Choosing a Cosmetic Surgeon

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Cosmetic surgery is booming. Americans spent more than $12 billion on over 10 million cosmetic surgical and non-surgical procedures such as Botox in 2014 (data from the American Society for Aesthetic Plastic Surgery). In the UK, cosmetic surgical procedures were up by 0.6% from the previous year (data from the British Association of Aesthetic Plastic Surgeons), notably with a rise in liposuction of 12%. While breast augmentation remains the most popular cosmetic surgery in women, men are also going under the knife. In the UK, male surgery numbers decreased overall in 2018.
This is big business, so it is not surprising that some clinics use aggressive marketing techniques and advertise persuasively. Therefore, you have to be very careful.
What do the words mean?

  • Cosmetic surgery is surgery to improve appearance
  • Aesthetic surgery is another name for cosmetic surgery. It comes from the Greek word for beauty
  • Plastic surgery is surgery to change the shape or form of the surface and sometimes the deeper structures of the body. The word ‘plastic’ comes from the Greek word for moulding. Plastic surgery includes cosmetic surgery, repair operations after burns and other injuries, correction of inherited deformities, breast reconstruction after operations for breast cancer, and removal of skin tumours

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.

Do not rush into anything. Read as much as you can about cosmetic surgery and note down the names of surgeons who are mentioned or quoted. Remember that all surgery has risks. Think carefully about why you want the procedure done. For example, cosmetic surgery is unlikely to improve a relationship that is problematic. If you are going through a life event, or a period of vulnerability, do not make any decisions about cosmetic surgery.

Do not be pressured by anyone else. You will be the one undergoing surgery, so do it only if you want it for yourself.

Be very clear what you are hoping to achieve. For example, if you want your breasts enlarged, what size do you want them to be? Having a clear idea is essential for a proper discussion with the surgeon.

Find out as much as you can about the procedure itself. Even a simple-sounding procedure such as liposuction requires a lot of skill. Look at the good cosmetic surgery websites. Various cosmetic procedures are also discussed elsewhere: for example, breast reduction, breast enlargement, thread veins, ageing skin and ears.

Locate a good, reputable surgeon. Do not just answer a persuasive advertisement in a magazine or on the web.

The best plan is to ask your own doctor for a referral. If you think your doctor would be unsympathetic, contact BAAPS for a list of their members and their different specialities.

  • 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.

Make sure you have a proper consultation with the actual surgeon who will be operating on you. UK government regulations insist on this. Be suspicious if you are not charged a fee for this consultation – a good surgeon’s time is valuable. A ‘free’ consultation may be with a counsellor or a nurse.

  • 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.

Shop around. Do not just go to the first clinic that you contact. Make a short-list of several surgeons and clinics and have a consultation with more than one. Although this will cost you, it is money well spent.

Consider location. It is tempting to travel overseas for cheaper surgery, but do not do so unless you are sure about follow-up arrangements and what would happen if there were problems.

Allow yourself a ‘cooling off’ period of about 2–3 weeks after the initial consultation, so that you can think clearly about the procedure before making the decision to go ahead. A respectable clinic will encourage this and will not hassle you into making an immediate decision. UK government regulations from the National Care Standards Commission (set up to regulate private clinics) ban having the surgery within 2 weeks of the consultation, but you could still be pressured into making the decision too quickly. Go ahead only if you feel you can trust the surgeon and that he/she has explained everything properly to you and understands what you are hoping to achieve.

Remember you can always change your mind. You can cancel right up to the moment you go to sleep for surgery.

BAAPS Audit Results 2019 – the figures in full

Most popular operations in the UK (information from the British Association of Aesthetic Plastic Surgeons; infographic):

The top surgical procedures for women in 2018 (26,043 total. A rise of 0.6% from 2017). 2018 figures for women in order of popularity:
• Breast augmentation: 7,727 – down 6% from last year
• Breast Reduction: 4,014 – up 7%
• Blepharoplasty (eyelid surgery): 2,820 – down 2%
• Abdominoplasty: 2,733 – up 5%
• Liposuction: 2,286 – up 12%
• Rhinoplasty: 2,260 – up 3%
• Face/Neck Lift: 2,013 – up 9%
• Fat Transfer: 1,330 – down 2%
• Otoplasty (ear correction): 532 – down 10%
• Browlift: 328 – down 15%

The top surgical procedures for men in 2018 (2,304 total. A fall of 4.7% from 2017). 2018 figures for men in order of popularity:
• Rhinoplasty: 571 – up 3% from last year
• Otoplasty (ear correction): 412 – down 2%
• Blepharoplasty (eyelid surgery): 333 – down 17%
• Breast Reduction: 285 – down 4%
• Liposuction: 232 – down 14%
• Abdominoplasty: 179 – up 18%
• Face/Neck Lift: 121 – down 16%
• Fat Transfer 98 – down 10%
• Brow lifts 55 – down 4%
• Breast augmentation: 18 – static


First published on:
Reviewed and edited by: Dr Victoria Harmer
Last updated: October 2020

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