Certification Scheme’ was developed and provides recognition to surgeons who have the appropriate training, qualifications and experience to perform cosmetic surgery. However, this is a voluntary scheme; currently just over 30 practitioners are registered. Indeed, matters are complicated further with the rise of the “fly in, fly out” doctors who are not subject to rigorous regulations when they visit the UK to undertake procedures.

There remains no centralised register of UK practioner for surgical and non-surgical cosmetic procedures.

Following the Ian Paterson scandal in 2017 in an open letter the RCS called for more transparency in the private sector and specifically identified the shortcomings of cosmetic surgery governance. The letter cited there remained nothing to stop any doctor, even a non-surgeon, from performing cosmetic surgery and that legislation had failed to keep up with modern practice. Reform was now urgent. The letter called for the GMC to be given powers to annotate the medical register with details of surgeons who are qualified to undertake cosmetic procedures. This would assist the public in making decisions.

A call for a single register is echoed in the findings of the  ‘Report of the Independent Inquiry into the Issues raised by Paterson’ published in February 2020. The report found Paterson’s patients had no means of independently testing or verifying the information they received about him prior to undergoing a procedure, apart from that of hearsay and word-of-mouth.

The Inquiry recommended there should be a single repository of the whole practice of consultants across England, setting out their practising privileges and other critical consultant performance data, for example, how many times a consultant has performed a procedure and how recently. This should be accessible and understandable to the public. It should be mandated for use by managers and healthcare professionals in both the NHS and independent sector.

However, for the time being patients must undertake their own research and checks.

This remains a concern. With onus being on the patient to validate information provided by the professional and/or the private healthcare companies on their websites and with a lack of comparative data about the comptenancy of clinicians, are patients really able to make informed choices?